WebMD Medical Reference

It can be difficult to get all the nutrients you need when you have rheumatoid arthritis (RA). Even if you’re eating what seems like a healthy diet, you may still be missing key vitamins and minerals.Managing RA is enough of a challenge on its own. You don’t want to have to deal with a nutritional deficiency as well. This guide looks at common vitamins and minerals that people with RA may be missing and how to make sure you’re getting the nutrients your body needs.

How Does RA Hurt Nutrition?

There are a few key reasons why rheumatoid arthritis and nutritional deficiencies often go together:

  • RA medications. A number of the medicines that people need for RA can block nutrients from getting into the body. For instance, methotrexate can block the absorption of folic acid and corticosteroids block the absorption of calcium.
  • Speeded-up metabolism. The chronic inflammation caused by rheumatoid arthritis triggers the production of chemicals called cytokines. They speed up the metabolism and the breakdown of protein. This means that some people with RA may need more calories and protein to compensate. Otherwise, they’re at risk for weight loss and muscle wasting, called cachexia.
  • RA symptoms. Joint pain and stiffness can make it harder to cook healthy food. If lifting a sauté pan or peeling vegetables is frustrating or painful, you start to do it less. People with RA may unintentionally choose the easiest food options rather than the healthiest.

RA and Folic Acid

Some common RA drugs such as methotrexate and sulfasalazine (Azulfidine) interfere with how the body uses folate, a critical vitamin that promotes health and supports your body’s metabolism. Folate also plays a crucial role in pregnancy, where it helps prevent certain birth defects.

Eating more foods with folic acid — such as spinach, collards, broccoli, garbanzo beans, lentils, peas, oranges, and fortified breads and cereals — can help. Some people may need to take folic acid supplements.

Ask your doctor or dietician how much folic acid you need to help prevent medication side effects during methotrexate treatment. Â There’s some evidence that taking nonsteroidal anti-inflammatory drugs (NSAIDs) may also cause low levels of folate, so you may want to ask your doctor if you take NSAIDs often or take high doses.

RA, Calcium Deficiency, and Osteoporosis

Corticosteroids for RA can make it harder for your body to absorb calcium, increasing your risk of weakened bones and osteoporosis. RA can also put you at risk for weak bones in other ways. Physical activity is important in keeping up bone strength, but many people with rheumatoid arthritis have trouble being active. Your immune system, which RA makes overactive, may even attack your bones directly.

Sources of calcium include dairy products, canned sardines and salmon, almonds, broccoli, kale, and fortified orange juice and cereal.

How much calcium do you need? The general recommendations are 1000 mg a day for adults under age 50 and 1200 mg for people 51 and older. However, check with your doctor. Your doctor may recommend a higher amount or suggest that you take calcium supplements.

Rheumatoid Arthritis, Vitamin D, and Healthy Bones

Vitamin D is also key in strengthening bones and preventing osteoporosis. Without enough vitamin D, your body can’t absorb the calcium from your diet. Among people who have RA, low vitamin D is associated with more active RA symptoms. Vitamin D deficiency may also play a role in developing rheumatoid arthritis. Studies have found that women who have a higher intake of vitamin D seem less likely to get RA. So far, however, there is no clear evidence that vitamin D plays a role in preventing or treating rheumatoid arthritis. Some milk, orange juice, and breakfast cereals are fortified with vitamin D. Natural sources include egg yolks, salmon, tuna, and sardines. Your body also makes vitamin D when it’s exposed to sunlight. Ask your doctor about how much you should get a day and the best way to get it.

RA and Omega-3 Fatty Acids

Many researchers believe that people in the U.S. generally don’t get enough omega-3 fatty acids. People with RA may be at special risk. Studies suggest that people with RA have lower than average levels of EPA and DHA, two key fatty acids. EPA and DHA are found primarily in fatty fish, such as tuna and salmon. Fish oil supplements, which contain omega-3 fatty acids, seem to help with rheumatoid arthritis. Studies have found that they can reduce RA symptoms like morning stiffness. Because EPA and DHA seem to protect the heart, they may also help lower the risk of heart problems associated with RA.

RA: Other Vitamins and Minerals

Researchers have looked at how other nutritional deficiencies — in vitamins, minerals, and antioxidants like vitamin C, vitamin E, magnesium, zinc, and selenium — may affect RA symptoms. So far, there’s no clear evidence that getting more of any of these nutrients helps RA.

Getting More Nutrients: Foods or Supplements?

Generally, it’s better to get your nutrients from foods than from supplements. That’s because food also provides different vitamins, minerals, and healthy phytochemicals. However, because people with RA are at special risk for nutritional deficiencies and may have trouble absorbing nutrients from foods, many rheumatologists prescribe supplements. Ask your doctor whether supplements may help you. Although it’s especially important to pay attention to your diet and nutrition with RA, remember that eating a healthier diet and taking supplements are no substitute for good medical management of RA. Dietary changes — or dietary supplements — are not an effective treatment for rheumatoid arthritis on their own.

Always work with your doctor to make sure you are getting all the nutrients your body needs.