Tips for Living Well with Rheumatoid Arthritis: Lifestyle Changes and Management

Living with Rheumatoid Arthritis: How to help yourself with a healthy lifestyle change.  Managing Rheumatoid Arthritis through a healthy lifestyle: Tips for living, help reduce pain and help improve arthritis symptoms

Physical Activity to protect your joints and make daily tasks easy:

Aerobic exercise (moderate evidence): Regular moderate-intensity aerobic exercise (e.g. walking, cycling) for at least 30 minutes per day, 3 days per week, can reduce disease activity scores and improve physical function in RA patients.

Regular moderate-intensity aerobic exercise, such as walking and cycling, has been shown to have positive effects on aerobic capacity, fatigue, and hematologic indices in patients with rheumatoid arthritis (RA). Meta-analyses and systematic reviews have provided evidence supporting the efficacy and safety of aerobic exercise in improving disease activity scores and physical function in RA patients. These findings suggest that engaging in at least 30 minutes of moderate-intensity aerobic exercise for a minimum of 3 days per week can be beneficial for RA patients. Aerobic exercise, including supervised land-based activities like cycling and walking, has been found to effectively reduce fatigue and improve the overall well-being of RA patients (Dartel et al., 2015). Furthermore, the positive impact of aerobic exercise on hematologic indices, such as hemoglobin and hematocrit, indicates its potential to enhance physiological parameters in women with RA (Shapoorabadi et al., 2016). The systematic review and meta-analysis also emphasize the effectiveness and safety of aerobic exercise in managing RA, supporting its incorporation into the treatment regimen for RA patients (Ye et al., 2022). In conclusion, the evidence from these studies underscores the benefits of regular moderate-intensity aerobic exercise in reducing disease activity scores and enhancing physical function in RA patients. These findings provide valuable insights for healthcare professionals and patients in developing exercise interventions tailored to the specific needs of individuals with RA.

Resistance training (moderate evidence): Progressive resistance training 2-3 days per week, including exercises that target major muscle groups, can help preserve lean muscle mass and improve muscle strength and physical function.

Resistance training, particularly progressive resistance training (PRT), has been shown to have significant benefits for patients with rheumatoid arthritis (RA). High-intensity resistance training has been found to be effective in restoring muscle mass and function in RA patients, indicating the potential of resistance training in managing the condition . Additionally, resistance exercise has been demonstrated to reduce skeletal muscle cachexia and improve muscle function in RA, highlighting its positive impact on muscle health in this population . In older adults with RA, person-centered resistance exercise has been shown to improve physical fitness in terms of aerobic capacity, endurance, and strength, emphasizing the potential of resistance training in enhancing overall physical function in this demographic . Furthermore, a systematic review with meta-analysis has indicated that resistance training, particularly when combined with blood flow restriction, can lead to improvements in muscle strength, muscle hypertrophy, and functionality in patients with osteoarthritis and RA . Moreover, eccentric training has been found to enhance the binding of αB-crystallin to myofibrils and prevent skeletal muscle weakness in an adjuvant-induced arthritis rat model, suggesting the potential of eccentric resistance training in mitigating muscle weakness associated with arthritis . Additionally, a study has highlighted the association between low levels of physical activity and cardiovascular risk factors in women with RA, underscoring the importance of interventions such as resistance training to address these risk factors and improve overall health in RA patients. Furthermore, a review on the health benefits of resistance training emphasizes its role in managing weight and body fat by increasing fat-free mass, resting metabolic rate, and caloric expenditure, indicating its potential impact on body composition and metabolic health. 

Seeing a physical or occupational therapist

physical and occupational therapists can ensure that people with rheumatoid arthritis do exercise appropriately.

Mental Health Interventions: Cognitive behavioral therapy (moderate evidence): 8-12 weeks of CBT significantly reduces pain, disability, depressive symptoms, and anxiety compared to control groups.

The evidence supporting cognitive behavioral therapy (CBT) in reducing pain, disability, depressive symptoms, and anxiety is substantial. A randomized controlled trial demonstrated that after 12 weeks, CBT resulted in significantly higher quality of life scores and lower depression scores compared to a waiting list placement. Additionally, CBT has been associated with decreased depression scale scores in patients with heart failure, indicating its potential in addressing depressive symptoms in various populations. Furthermore, CBT has shown effectiveness in managing pain and disability in patients with rheumatoid arthritis, as evidenced by increased use of coping strategies and improved confidence in pain management among CBT subjects . Moreover, CBT has been found to be effective in reducing anxiety and depression in patients with psoriasis, further highlighting its broad applicability in addressing psychological symptoms across different conditions. The implementation of CBT typically involves 8-12 sessions, each lasting 25-35 minutes, emphasizing the structured and time-limited nature of this intervention .

Mindfulness-based practices

There is benefit but low evidence for Mindfulness-based stress reduction programs and mindfulness meditation practiced regularly can improve quality of life, pain, and psychological health.

On the other hand, the evidence supporting mindfulness-based practices and relaxation techniques is relatively limited. While mindfulness-based stress reduction programs and mindfulness meditation have shown potential in improving quality of life, pain, and psychological health, the evidence is categorized as low. Similarly, relaxation techniques such as progressive muscle relaxation, diaphragmatic breathing, and guided imagery have shown promise in reducing pain and perceived stress, but the evidence supporting their effectiveness is also categorized as low. However, it is important to note that these techniques have been associated with statistically significant improvements in pain, anxiety, and quality of life in various clinical settings, indicating their potential as complementary approaches to managing symptoms 

Dietary Changes and ease living with rheumatoid arthritis:

The sections below highlight the importance of considering dietary factors in both reducing the risk of RA and as an reduce painful swelling. They help your medications work better.  This includes the potential role of vitamin D, omega-3 fatty acids, and folate in the treatment outcomes of patients with early RA, as indicated by data from a Swedish population-based prospective study. Also eating fish like salmon may act like fish oil. 

