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Arthritis and nutrition

What is arthritis?

Arthritis is a common condition that causes pain and inflammation in the body’s joints. In the UK, more than 10 million people have arthritis, or other similar conditions that affect the joints.

 

Although arthritis is more common in older people, it can affect people of all ages, including children. Arthritis can affect quality of life and make daily activities a challenge.

 

There is no special diet that can cure arthritis but some people living with arthritis use dietary changes to try to improve symptoms.

 

Sarah Coe, Nutrition Scientist, British Nutrition Foundation

Is nutrition important for people with arthritis?

It is important to have a balanced diet and maintain a healthy body weight when you live with arthritis. A healthy lifestyle can help to manage the symptoms and help to reduce the risk of other diseases, such as obesity, cardiovascular disease and type 2 diabetes.

 

There is no special diet or ‘miracle food’ that can cure arthritis, but there is a great deal of interest in how diet may affect people living with arthritis. It is important to note that much of the current popular advice does not have robust scientific evidence to support it and research is still developing. We understand this may be confusing, so we have summarised the key information below.  

Key Facts about arthritis and nutrition

  • Arthritis is a condition that causes pain and inflammation in the body’s joints.
  • The most common types of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA). 
  • There is no special diet that can cure arthritis but some people living with arthritis use dietary changes to try to improve symptoms. 
  • Research aiming to identify whether or not there are any benefits associated with dietary changes and arthritis is limited. More studies are required to provide conclusive advice. 

Tips on shopping for people with arthritis

Get heavier items delivered

If lifting shopping bags is difficult, consider getting heavier items delivered through online shopping. That way you can still visit the supermarket if you like to, but only to buy lighter items.

Use convenience foods when you need to

Use convenience foods to help you when you need to, for example ready-prepared food such as chopped vegetables and grated cheese.

The freezer is your friend

Frozen vegetables are another way to avoid chopping fresh vegetables. Have some pre-prepared ingredients and ready-made meals in the freezer to avoid struggling when your arthritis is particularly troublesome.

Should I take supplements for osteoarthritis? (FAQ)

Many people with osteoarthritis try dietary supplements to help try to relieve pain and improve function.

 

  • Joint cartilage contains glucosamine and chondroitin compounds. It’s thought that taking these as supplements may help to improve the health of damaged cartilage. 
  • Although these supplements are considered safe, evidence of clinical benefit is small. Therefore, prescribing these supplements is not routinely recommended for the management of OA.
  • If you do take glucosamine and/or chondroitin, always seek advice from your pharmacist on potential interactions with other medications you may be taking.
  • Dosage for glucosamine is usually between 1250 and 1500mg per day. Treatment should be reviewed if there are no noticable benefits after 2–3 months.
  • There is no established dose of chondroitin for OA, but manufacturers tend to recommend between 400 and 1200mg daily.
  • Note: these supplements are often made from shellfish, and so are not suitable if you have a shellfish allergy.

  • Vitamin D is important for building and maintaining overall bone health.
  • Although some research suggests an association between low levels of vitamin D and increased risk and progression of OA, current trials do not show that vitamin D supplements ease OA pain and joint degeneration. 
  • People with OA should follow government advice for the general population which is to consider taking a daily supplement of vitamin D during the autumn and winter months.

  • There is generally very limited, conflicting, and poor-quality evidence on dietary supplements and complementary treatments such as MSM (methylsulfonylmethane), rosehip and curcumin (the active ingredient in turmeric) supplements used by people living with OA for symptomatic relief.
  • Further research is needed to understand whether any supplement may be of benefit and be safe.
  • In addition, there is no strong evidence that fish oil supplements can confer any benefit for OA but including oily fish in your diet is recommended (at least two portions of fish a week, including one of oily fish*), within healthy eating advice for the general population.

*Note: Girls, women of childbearing age and pregnant and breastfeeding women should not eat more than two portions of oily fish a week

Tips on cooking food for people with arthritis

Cooking at home can be enjoyable and help with eating healthily. However, when movement is restricted activities around cooking can be difficult.

