There is a lot written about diet and arthritis but unfortunately little of it is based on good science. Here, top rheumatologist Dr Gerald Coakley explains whether certain foods should be avoided for a person living with rheumatoid arthritis and the treatment options that are available.
Should specific foods be avoided if you live with rheumatoid arthritis?
There are some patients who tell us that particular foods seem to cause their arthritis to flare up. I do think that it makes sense to exclude foods which do this wherever practicable, but it depends on the individual, as what might trouble one person may not affect another.
There is, however, no good quality evidence to support the commonly expressed view that people with rheumatoid arthritis should not eat tomatoes, for example. There is no real evidence that any particular ingredient should be avoided for the generality of people with the condition.
In my experience, RA patients who believe that diet has a big influence on their health tend to feel more in control of their life and their arthritis if they adjust their eating habits, which I see as a good thing. There is no doubt that taking an active role in managing our health is good for us, and feeling helpless in the face of a long-term condition is definitely bad for our physical and mental wellbeing.
I do, however, caution against people becoming obsessed with their diet or pursuing extreme fads because I think diet plays a relatively modest role in the condition. It is also clear that the use of conventional immune-suppressing treatments is much more effective in controlling arthritis activity than dietary manipulation.
What are your tips for diet and rheumatoid arthritis?
It is important not to become overweight because that increases the load on damaged joints and makes them wear more quickly than they otherwise would. Obesity can be a challenge, partly because steroids are often used in early rheumatoid arthritis and they tend to make people gain weight, and also because RA sufferers tend to become less physically active in light of their joint pain. With the right advice and support, it is possible to continue to exercise and maintain a healthy weight though.
It is also worth thinking about making sure your diet is balanced and varied and includes plenty of fish, pulses, nuts, olive oil and plenty of fruit and vegetables. Some ethnic groups are prone to developing vitamin D deficiency in the winter months in the UK and should consider taking an over the counter supplement when the clocks are set to Greenwich Meantime.
What's the safest treatment for rheumatoid arthritis?
This is a big question. Apart from corticosteroids, which are widely used to achieve rapid control of inflammation in early RA, the commonest treatment used throughout the world is Methotrexate. This immunosuppressive medication (known as a Disease-Modifying Anti-Rheumatic Drug or DMARD) has a number of risks, which means it can only be initiated by specialists.
If used correctly, it will usually suppress joint inflammation to a very low level with minimal side effects. It has been shown to reduce the need for joint replacements and to extend the life expectancy of RA patients.
Methotrexate remains, therefore, the foremost treatment for RA but there are some people who cannot tolerate it, or for whom it is inadequate to control their arthritis. For this group, there are other DMARDs like Sulfasalazine, Hydroxychloroquine and Leflunomide.
For the subset of RA patients whose arthritis is very difficult to control with Methotrexate or other DMARDs, there are now many novel therapies targeting specific molecules involved in the immune response. Common agents include the Tumour Necrosis Factor blockers Adalimumab, Certolizumab and Etanercept, and the B-cell blocker Rituximab.
Selection of these treatments is increasingly complicated, and a rheumatologist is best placed to advise on which treatment would be best suited to a particular patient’s case.
Read more information about all of these options and about diet and arthritis here.