Rheumatoid arthritis is a common autoimmune disease affecting approximately 1.5 million people only in the United States. The most common symptoms that will bring patients to the doctor are:

• pain
• swelling and stiffness in multiple joints.
• most of the time, in a bilateral and symmetric pattern

Unfortunately, rheumatoid arthritis is not only a disease of the joints. Chronic, ongoing inflammation may involve multiple other organs, such as the heart, lungs, eyes, skin, and kidneys. 

Interestingly, many of my patients reported that eating affects their disease symptoms. Is this a simple observation, or is this a reality call?

At first, I thought this was just an incidental report, but then I started hearing it from more and more patients.

It made me curious to find out more. During our medical training, we tend to get supra-specialized. As a rheumatologist, I learned extensively how to diagnose autoimmune diseases and use targeted therapy to modulate the immune system. However, I knew nothing about nutrition or the gut microbiome’s impact on the immune system.

This led me to my own discoveries. After reading hundreds of research studies, I found scientific evidence in a few years. And yes, the patients were right! Their immune system was massively impacted by the food they ate, the stress they experienced, and their sleep.

In my practice, I approach the patient from multiple angles. I learned that it is essential to ask my patients :

“How do you feel?”

“What do you usually eat? ”

“What are the major stressors in your life?”

“How much do you exercise?”

“How much sleep do you have?”

Suppose patients don’t have a diagnosis of rheumatoid arthritis. In that case, I educate them to adopt an anti-inflammatory/ Mediterranean diet, which reduces the risk of developing this disease by 21 percent. If they have rheumatoid arthritis, I start my conversation by presenting scientific evidence.

Let me give you a few examples: in a study of 300 patients with rheumatoid arthritis who were surveyed about the consumption of 20 foods, the patient’s symptoms were impacted by the type of food they ate. Nearly a quarter of patients reported that foods such as blueberries, strawberries, fish, and spinach relieved their symptoms, while sugary juices and desserts worsened their symptoms. Excessive use of salt increases joint pain and blood markers of inflammation. Excluding red meat, glucose, and lactose for three months can also benefit some patients. Replacing coffee with green tea was also recently recommended. Eating a diet full of fibers (e.g., leafy greens, lentils, beans, soy, whole grains) increases the amount of short-chain fatty acids produced by our gut microbiota, which is linked to reduced inflammation. Patients using probiotics for at least eight weeks experienced less joint pain and swelling. Adding spices to the food or as a supplement (e.g., turmeric, garlic, ginger) was also shown to reduce the symptoms of rheumatoid arthritis.

Being overweight or obese was associated with higher chances of developing autoimmune and inflammatory diseases, such as Rheumatoid arthritis. Thus, I encourage my patients to perform walking, stretching, and swimming exercises. The goal is to reduce pain, inflammation, and fatigue and improve joint mobility, strength, flexibility, mood changes, and weight decrease.

Unfortunately, about 60 percent of arthritis patients report poor sleep quality. Chronic sleep deprivation leads to severe fatigue, mood changes, increased pain, inflammation, and decreased immune system function. In my experience, patients describe their pain levels worsening after a night of poor sleep while sleeping better decreases their pain level. Research confirmed that patients with rheumatoid arthritis that sleep shorter periods or have fragmented sleep will have increased pain sensitivity the following day.

I always encourage my patients with rheumatoid arthritis to sleep up to 8 to 9 hours per night to improve their disease activity.

Let’s talk about the impact of stress. Many patients describe that before their symptoms of autoimmune disease surface, they experience significant stress in their life. Research done in the last 20 years showed a connection between the immune system and our mind. A 2020 meta-analysis of randomized control trials in patients with rheumatoid arthritis of 337 patients showed that mindfulness interventions could significantly improve pain intensity, depression, and symptoms compared with conventional therapy. Mindfulness will also decrease the daily pain in patients with rheumatoid arthritis.

I teach patients how to approach pain and incorporate simple breathing techniques, guided imagery, or other relaxation techniques. Patients will experience less pain, better sleep, and quality of life in just a few weeks.

To be easier for my rheumatoid arthritis patients, I have designed a lifestyle pyramid (see above).

It includes the amounts and types of food needed to prevent or reduce the risk of developing rheumatoid arthritis and reduce the inflammation and pain related to this disease. It was adapted to include scientifically proven foods with anti-inflammatory properties and exclude foods that can potentially cause more inflammation. I had recommendations about supplements, exercise, and mindfulness, all based on scientific evidence. My patients find it very easy to use and beneficial.

As I mentioned, the science of nutrition, exercise, and stress management is available. Physicians must take the lead in educating patients about healthy lifestyle interventions. Otherwise, patients will get lost trying to research it on Google.

Therefore, I constantly encourage my patients with rheumatoid arthritis or other autoimmune diseases to make better lifestyle choices that will positively influence their minds, health, and life.

Diana M. Girnita is a rheumatologist and founder and CEO, Rheumatologist OnCall. She can also be reached on Facebook, Instagram, and YouTube.

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