Approximately 1.3 million Americans, mostly women, are affected by rheumatoid arthritis. RA is a long-term chronic autoimmune disease that is treatable, but not curable.
For some, the disease can go into remission periods, while for others the disease is a constant presence in their lives especially as it progresses. RA causes moderate to severe pain as it destroys and disfigures the joints in the body; symptoms can be exacerbated by “triggers”.
Although rheumatoid arthritis can involve different parts the body, joints are always affected. When the disease acts up, joints become inflamed. Inflammation is the body’s natural response to infection or other threats, but in rheumatoid arthritis inflammation occurs inappropriately and for unknown reasons.
Strong medication can help, but knowing what things can trigger your symptoms can be your first line of defense in keeping the disease under control and pain manageable. In the big picture, these play minor roles in RA in comparison to taking the right medication for instance, but a whole body approach is always best in managing disease rather than expecting one specific treatment or medication to manage it entirely.
One factor that affects RA is smoking, says Susan Goodman, MD, a rheumatologist at the Hospital for Special Surgery in New York City. “Smoking clearly has an impact—it makes it worse and increases the likelihood of getting it,” she says.
RA nonsmokers have fewer swollen, painful joints than smokers, research suggests. RA smokers are three times as likely to have rheumatoid factor—a sign of more severe disease—and twice as likely to have joint damage.
The link between coffee or tea and RA is debatable. Research has suggested that decaf coffee (four or more cups a day) can increase the risk of getting RA, but caffeinated coffee has no impact, and tea may reduce risk. Other research found no correlation between decaf and RA.
One issue, though, is that coffee may make some RA medications, such as methotrexate, less potent, therefore limiting its effectiveness.
While research on the topic is few and far between, there does seem to be a link between weather and RA symptoms. It is likely that barometric pressure and temperature changes have the biggest impact on symptoms because it affects the swelling of the joints.
As with many conditions, any change in climate tends to worsen symptoms—so RA patients may fare better when the weather is more consistent.
As with the other factors on the list, the link between RA and allergies may vary from person to person.
Still, there is some research that suggests that people with RA are less likely to have hay fever. And people who do have both may have less-severe RA symptoms.
“My guess is that some of the allergy medications may help with some (RA) symptomatic therapy,” Dr. Goodman says. “Or it could just be that people notice RA symptoms less because they are so distracted and miserable with their allergies.”
Another possible answer is that the histamines from the allergies or the antihistamines taken for treatment could play a role as well.
In a recent study in the journal Rheumatology, researchers asked about 1,800 people about their alcohol-drinking habits and RA.
They found that people who had at least one drink three or more days a week were four times less likely to have RA than nondrinkers. Also, RA patients who did drink tended to have milder symptoms than those who didn’t.
Add a glass of wine with dinner a few nights a week and see if you experience added relief.
The link between vitamin D and RA is tricky.
Research suggests women in the northeastern U.S. are at greater risk of RA than those in sunnier regions. Lack of sun can cause vitamin D deficiency. And vitamin D deficiency has been linked with other autoimmune diseases.
“Vitamin D has a lot of interesting immune effects and metabolic effects and is critical to bone health,” Dr. Goodman says. “Whether taking vitamin D will delay the onset or prevent it seems less clear-cut, but it is an important part of overall bone health.”
It’s tough to predict the impact of pregnancy on RA. Women generally stop taking medication in pregnancy because the drugs may hurt the fetus.
For some, RA symptoms improve or even go into remission, Dr. Goodman says. She attributes this to the fact that the immune system is suppressed during pregnancy.
But others can experience even more pain than they normally do. And those who have a great pregnancy can have a flare-up after they give birth.
There are many benefits to breast-feeding, including a possible reduction in RA risk.
A 2004 study in the journal Arthritis and Rheumatism found that, compared to women who didn’t breast-feed, those who spent a total of one to two years breast-feeding had a 20% lower chance of getting RA. Those who did for two years or more had a 50% reduced risk.