Mediterranean diet (moderate evidence): Replacing an unhealthy “Western” diet with a Mediterranean-style diet high in fruits, vegetables, legumes, whole grains, olive oil, nuts, seeds, and fish can reduce RA disease activity.

The Mediterranean diet has been a subject of interest in the context of rheumatoid arthritis (RA) due to its potential influence on disease development and clinical manifestations. Several studies have highlighted the potential benefits of the Mediterranean diet in the management of RA. It has been suggested that the Mediterranean diet, in combination with genetic and other lifestyle factors, could contribute to the lower incidence of RA in Southern Europe compared to Northern Europe and North America. Additionally, adherence to the Mediterranean diet, which is rich in vitamins and antioxidants, has been associated with a significant alleviating effect for rheumatoid arthritis. Furthermore, a randomized controlled trial investigated the efficacy of a Mediterranean diet versus an ordinary Western diet for the suppression of disease activity in patients with RA, indicating the potential of the Mediterranean diet as an intervention for RA. Moreover, the Mediterranean diet has been proposed as a modulator of intestinal microbiota and intestinal barrier function, potentially improving RA-related outcomes (Dourado et al., 2020). The anti-inflammatory effects of the Mediterranean diet, attributed to the protective properties of omega-3 polyunsaturated fatty acids and vitamins, have also been noted. Furthermore, a population-based case-control study found a dose-response relationship between the Mediterranean diet score and the risk of rheumatoid arthritis, suggesting a potential protective effect of this dietary pattern (Johansson et al., 2018).

Omega-3 fatty acids (moderate evidence): Ingesting omega-3s from fish, fish oil supplements, walnuts or enriched foods reduces tender joint count and duration of morning stiffness.

Supplements can potentially play a significant role in the management of rheumatoid arthritis (RA), and several studies have explored their potential benefits in influencing disease activity and clinical manifestations. 

Clinical research has shown that omega-3 PUFAs can have a small effect in reducing pain, tender and swollen joint count, and C-reactive protein (CRP) levels, which are markers of inflammation. A systematic review and meta-analysis including randomized controlled trials (RCTs) found that omega-3 supplementation had a small but significant effect on these parameters in patients with rheumatoid arthritis (RA). Furthermore, a sub-group analysis indicated that most parameters were significantly improved with animal-derived PUFAs compared to vegetable-derived PUFAs when using a high-dose supplementation of omega-3 PUFAs for 3 to 6 months 2.

Omega-3 PUFAs contribute to the reduction of inflammation by influencing various inflammatory processes and pathways, leading to a decrease in inflammatory markers and symptoms associated with inflammatory conditions such as RA. However, it is important to note that while omega-3 PUFAs can be beneficial, higher doses may increase the risk of bleeding and should be used with caution

Role of Vitamin D

Vitamin D is suggested to play a role in the management of rheumatoid arthritis (RA) through several mechanisms. It may contribute to improvements in the cytokine balance by shifting it towards anti-inflammatory cytokines and reducing interleukin-6 (IL-6), which is associated with the progression and severity of RA. Additionally, vitamin D may help restore barrier mechanisms in the gut mucosa and directly modulate the immune system. However, further research is needed to better understand the prospective therapeutic application of vitamin D in RA and to ensure the lack of pathogenicity of the strains used in such treatments.

Elimination diets, vegan and vegetarian diets and anti-infammatory diets

There is low evidence for the benefit of elimination diets. Eliminating problematic foods like gluten, dairy, or nightshades may improve symptoms in some RA patients, but benefits are inconsistent. Plant-based diets may reduce RA symptoms and disease activity scores, but larger controlled trials are needed. Diets high in colorful fruits, vegetables, nuts, seeds, and anti-inflammatory spices may reduce RA symptoms, but more research is required.

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References:

Hurkmans, E., van der Giesen, F. J., Vliet Vlieland, T. P., Schoones, J., & Van den Ende, E. C. (2009). Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. The Cochrane Database of Systematic Reviews, 2009(4), CD006853. https://doi.org/10.1002/14651858.CD006853.pub2

Dissanayake, R. K., & Bertouch, J. V. (2010). Psychosocial interventions as adjunct therapy for patients with rheumatoid arthritis: A systematic review. International Journal of Rheumatic Diseases, 13(4), 324–334. https://doi.org/10.1111/j.1756-185x.2010.01563.x

Khanna, S., Jaiswal, K. S., & Gupta, B. (2017). Managing rheumatoid arthritis with dietary interventions. Frontiers in Nutrition, 4, 52. https://doi.org/10.3389/fnut.2017.00052

O’Connor, Á. (2013). An overview of the role of diet in the treatment of rheumatoid arthritis. Nutrition Bulletin, 39(1), 74-88. https://doi.org/10.1111/nbu.12041

Lourdudoss C, Wolk A, Nise L, Alfredsson L, Vollenhoven RV. Are dietary vitamin D, omega-3 fatty acids and folate associated with treatment results in patients with early rheumatoid arthritis? Data from a Swedish population-based prospective study. BMJ Open 2017;7(6):e01615