March 2015 Issue

Nutrition Considerations for Patients With Rheumatoid Arthritis

The following are nutrition management goals to consider during assessment, diagnosis, intervention, monitoring, and evaluation of patients with rheumatoid arthritis (RA):

  • achievement of nutritional adequacy and correction of nutrient deficiencies;
  • management of medication side effects and medication-nutrient interactions;
  • achievement and maintenance of a healthy BMI while preserving fat-free mass;
  • prevention or treatment of comorbidities such as cardiovascular disease and osteoporosis;
  • reduction of pain and inflammation; and
  • optimization of food-related activities of daily living and quality of life.



Body weight/BMI
(use more than two indicators if older adult): current weight, recent changes in weight, weight history, BMI, height, waist circumference, and body composition)

• Recent weight loss or gain
• BMI less than 20 or more than 30 can affect outcomes and comorbidities


• Homocysteine, C-reactive protein, albumin, lipid panel, etc
• May be affected by level of disease activity or malnutrition

Activities of daily living

• May affect shopping for, preparing, or eating food

Diet history

• History of treating RA with diet 
• History of weight-loss dieting


• Nutrition-related side effects such as abdominal pain, stomatitis, weight gain, and ulcers
• Drug-nutrient interactions, especially with methotrexate and steroids


• Safety and effectiveness
• Most not recommended


• Meeting recommended targets
• Limiting trips to the bathroom because of RA pain


• Women often affected more severely in all respects

Economic status

• Food insecurity possible

Mental health

• Anxiety or depression often seen with RA






Level of disease activity

• Can affect labs, resting energy expenditure, activities of daily living, weight, loss of fat-free mass, etc
• Can vary over the course of the disease

Cardiovascular disease

• Will likely need intervention to minimize risk


• Will likely need intervention to minimize risk
• Risk of fracture is higher if long-standing RA, low BMI, or corticosteroid use

Rheumatoid cachexia/weight loss

• Possible loss of fat-free mass
• Can affect outcomes and comorbidities

Temporomandibular disorder

• May have difficulty chewing

Sjögren's Syndrome

• May experience dry mouth


• Higher risk of infection






• Resting energy expenditure may be elevated, but physical activity may be reduced
• Additional calories generally unnecessary
• Carefully consider appropriateness of weight-loss intervention


• No clear guidelines
• 0.8 g/kg body weight is adequate
• 1 to 1.6 g/kg of body weight also suggested for seniors


• Monounsaturated fat encouraged, no specific amounts
• Saturated fat discouraged, no specific amounts
• Use of fish or fish oil supplements up to health care provider
• To target cardiovascular disease risk, use standard guidelines and address dyslipidemia, if present

Vitamins and minerals

• Use Dietary Reference Intakes as goal
• Special attention to folate, calcium, zinc, selenium, and vitamins A, B6, B12, D, and E
• Food sources recommended over supplements
• Iron supplements not recommended for anemia or chronic disease

Fruits and vegetables

• Address any issues with acquiring and consuming them
• Important sources of antioxidants, vitamins, and minerals

Dietary patterns

• Mediterranean, vegetarian, vegan, elemental, and elimination common
• No practice guidelines endorsing any specific diet
• May be worthwhile if adequacy can be ensured
• Individual patients may identify unique problem foods
• Makes sense to recommend general healthful eating habits


• Diet may be hard to maintain
• Unintended weight loss from RA-specific diets
• Social influences and family may negatively affect success

Referrals and resources

• Occupational therapist, fitness expert, or other as needed
• Websites or health organizations as appropriate (eg, Arthritis Foundation at, American Heart Association at