From the Guidelines
Managing Rheumatoid Arthritis (RA) effectively requires a comprehensive approach that prioritizes a combination of medications, dietary changes, supplements, and lifestyle modifications to reduce morbidity, mortality, and improve quality of life. The cornerstone of RA treatment involves disease-modifying antirheumatic drugs (DMARDs) like methotrexate, hydroxychloroquine, or sulfasalazine, which may be combined with biologics such as TNF inhibitors for moderate to severe cases 1. For pain management, NSAIDs like ibuprofen or naproxen can provide relief.
Dietary Changes
Dietary changes should focus on an anti-inflammatory diet, with the Mediterranean-style diet being the only diet with sufficient evidence to be recommended for RA management 1. This diet is rich in omega-3 fatty acids from fatty fish, olive oil, nuts, and colorful fruits and vegetables, while reducing processed foods, refined sugars, and red meat. A "food first" approach is emphasized, using high-quality foods to obtain necessary nutrients rather than relying on dietary supplements 1.
Supplements
While there is not sufficient evidence to recommend dietary supplements for RA management, omega-3 fish oil, vitamin D, and turmeric/curcumin may be considered 1. However, the use of these supplements should be approached with caution and under the guidance of a healthcare professional.
Lifestyle Modifications
Regular low-impact exercise like swimming, walking, or cycling for 30 minutes most days helps maintain joint mobility and muscle strength. Consistent engagement in exercise is strongly recommended, with the type, frequency, intensity, and duration tailored to each person with the assistance of their clinicians 1. Adequate rest, stress management techniques like meditation, maintaining a healthy weight, and applying hot/cold therapy to affected joints can further reduce symptoms.
Additional Interventions
Additional integrative interventions that may be beneficial include standardized self-management programs, cognitive behavioral therapy, mind–body approaches, acupuncture, massage therapy, and thermal modalities 1. However, the evidence supporting these interventions is of very low to low certainty, and their use should be considered on a case-by-case basis.
Tobacco Cessation
Individuals with RA who currently use tobacco should be supported in their tobacco cessation journey, as tobacco use can exacerbate RA symptoms and worsen outcomes 1.
Interprofessional Care Team
The management of RA requires an interprofessional healthcare team, including rheumatology clinicians, physical and occupational therapists, dieticians, and other healthcare professionals 1. This team can provide comprehensive care and support to individuals with RA, helping them to manage their symptoms and improve their quality of life.
Monitoring and Adjustment
Regular monitoring of disease activity and adjustment of treatment as needed is crucial in managing RA. Frequent monitoring should be done every 1–3 months in active disease, and therapy should be adjusted if there is no improvement by at most 3 months after the start of treatment or the target has not been reached by 6 months 1.
In summary, managing RA effectively requires a comprehensive approach that combines medications, dietary changes, supplements, and lifestyle modifications, with a focus on reducing morbidity, mortality, and improving quality of life. A personalized treatment plan, developed in collaboration with an interprofessional healthcare team, is essential for optimal management of RA.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Essential Dietary Changes for Managing Rheumatoid Arthritis (RA)
- A low-fat, low-sodium Mediterranean diet rich in fruits, vegetables, whole grains, and nuts, and poor in sugar-sweetened beverages, red and processed meat, and trans fats 2
- Vegan diet, which is high in dietary fiber, antioxidants, and anti-inflammatory compounds from fruits, vegetables, grains, nuts, and seeds, but patients need to be monitored closely for intake of all critical nutrients 3
- Certain calorie restrictions and intermittent fasting diets have been shown to benefit RA patients, although further studies are needed to establish solid evidence-based recommendations and guidelines 3
- Foods that can be a potential aggravating factor for the disease or may help in symptomatic relief, such as:
Supplements for Managing RA
- Omega-3 fatty acids, which have anti-inflammatory properties 2, 4
- Non-essential amino acids, which may have anti-inflammatory effects 2
- Probiotics, which have anti-inflammatory and antioxidant activities 2, 3, 4
- Vitamin D, which may have a protective role in RA development 4
Medications and Potential Negative Effects
- Patients with RA should be aware of the potential negative effects of their medications and monitor their condition closely 5
- Medications for RA can have various side effects, and patients should discuss their concerns with their healthcare provider 5
Lifestyle Adjustments for Managing RA
- An appropriate physical activity program based on an active daily lifestyle, aerobic exercise, and resistance training 2
- Adequate sleep hygiene and smoking reduction/cessation, which can have positive effects on disease progression and related outcomes 2
- Stress reduction techniques, such as meditation and yoga, which can help manage RA symptoms 6
- A healthy lifestyle and nutrition should be encouraged in patients with RA, as diet has a central role in disease risk and progression 4
Nutrient Interactions and Considerations
- Patients with RA should be aware of potential nutrient interactions and consider consulting a healthcare provider or registered dietitian to develop a personalized diet plan 5
- Certain nutrients, such as polyunsaturated fatty acids, have anti-inflammatory and antioxidant properties, while others, such as red meat and salt, have a harmful effect 4
- Gut microbiota alteration and body composition modifications are indirect mechanisms of how diet influences RA onset and progression 4