A 2008 Swedish study showed similar results. Breast-feeding for up to one year was associated with a 25% reduced risk, and breast-feeding for 13 months or more was linked to a 50% reduction in risk.
The data is a bit up in the air when it comes to hormones and RA. Studies have not found a link between contraceptives and the risk of RA or the severity of disease. A 2004 study found that women with irregular menstrual cycles do have a higher RA risk.
“The data aren’t completely clear” on this topic, Dr. Goodman says. But hormones may play a role in reducing symptoms. “There is no question that estrogen can decrease pain, so part of some of the perimenopausal flares may be caused by estrogen withdrawal.”
There seems to be an anecdotal link between the flu and worsening RA symptoms. And the flu can be especially dangerous for people taking medication that weakens the immune system, which includes most of the drugs used to treat RA.
The CDC recommends flu shots for people with RA. (But not nasal-spray flu vaccines, which contain live viruses.) One note of caution: Certain RA medications—methotrexate, prednisone, and rituximab—may lower the effectiveness of flu shots.
Shed extra pounds
If you’re overweight, losing those excess pounds may take some of the pressure off of your joints. “If I have a patient with RA who’s overweight and loses 10 pounds, every time he takes a forceful step forward, that’s 30 pounds less on weight-bearing joints [such as the hips and knees],” says Dr. Hadler.
What’s more, it may also improve quality of life. A 2006 study found that overweight and normal weight people with RA had a higher quality of life than those who were obese.
Several studies suggest that people with RA may benefit from fish oil supplements, which contain inflammation-fighting omega-3 fatty acids. RA patients are also at greater risk of cardiovascular disease, and fish oil is thought to be good for the heart too.
However, studies suggest that you need to get 3 grams of omega-3 fatty acids per day (a 4-ounce piece of salmon has a little over 2 grams) for 12 weeks, which could get pricey or the diet hard to maintain.
Make it Mediterranean
In a 2003 Swedish study, people with RA who ate a Mediterranean diet rich in fruits, vegetable, cereals, legumes, and olive oil for three months experienced improved physical functioning and vitality when compared to RA patients who did not.
The effects of the Mediterranean diet on rheumatoid arthritis long-term are still unclear, but including more fruits and vegetables in your diet isn’t a bad idea.
Consider a vegetarian diet
At least one study found that people who ate a vegetarian or vegan diet reported an improvement in RA symptoms, including pain score, morning stiffness, and grip strength compared to those who didn’t.
However, because these diets are restrictive, many of the participants were unable to maintain them for the year long study period.
If you can’t give up meat, then at least try to get a few more greens on your plate. The antioxidants, such as those found in green peas, bell peppers, and broccoli, may protect against tissue damage around the joints caused by free radicals.
Check your vitamins
Some evidence suggests certain nutrients may help patients with RA. For example, some studies showed that vitamin E supplements reduce RA joint destruction and pain, while others do not.
Selenium levels are also thought to be too low in some people with RA. However, only one study has found that selenium reduced swollen joints and stiffness, and it also involved fish oil supplementation, so it’s difficult to determine if selenium can help reduce RA symptoms.
In addition, some RA patients take methotrexate to slow disease progression. But the drug also inhibits folic acid metabolism and causes a range of side effects, including mouth sores, says Dr. Hadler. He suggests folic acid supplements to decrease these adverse effects.
Find out about allergies
Food allergies, especially to dairy and shrimp, may aggravate rheumatoid arthritis. Some people try elimination diets, which involves removing all potential allergens from the diet and slowly adding these foods back to see if they trigger symptoms.
Studies have tested whether exposing patients to foods that had previously upset their RA consistently worsened their symptoms. “You get a smidgen of a hint that food aggravates symptoms,” says Dr. Hadler.
But he explains that there’s tremendous variation within any individual’s symptoms in a given time period, making it difficult to study the effects of elimination diets.