Leave the skins on

If you find peeling fruit and vegetables (such as potatoes and carrots) painful then try washing them thoroughly and keeping the skins on – this will also help to keep important nutrients such as fibre.

Use suitable equipment

Use suitable equipment or special gadgets to help you. Appliances like electric can openers, microwaves and handheld blenders can make food preparation and cooking easier.

Batch cook when possible

If you are cooking, try to make more than usual and freeze what you don't eat so meals can be readily available when you are in pain or tired. Remember to label the containers and the date they were frozen.

What are the most common types of arthritis?

Two of the most common types of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA). 

Osteoarthritis

Osteoarthritis (OA) is the most common type of arthritis in the UK, affecting nearly 9 million people. It is a disease that damages the cartilage (the tissue that cushions joints and helps them move smoothly) making movement harder and leading to increased stiffness and pain.

Osteoarthritis can affect any joint in the body, but the most common areas affected are the knees, hips and small joints in the hands.

The management of OA focuses on symptom management. It is not possible for specific foods or nutritional supplements to cure osteoarthritis, but having a healthy, balanced diet and exercising can be important to help ease symptoms. It is widely accepted that weight reduction (if overweight) in combination with increased physical activity can improve function and symptoms such as pain and stiffness.

 

Osteoarthritis and diet  

Reaching or maintaining a healthy weight can relieve pain, improve function, and slow the progression of OA.

Being overweight or obese are crucial factors in OA since overload to the affected joint is one of the risk factors for developing OA or worsening of symptoms. Losing weight reduces pressure on joints, particularly weight bearing joints like the hips and knees.

There is increasing interest in not only reducing weight but specifically in reducing fat tissue, as fat tissue in our bodies is ‘active’ and can secrete several chemical factors, some of which may have inflammatory effects.

If you’d like more information on weight loss talk to your GP or practice nurse. You can also find tips and advice on our healthy weight loss page.

 

Osteoarthritis and physical activity

Painful joints and stiffness can make it more difficult to be physically active. However, physical activity can help maintain a healthy body weight and protect joints by keeping muscles strong, reduce the load on our joints, increase your range of movement and reduce stiffness.

Muscle strengthening exercises (activities such as yoga, pilates or dancing that work the major muscles) and aerobic exercise (activities such as walking, cycling or swimming that temporarily increase your heart rate and respiration) are recommended.

It is important to find the right type of activity for you. If you are unsure, ask your GP to refer you to a physiotherapist, who can help you work out a suitable programme.

 

Healthy dietary patterns for osteoarthritis and more 

Some research suggests a link between high blood cholesterol and an increased risk and progression of OA. Although it is unclear whether lowering blood cholesterol will improve OA, raised blood cholesterol is a risk factor for cardiovascular disease. 

It is therefore important to have a balanced, healthy diet as it may help to reduce blood cholesterol and the risk of cardiovascular disease. It will also help you to maintain a healthy weight.

Tips for creating a healthy diet:

  • Include a variety of at least five portions of fruit and vegetables a day in your diet. 
  • Base your meals on higher fibre starchy foods and choose wholegrain or higher fibre versions with less added fat, salt and sugar.
  • When choosing dairy foods and dairy alternatives, choose lower fat and lower sugar options.
  • Eat some beans, pulses, fish, eggs, lean meat and other protein sources. 
  • Avoid unhealthy habits, like smoking and drinking in excess, and include regular physical activity.
  • If you want to lower your cholesterol, try eating oats and barley, which have a special soluble fibre called beta–glucan which can help to reduce blood cholesterol levels.
  • Reduce foods high in saturated fats in your diet like sausages, cream, butter, biscuits, cake, pies, pastries and fatty meats, and replace with those containing unsaturated fats, like oily fish, avocados, nuts and seeds and small amounts of olive, rapeseed and sunflower oils and unsaturated spreads made from them.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a long-term inflammatory condition that causes pain, swelling and stiffness in joints. The hands, wrists and feet are typically affected, but it may affect any joint. 

