Rheumatoid Arthritis and Weight Loss
There are two distinct issues when we speak of weight loss and
rheumatoid arthritis (RA). The first is the issue of weight loss as
a part of the disease and the second is the need for weight loss
when an RA patient is overweight.
Weight loss can be serious issue associated with malnutrition in patients with RA. There are several reasons for the weight loss, some associated with the autoimmune process and others related to treatment. Depression is also common for those diagnosed with a serious chronic illness like RA and this can lead to under eating as well as to over eating. Treating the depression may be as important as treating the arthritis.
Many patients with RA have digestive system problems such as chronic gastritis. This makes eating unpleasant and intake is likely to be decreased. The unwanted weight loss associated with RA also usually means feeling weak and tired which adds to the negative symptoms being noticed. Treating the RA effectively may decrease the gastritis and allow for eating a better and more complete diet.
Medications commonly used to treat RA can also affect the appetite. NSAIDs like ibuprofen, aspirin and prescription drugs can irritate the stomach and cause indigestion and loss of appetite. The Cox-2 inhibitors such as Celebrex are believed to cause less stomach upset and may result in better intake while still treating the inflammation of the disease.
Drugs such as methotrexate which is commonly used as a disease modifying treatment can cause nausea and vomiting as well as loss of appetite and thus decrease food and nutrient intake. One way of minimizing the eating issues with methotrexate is to give it by injection rather than by mouth.
Weight loss alone is not the only problem when RA or its treatment causes poor food intake. Vital nutrients are also consumed in too small quantities and deficiencies can develop. Methotrexate interferes with the use of folates, and many patients on this therapy will need supplements of folic acid. Other nutrients often found to be insufficient in RA patients are selenium, calcium, vitamin D, vitamin C, vitamin E, vitamins B12 and B6, magnesium and zinc. A multivitamin with 100% of the RDA for these and other vitamins may be indicated for all RA patients but some will require higher doses of specific nutrients.
But not every RA patient has the problem of losing too much weight. Obese people also get RA and the excess weight adds unwanted stress to joints affected by the disease. Obesity also means other conditions that can complicate RA treatment such as diabetes, sleep apnea, and hypertension. The aim should be a normal weight for all RA patients to maximize overall health.
Both those who have lost too much weight and those who need to lose
weight can benefit from the same healthy diet following USDA
guidelines. This means a variety of foods from the basic groups and
using portion control while limiting empty calorie foods like fatty
and sugary “junk” foods. All RA patients can benefit from
nutritional counseling and should have a consultation with a
registered dietician or nutritionist .
Resources
Johns Hopkins article about the role of nutrition in RA:
www.hopkins-arthritis.org/
Weight loss as part of the RA disease process: www.arthritis.ca/
Excess weight loss as a symptom of RA: www.mamashealth.com/
Impact of being overweight on RA: www.cnn.com/