WORLD Arthritis Day, referred to as WAD, is a global awareness day held every year on October 12.
WAD aims to help raise awareness of the existence and impact of rheumatic and musculoskeletal diseases, often referred to as RMDs.
The goal of World Arthritis Day 2022 is to increase public awareness of the condition known as arthritis.
The objectives of World Arthritis Day 2022 are as follows:
- Increasing understanding of the value of pursuing a healthy lifestyle;
- Educating people on the value of living a healthy lifestyle;
- Encouraging early arthritis detection.
The Malaysian Society of Rheumatology (MSR) defines the terms ‘arthritis’ and ‘rheumatism’ to encompass a range of painful musculoskeletal conditions.
Arthritic and rheumatic diseases represent a spectrum of musculoskeletal disorders. Among the most common are rheumatoid arthritis (RA) and osteoarthritis (OA).
Associate Professor Dr Raja Jasmin Begum Raja Mohamed, Consultant Rheumatologist at University Malaya Medical Centre (UMMC) describes RA as a chronic, progressive, inflammatory, autoimmune and multi-systemic disease that causes chronic synovial inflammation leading to joint destruction and chronic disability.
A disease burdened with long-term economic consequences and reduced health quality of life.
Dr Raja Jasmin further said RA is the most common autoimmune inflammatory arthritis in adults.
The prevalence of RA is estimated to be 1% worldwide of the adult world population. In Malaysia, it affects about five in 1,000 patients. The female-to-male ratio is three to one.
It affects people of all ages, with a peak age of onset at approximately 50 years of age.
However, only up to 20% of adults seek help from their primary care GP for musculoskeletal problems every year.
Gioia Chiara et al. reported in Nutrients (2020) that dietary habits could represent both disease risk and protective factor, based on the properties of specific foods.
Physical activity, weight loss and healthy dietary patterns may represent helpful tools for disease management, promoting a reduction of inflammation, symptoms and disability.
Mediterranean diet is the most encouraged dietary pattern, coupled with a high consumption of ‘fatty’ fish (sardines, salmon, seabass, trout) for their well-known anti-inflammatory properties.
Red meat intake should be limited (once or twice per month), healthy oils used in cooking, along with one to two per week consumption of fatty fish.
Weekly consumption of other types of fish and lean poultry (e.g. chicken) and high consumption of wholegrains (brown rice, wholemeal bread, oats), legumes/beans, five or more fruit and vegetables per day, preferably seasonal and locally produced.
Sugar-sweetened drinks, salt and alcohol should be avoided or only moderately consumed.
Physical activity and a healthy lifestyle should be combined with dietary patterns, to reach an optimal body weight.
Vitamin D supplementation is important in established RA for bone health, for its anti-inflammatory properties and potentially for its beneficial effect on disease activity.
On the contrary, solid evidence of vitamin D utility in RA prevention is still lacking.
Body weight control is a primary target, because of its negative impact on disease activity remission and the efficacy of treatment.
In a review by Khanna Shweta et al. (2017), the researchers stressed better patient compliance is, however, always necessary for effective care and management of RA.
Based on findings discussed in their review, anti-inflammatory foods may aid in reducing signs and symptoms of RA.
The authors further added that this may not cure the patients; however, an effective incorporation of these food items in the daily food plan may help to reduce their disease activity, delay disease progression and reduce joint damage.
The most common vitamin and mineral deficiencies in RA are folic acid, vitamins C, D, B6, B12 and E; calcium, magnesium; zinc and selenium.
Studies have shown that some but not all supplements may improve disease activity and reduce pain associated with RA.
Studies have found that people with RA have an increased likelihood of insufficient vitamin D, effects of supplementation on RA disease activity and symptoms are mixed.
Omega 3 supplements have been found to benefit the clinical outcome of RA and as mentioned above, may even delay the need for medications.
As the importance of gut health is now well recognised in inflammation, studies have tried to answer if probiotics can reduce inflammation and improve RA.
In a meta-analysis of nine studies, no improvement in RA was seen with probiotics.
Instead try to maintain good gut health, as the balance of microorganisms that live in our digestive systems is vital to our immunity, physical and mental health.
Prebiotics, present in fiber-rich foods like fruits, vegetables and wholegrains, help ‘fertilise’ our existing gut bacteria and encourage the development of a diverse community of microbes.
This is typically found in cultured yoghurts, fermented foods like kefir, kimchi, miso and fermented drinks like kombucha and kefir.
In a narrative review done by Rondanelli M. et al. (2021), the authors suggested an ideal food pyramid for patients with RA.
The pyramid shows that carbohydrates should be consumed every day (three portions of whole grains, preferably gluten-free), together with fruits and vegetables (five portions; among which fruit, berries and citrus fruit are to be preferred, and among the vegetables, green leafy ones.), light yogurt (125 ml), skim milk (200 ml), one glass (125 ml) of wine and extra virgin olive oil; weekly, fish (three portions), white meat (three portions), legumes (two portions) eggs (two portions), seasoned cheeses (two portions), and red or processed meats (once a week).
At the top of the pyramid, there are two pennants: one green means that subjects with RA need some personalised supplementation (vitamin D and omega 3) and one red means that there are some foods that are banned (salt and sugar). The food pyramid allows patients to easily figure out what to eat.
Drinking at least 1.5 to 2 litres of water and staying hydrated is one of the easiest ways to keep your immune system functioning, reduce inflammation and keep joints cushioned/lubricated.
Metsios G.S et al (2018) reported some of the beneficial effects of physical activity and exercise in people with RA which include increased functional ability/capacity (increased quality of life) and reduce inflammation/pain and cardiovascular disease risk.
The authors recommended a gradual long-term target of 10,000 steps a day.
Excessive body weight and diets that include processed food and high fat/salt/sugar diets exacerbate the RA symptoms likely due to their pro-inflammatory effects.
In contrast, diets rich in vegetables, fruits, and fiber (legumes/pulses) are associated with lower BMI, have anti-inflammatory properties and help reduce pain and inflammation in these patients.
Studies have shown that dietary fibre can improve the gut bacteria composition and increase the bacterial diversity in RA patients, potentially reducing inflammation and joint pain.
Although some of the trigger foods in RA patients are individualised, a diet comprised of fruits, whole grains, legumes, and vegetables, can improve symptoms by eliminating many common trigger foods.
People with RA are encouraged to have a balanced diet that maintains a healthy weight. Do take note that this general structure of a healthy and balanced diet may be suitable for most, but not all.
The ideal diet for you may look slightly different depending on your individual medical and health condition.
The best course of action is to talk to your doctor or dietitian about your individualised nutritional needs. – The Vibes, October 12, 2022
Rozanna M Rosly is a clinical dietitian at Global Doctors Hospital