 

RA is an auto-immune condition that happens when the body’s immune system, which usually fights infection, starts to attack healthy joints instead. At times symptoms can become suddenly worse causing severe pain and making it hard to go about everyday life. 

 

RA is associated with a number of complications and comorbidities (conditions that often occur together with another condition) such as an increased risk of cardiovascular disease and osteoporosis (a condition that weakens bones).

 

Rheumatoid arthritis is less common than osteoarthritis, but it nonetheless is estimated to affect over 400,000 adults in the UK. There is no permanent cure, and it can have a significant personal impact for people with the disease and their families. However, early treatment can help to control it and help people carry on active and full lives. Medical management with drug therapy aims to relieve pain and stiffness whilst helping mobility. 

 

Rheumatoid arthritis and diet 

Diet and inflammation

People living with RA often use dietary changes to try to improve symptoms. A wide range of dietary advice exists but there is a lack of scientific information in support of the claimed benefits.

 

The most common dietary patterns people with RA try are those that may have anti-inflammatory benefits or increase antioxidant levels (see section on antioxidants below). Other dietary strategies focus on cutting out foods or food groups that may be perceived as the cause of symptoms. However, much clarification is still needed to understand the relationship between diet and RA. Available evidence does not establish diet as a substitute for pharmaceutical treatments.

 

For people living with RA it is important to be aware of the dietary advice for which there is some evidence of benefit, and where the evidence is limited, as well as awareness that some alternative diets proposed can compromise nutrient intake.

 

Eliminating foods

It is a common belief among people living with RA that certain foods or ingredients have adverse effects, and that a food allergy/intolerance may cause or make inflammation worse.

 

Several reviews have aimed to evaluate the effectiveness of a range of interventions that restrict certain foods for the treatment of RA and management of its side effects. These include:

  •   Vegan diets
  •   Elemental diets (liquid diets that contain nutrients that are broken down to make digestion easier)
  •   Fasting
  •   Elimination diets (used to find foods that might be the cause of symptoms)

However, there is very limited research in this area and the results remain largely unclear. It is uncertain whether any of these dietary strategies can improve pain, stiffness, and mobility. Certain individuals or subgroups may show improvement if they cut out certain foods, but many others do not. Furthermore, some of these diets may be difficult to stick to, and people may lose weight even though they did not need or plan to.

 

There is no test that can identify if someone with RA may benefit by a change in diet, although offending foods can be identified through an exclusion programme under the supervision of a dietitian.

 

Several tests that claim to identify food allergies can be bought on the high street or online but are not recommended because there is little evidence that they work.

 

These include:

  •   Applied kinesiology (a process based on muscle testing)
  •   Vega test (which involves measuring electromagnetic conductivity in the body)
  •   Hair analysis
Fasting

Fasting has been reported to reduce pain and inflammation in some people with RA. It is recognised that inflammatory activity is reduced when fasting, but the effects are short term and could also be a result of weight loss. Symptoms return when regular diets resume and fasting carries health risks, so it is not recommended.

 

Authoritative bodies typically will not suggest cutting out important food groups as this can increase risk of nutritional deficiency.

 

Milk and dairy foods

There has been some suggestion that dairy foods are associated with inflammation, but the evidence is conflicting, and limited due to small trials.

 

Studies of milk and dairy products more typically suggest a neutral or even beneficial effect on levels of inflammatory markers and would not point to an adverse inflammatory effect.

 

Specific dietary guidelines are difficult to define in people living with RA as there are individual differences. However, as dairy products can play an important part of a healthy, balanced diet, based on the available data, there is no evidence to support exclusion of dairy products unless an intolerance or allergy are shown. If you think you may have an adverse reaction to milk and dairy products talk to your GP or a health professional involved in your care such as your specialist nurse.

 

The nightshade plant family

Aubergines, peppers, tomatoes, potatoes and goji berries are all members of the nightshade family. Some people believe that solanine, one of the alkaloids (naturally produced compounds in various plants), contributes to inflammation and pain in arthritis. However, the connection between arthritis and nightshades is largely considered anecdotal. There is a lack of any clinical human studies and so currently there is no scientific evidence that nightshade vegetables make arthritis symptoms worse. It is also worth noting that solanine is also found in blueberries, apples, cherries, okra and artichokes, none of which is in the nightshade family and not included in anecdotal reports of adverse effects.

