Diet and Nutrition

Proper nutrition is an important part of healthy living for everyone, especially if you have a chronic health condition like rheumatoid arthritis (RA). All bodies require a balanced diet to get all the nutrients and calories needed to function optimally, and some research has indicated that people with RA who have a low-quality diet and are overweight may be at an increased risk of active disease.1

Maintaining a healthy weight is essential in managing your RA symptoms. Being overweight increases stress on large weight-bearing joints, such as hips and knees, which may already be susceptible to damage from the disease processes involved in RA. Being overweight has also been associated with difficulties in achieving low disease activity in early stage RA, and controlling the disease is critical to prevent or slow the joint damage that can cause disability.1 In addition, since people with RA are at increased risk for health problems including cardiovascular disease, blood clots, and osteoporosis, it is important to include heart-healthy and bone-health promoting foods in your diet. Proper nutrition can help reduce symptom severity, and should be a central part of your overall RA management strategy.

Guidelines for healthy eating

Everyone should aim to have a healthy, balanced diet that provides essential vitamins, minerals, nutrients, and calories to support the requirements for energy and fitness. General guidelines for everyone include:2

  • Eating a variety of foods, including from different food groups and fruits and vegetables of different colors
  • Maintaining a balance between calories consumed and calories burned to achieve and maintain a healthy weight
  • Eating plenty of fruits, vegetables, and whole grains
  • Choosing foods that are low in fat, sugar, and cholesterol
  • Consuming alcoholic beverages in moderation (if any)

Nutrition experts recommend eating mostly whole, unprocessed foods to help you get the nutrients your body needs, versus processed foods which frequently contain more calories, fat, and preservatives.2

Specific dietary interventions for RA

In addition to general recommendations on healthy eating, there are specific nutritional interventions that may be useful if you have RA. People with RA may be at risk for malnutrition for two reasons: 1) chronic inflammation can increase the breakdown of proteins and increase the resting metabolic rate, and 2) medications used to treat RA may cause side effects (such as ulcers) or deficiencies in certain vitamins or minerals.2

Common deficiencies in people with RA include:2

  • Folic acid
  • Vitamin C
  • Vitamin B6
  • Vitamin B12
  • Vitamin D
  • Vitamin E
  • Calcium
  • Magnesium
  • Selenium
  • Zinc

Ideally, the nutrients your body needs come from food. However, supplementation of certain vitamins and minerals may be necessary.2

Omega 3 fatty acids and RA

The strongest evidence of RA symptom improvement with a dietary intervention is for fish oil and other sources of omega-3 (sometimes called n-3) fatty acids, which have been shown to play an important role in immune system function. However, whether omega 3’s should be included as a standard part of treatment for RA is controversial.2 Learn more about foods high in omega-3.

Food sensitivities and RA

Some people with RA have identified certain foods that act as a trigger for them. These hypersensitivities may cause an increase in inflammation in the body and worsen symptoms of RA. Avoidance of trigger foods has been shown to have short-term benefit, although eliminating these foods does not appear to have a long-term benefit. Diet elimination therapy is used to determine if there are any hypersensitivities to foods. In an elimination diet, food groups (such as dairy, processed foods, or gluten) are avoided for a period of time and then reintroduced to see if a reaction occurs.2

What’s the best diet for RA?

Many different diets and nutritional interventions have been tested for their benefits in patients with RA. For most, the evidence is not strong enough to make definitive recommendations. However, even though firm evidence may be lacking, many patients report feeling better when they eliminate certain foods from their diets, adopt specific diets that emphasize or eliminate certain foods (like increasing plant based foods or adhering to a gluten-free diet) or when they take specific supplements. Up to three-quarters of patients with RA believe that diet plays an important role in disease severity and as many as half have tried some sort of dietary intervention to get relief from symptoms.3

Written by: Jonathan Simmons and Emily Downward | Last reviewed: June 2018.
View References
  1. Sandberg MEC, Bengtsson C, Källberg H, et al. Overweight decreases the chance of achieving good response and low disease activity in early rheumatoid arthritis. Annals of the Rheumatic Diseases 2014;73:2029-2033. http://dx.doi.org/10.1136/annrheumdis-2013-205094.
  2. Koch C. Nutrition and rheumatoid arthritis. Johns Hopkins Arthritis Center. Available at https://www.hopkinsarthritis.org/patient-corner/disease-management/rheumatoid-arthrtis-nutrition/. Accessed 6/14/18.
  3. Stamp LK, James MJ, Cleland LG. Diet and rheumatoid arthritis: a review of the literature. Semin Arthritis Rheum 2005;35:77-94.