The Dietitian’s Role in Managing Rheumatology Patients

Registered dietitians can help patients make the changes needed for good health.

“Do I need to be on a special diet?” Those who care for rheumatology patients field this question every day. Many rheumatology patients think that what they eat will affect the course of their disease and their symptoms. In search of a diet prescription, rheumatology patients obtain nutritional information from a variety of sources. Some hear anecdotes from family members or friends regarding what they should or shouldn’t eat to treat their condition. There is also an abundance of information (and misinformation) circulating in the media related to the impact of nutrition on rheumatoid arthritis (RA) and lupus.

Although resources on diet and disease management are widely available to patients with rheumatic diseases, not all the sources of this information can be trusted. Furthermore, it can be daunting for patients to read about nutritional “arthritic cures” or “antiinflammatory diets” when they must deal with pain and fatigue symptom in addition to managing their medication regimens. How can patients filter which information is credible and which dietary advice is false? What support can be given to patients who may want to seek out nutritional guidance from experts? Registered dietitians can be valuable team members, and help properly educate patients with rheumatic conditions on the role of nutrition and their health.

As a registered dietitian, I have often been asked by patients with RA whether a diet that eliminates all dairy, nightshade vegetables and/or gluten will help reduce their symptoms and manage their disease. Questions about the use of herbal supplements and vitamins are also common. Although following these diets and using select supplements are popular nutritional practices among rheumatology patients, their use may be inappropriate.

According to one study, 60% of patients with RA have used dietary supplements or health foods as a means for treatment.¹ Of those patients, 57% received information about the supplements and diet foods from friends and relatives, and 34% obtained information from mass media.

A striking statistic to keep in mind is that 73% of these patients did not disclose the use of supplements or dietary practices to their medical providers. Dietary counseling by a registered dietitian is an important treatment modality to help provide clarity and evidenced-based facts on the effectiveness of nutritional claims related to rheumatic diseases.

When dietitians consult with patients who inquire about dietary claims and supplements, they often review the evidence and safety concerns related to the claims. In addition, they evaluate patients’ eating styles to ensure that individual nutritional requirements are met in order to prevent nutrient deficiencies. Nutrition consultations for rheumatology patients also include education on balanced diets and addressing health risks associated with rheumatic diseases.

Although there is no evidence to support most of the dietary claims out there, such as avoiding nightshade vegetables or following elimination diets, there is some support to promote the Mediterranean diet, consuming omega-3 fatty acids, and vegetarian diets.²

Rheumatic diseases are risk factors for cardiovascular disease and osteoporosis.^3,4 Obesity, hypertension, and kidney disease are also concerns for rheumatology patients.⁵ Patients who present with these additional health risks should be guided on heart-healthy diets and weight-management guidelines, and counseled on adequate calcium and vitamin D intake.

Registered dietitians can educate patients on these guidelines, and can help patients make the necessary lifestyle and behavior changes needed for increased adherence to nutritional guidelines and overall good health.

Sotiria Everett is a clinical nutritionist at the Hospital for Special Surgery in New York City. She studied Nutrition and Applied Physiology at Teachers College at Columbia University.

References

1. Ikuyama S, Imamura-Takase E, Tokunaga S, Oribe M, Nishimura J. Sixty percent of patients with rheumatoid arthritis in Japan have used dietary supplements or health foods. Mod Rheumatol. 2009;19:253-259.
2. Stamp LK, James MJ, Cleland LG. Diet and rheumatoid arthritis: A review of the literature. Semin Arthritis Rheum. 2005;35:77-94.
3. Sinicato NA, da Silva Cardoso PA, Appenzeller S. Risk factors in cardiovascular disease in systemic lupus erythematosus. Curr Cardiol Rev. 2013;9:15-19.
4. Vis M, Güler-Yüksel M, Lems WF. Can bone loss in rheumatoid arthritis be prevented? Osteoporos Int. 2013;24:2541-2553.
5. Hollan I, Meroni PL, Ahearn JM, et al. Cardiovascular disease in autoimmune rheumatic diseases. Autoimmun Rev. 2013;12:1004-1015.