 

The fruit and vegetables that contain solanine are rich in nutrients and antioxidants. However, if you think you may have an adverse reaction to vegetables like potatoes, tomatoes and peppers then talk to your GP or a health professional.

Should I take supplements for rheumatoid arthritis?

Evidence is mixed on the effectiveness of supplements:

A diet rich in antioxidants may help to reduce the risk of developing RA and possibly reduce the inflammatory response in people with RA. Antioxidants can be found in a healthy, balanced diet. However, the benefit of antioxidant nutrient supplements like vitamin A, vitamin C, vitamin E, selenium and zinc is not supported by scientific trials in people with RA. It is important to know that ‘mega-dosing’ (taking doses well above current recommendations), can have adverse effects and is not advised. 

There is some evidence to suggest that taking fish oil supplements may be useful for reducing joint pain and stiffness in people with RA. This may be because long-chain omega-3 fats found in fish oils have anti-inflammatory properties.

 

However, existing research exploring the benefit of fish oil and long-chain omega-3 fats in people with RA have had inconsistent findings. Some studies show that long-chain omega-3 fats may help to reduce joint swelling, pain, and morning stiffness in addition to reducing the amount of medication needed for symptom relief. Other studies have found that they do not significantly affect the clinical symptoms of RA.

 

Whilst the current NICE guidelines for the management of RA do not discuss the role of fish oil supplements, their use appears to be common among RA patients. However, the optimal dose is unclear, and it has been reported that supplementation can take up to three months before symptom relief is experienced.

 

Whilst there is not enough evidence to recommend omega-3 supplements for people with RA, dietary advice for the general population is to eat at least two portions of  fish per week, one of which should be an oily type (Note: girls, women of childbearing age and pregnant and breastfeeding women should not eat more than two portions of oily fish a week). Oily fish (such as sardines and salmon) are the best source of these fatty acids and contain other nutrients such as vitamin D. Therefore, fish consumption in line with general healthy eating recommendations is promoted in patients with RA.

Some scientists have suggested that the micro-organisms (including bacteria) that live in our gut (the gut microbiota), may factor in the development of RA. However, the clinical effects of ‘good’ bacteria found in food products and supplements (probiotics) in RA remain unclear. Further studies are needed to provide conclusive evidence.

Supplements for the side effects of medication

Your specialist team or GP may prescribe certain nutrition supplements because they can be useful in preventing the side effects of medications. 

Folic acid

Folic acid supplements may help prevent some of the side effects of methotrexate, a conventional disease modifying anti-rheumatic drug (cDMARD), commonly used in first line management of RA. Folic acid reduces toxic effects and improves continuation of therapy and compliance.

 

The British Society for Rheumatology guidelines recommends a typical folic acid dose of 5mg once weekly, not on the same day as methotrexate (also typically taken once weekly).

Calcium and vitamin D

Calcium and vitamin D are essential nutrients for bone health and supplements may be prescribed for patients with RA taking steroids, which can increase the risk of bone loss and osteoporosis.

 

Steroids may be offered as a short-term treatment to manage flares in people with recent onset (or established disease) to rapidly decrease inflammation, and to improve symptoms while waiting for a new cDMARD to take effect (which can take 2–3 months).

 

Although laboratory research has suggested that vitamin D may have anti-inflammatory effects, further studies are needed to better understand the role of vitamin D in inflammatory conditions, and currently there is no evidence that vitamin D supplements are of benefit in RA. Regardless of possible effects on inflammation, it is recommended that all adults take a daily supplement containing 10µg (micrograms) of vitamin D during the autumn and winter months, when the sun is not strong enough for the body to make vitamin D.

Last reviewed October 2023. Next review due October 2026.

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Please note that advice provided on our website about nutrition and health is general in nature. We do not provide any individualised advice on prevention, treatment and management for patients or their family members.