Sunday 12th October marks World Arthritis Day 2008. The theme for the day this year is ‘Think Positive’, this acknowledges the fact that many arthritis sufferers are often emotionally affected. The World Arthritis Day website and the UK site Arthritis Care, both provide fantastic resources which include positive and helpful information to those suffering from arthritis. This campaign this year focuses on improvement of access to psychological forms of support and self-management courses.
Rheumatoid arthritis is an autoimmune disease; a disease when, for unknown reasons, the body starts to attack itself. In Rheumatoid arthritis the attack occurs on the membranes (synovial membranes) of a joint which becomes chronically inflamed which can cause pain, swelling, morning stiffness, muscle wasting and osteoporosis. Eventually bone and cartilage is damaged. Rheumatoid arthritis can affect several joints and commonly occurs in people aged between 30 and 50. The condition is three times more common in women than men and seems to run in families. Conventional treatment centres around pain relief and reduction of inflammation, most commonly with drugs called NSAIDs, Non steroidal anti-inflammatory drugs.
Healthy eating is important in order to support the body so that it may function optimally. A balanced diet will provide all the important vitamins, minerals, amino-acids (proteins), essential fatty acids and energy necessary for health. There is some indication that a healthy diet rich in fruits, vegetables and healthy fats , such as the omega 3 fatty acids found in oily fish and olive oil, is protective against the development of rheumatoid arthritis (e.g.1,2,3). A study last year(4) found that this kind of Mediterranean-type diet, rich in vegetables, fruits and fish, also seems helpful in relieving some of the symptoms of rheumatoid arthritis, such as pain and early morning stiffness, in those already suffering from the disease.
If you suffer from rheumatoid arthritis you may want to consider talking to your GP/health professional about being allergy tested. There are medical studies to show that in some individuals who suffer from rheumatoid arthritis, it is made worse when they eat foods they are allergic or sensitive to and made better when they avoid those specific foods (5,6,7,8,9,10). Please do not attempt an elimination diet without the support of a health professional.
With regards specific foods and/or supplements that may be helpful to rheumatoid arthritis sufferers the evidence centres mainly around the long chain omega 3 fatty acids, found in oily fish such as mackerel, salmon, trout and sardines. (Regular readers of my blog will, no doubt, have guessed these fats would have come up somewhere in this post). These long chain omega 3 fatty acids (EPA and DHA) decrease the production of inflammatory chemicals (such as eicosanoids, cytokines and reactive oxygen species) in the body and also give rise to a family of anti-inflammatory mediators (called resolvins). Omega 3 fatty acids are therefore potentially very potent natural anti-inflammatory agents. There have been many studies (11 provides a review) which report anti-inflammatory effects of supplemental fish oil in patients with rheumatoid arthritis.
The benefits of fish oil in these trials included reduced duration of morning stiffness, reduced number of tender or swollen joints, reduced joint pain, reduced time to fatigue, increased grip strength and decreased use of NSAIDs. The totality of current evidence really suggests that long chain omega 3 fatty acids so have clinical benefit in rheumatoid arthritis. One paper(12) concluded that "the findings of benefit from fish oil in rheumatoid arthritis are robust," "dietary fish oil supplements in rheumatoid arthritis have treatment efficacy," and "dietary fish oil supplements should now be regarded as part of the standard therapy for rheumatoid arthritis".
If you are not a regular eater of oily fish (at least twice a week) then you may wish to consider taking a fish oil supplement. The doses used in trials with rheumatoid arthritis sufferers have varied, you may wish to start by taking 2g of fish oil a day to provide around 500-700mg of EPA and 500-700mg DHA per day (try splitting this dose throughout the day as this will minimise any potential adverse effects on the digestive system).
In addition to increasing oily fish intake, or taking a supplement, it may be advantageous to simultaneously reduce your consumption of a specific type of fatty acid called ‘arachidonic acid’ this is a specific omega 6 fatty acid found preformed in egg yolk, beef, liver and kidneys (it can also be manufactured in the body from precursor fatty acids found in vegetable oils). Arachidonic acid can be used by the body to produce chemicals that have potent inflammatory activity. One study (13) found that fish oils were more efficacious when taken simultaneously with a diet low in arachidonic acid. In this study fish oil or placebo was given to patients who ate either their typical diet or an ‘anti-inflammatory diet’ that restricted the intake of arachidonic acid-rich foods. Patients consuming the anti-inflammatory diet in addition to taking the fish oil supplement had significantly lowered inflammatory chemicals in their blood plasma. The reductions in the number of swollen joints, number of tender joints and pain scores seen with fish oil supplementation were all also greater for patients consuming the anti-inflammatory diet.
For more information on rheumatoid arthritis please visit the Arthritis Care website.
Check back later in the week for information regarding osteoarthritis.
1.Cerhan JR et al. 2003. Antioxidant micronutrients and risk of rheumatoid arthritis in a cohort of older women. Am J Epidemiol. 157:345-354
2.Pattison DJ et al. 2004. Does diet have a role in the aetiology of rheumatoid arthritis? Proc Nutr Soc. 63:137-143
3. Linos A et al. 1999. Dietary factors in relation to rheumatoid arthritis: a role for olive oil and cooked vegetables? Am J Clinical Nutr. 70:1077-1082.
4.McKellar G et al. 2007. A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow. Ann Rheum Dis. 66:1239-1243
5.Darlington LG et al. 1986. Placebo-controlled, blind study of dietary manipulation therapy in rheumatoid arthritis. Lancet. i:236-238
6.Darlington LG. 1991. Dietary therapy for arthritis. Rheum Dis Clin North Am. 17:273-285.
7.Beri, D., et al. 1988. Effect of dietary restrictions on disease activity in rheumatoid arthritis. Ann Rheum Dis. 47:69-72
8.Hicklin JA et al. 1980. The effect of diet in rheumatoid arthritis. Clin Allergy. 10:463
9.Panush RS et al. 1988. Diet therapy for rheumatoid arthritis. Arthritis Rheum. 26:462-471
10.Taylor, M. R. 1983. Food allergy as an etiological factor in arthropathies: a survey. J Internat Acad Prev Med 8:28-38
11.Calder PC. 2006. N-3 polyunsaturated fatty acids, inflammation and inflammatory diseases. Am J Clin Nutr. 83:1505S-1519S
12.Cleland LG & James MJ. 2000. Fish oil and rheumatoid arthritis:anti-inflammatory and collateral health benefits. J Rheumatol. 27:2305-2307
13.Adam O et al. 2003. Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis. Rheumatol Int. 23:27-36
Written by Ani Kowal