Introduce variety into your diet. This provides a balance of nutrients and introduces new foods and tastes into your life.
Maintain a healthy weight. Being overweight adds stress to the joints and should be avoided. If you have a weight problem, avoid excessive sugar and alcohol intake, both of which add pounds through empty calories – calories that have no nutritional benefit. Sugar and alcohol in moderation are acceptable. Alcohol should not be taken with some medications, so check with your physician or pharmacist.
Choose a diet low in saturated fat and cholesterol. Both are sources of unhealthy calories. Bake or broil as an alternative to frying foods. Use nonstick pans or low-cholesterol sprays in place of oils. Select low-fat milk and other dairy products. Consider sherbets or ice milk over premium ice creams (premium in this case means high fat content). Avoid heavy gravies and sauces.
Choose a diet with plenty of vegetables, fruits, and grain products. This increased bulk will improve bowel function and may decrease your cholesterol level. Fiber-containing foods include fresh fruits and vegetables and whole grain breads and cereals. Consider taking carrot and celery sticks to work or keeping them handy at home for between-meal snacks.
Use salt and sodium in moderation. Salt and sodium can cause fluid retention and elevated blood pressure, so this is a good rule for everyone to follow. Because some RA medications (non-steroidal anti-inflammatory drugs and corticosteroids) also can cause fluid retention and elevated blood pressure, it is an especially important rule if you are taking one of these kinds of medications. Most people think that it is sufficient simply to limit the salt added to food. In fact, most of our salt intake comes from processed, canned, or convenience foods. Check the labels for sodium content.
Drink enough fluids. Drink at least six, and preferably eight or more, 8-ounce glasses of water per day. Drinking adequate fluids will improve bowel function and help remove promptly from your system by-products of medications. If weight control is a concern, drinking plenty of fluids is a good idea since this may help to suppress your appetite.
Exercise. Burning off calories by exercising will leave you feeling better and will allow you to eat more of the foods that you enjoy. Exercise also improves your well-being and keeps your joints mobile.
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A person’s diet must be both well balanced and nutritious to maintain energy stores and keep muscles functioning well enough to protect the joints. Ideally, the number of calories you consume each day is adequate to maintain your healthy weight—neither too many to add unwanted pounds nor too few to make you lose weight when you don’t want to. A nutritionally balanced diet is one that consists of a variety of foods from each of the four basic food groups: meat, fish, and poultry; dairy; fruits and vegetables; and breads and cereals. When planning your diet, remember that balance is the key. Favorite but “forbidden” foods may be eaten very occasionally and in moderation – if your doctor agrees.
Meat, fish, and poultry. Two servings daily from this group will provide adequate protein, iron, В vitamins, and trace minerals. One serving weighs 2 to 3 ounces. (More than 7 ounces of meat per day adds unnecessary calories with no nutritional benefit.)
Select low-fat products as often as possible. Examples include white fish (best), tuna (water packed), swordfish, poultry, and chicken (without skin). Products from this group that are considered medium fat are lean ham, lamb, lean red meat, lean ground beef, lamb, and smoked fish. High-fat products include most red meat, pork, luncheon meats, sausage, and pate.
Buy lean meat and trim any visible fat, and limit egg yolks to no more than three per week, including the eggs in baked goods.
Dairy. A daily minimum of two or three servings from this group is recommended to provide adequate calcium intake for most healthy adults. One serving consists of 1 cup of milk or yogurt or 1 ounce of cheese. People with RA, particularly women with RA, are at increased risk for osteoporosis, and therefore it is a good idea for them to consume four servings of dairy products each day if possible. If you have lactose intolerance or prefer not to eat so many servings of dairy products, ask your physician to recommend calcium supplements.
Focus on low-fat and nonfat dairy products to decrease your cholesterol intake. (Milk, cottage cheese, ice milk, yogurt, and cheese made from skim milk are available in low-fat varieties.)
Fruits and vegetables. This group of foods is high in fiber, carbohydrates, and vitamins A and C. Five or more daily servings are recommended. Select a variety to ensure adequate vitamin intake. Citrus fruits, berries, tomatoes, and green peppers are good sources of vitamin C. Yellow and dark-green leafy vegetables are high in vitamin A.
If weight maintenance is a concern, choose foods from this group to snack on. Vegetables and fruits with a high water content (less starch per ounce) and low amounts of sugar (lettuce, celery, tomato, lemon, and melon, for example) have fewer calories than those with less water and more sweetness (bananas, avocado, corn, and winter squash). In general, vegetables have fewer calories than fruits.
Fresh or frozen fruits and vegetables are preferable to canned. If canned fruits are desired, select those canned in juice, not syrup. Canned vegetables often have a high salt content and should generally be avoided.
Breads, cereals, pasta, rice. Six or more servings are recommended daily as a good source of dietary fiber, В vitamins, iron, and minerals.
Healthy baked goods include whole-grain or enriched breads, pasta, rice, and whole-grain cereals (watch for sugar content), dinner rolls, English muffins, and pancakes (top with fresh fruit). Avoid baked goods that are high in fat or sugars (doughnuts, pie crust, pastries, many crackers, and cookies).
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One need only scan the bookstore shelves to find books on the subject of dietary “cures” for arthritis. Although most of the claims made in these publications lack a scientific basis, the true relationship between nutrition and rheumatoid arthritis (RA) may soon be understood. Researchers recently have become increasingly interested in this subject.
Dr. Richard Panush at St. Barnabas Medical Center in Livingston, New Jersey, has led this research. He asks two questions about the relationship between nutrition and RA: First, can RA and other types of “chronic arthritis” be a result of food allergy in some people? And, second, can changes in the diet alter the body’s abnormal immune response and thereby lessen symptoms of RA?
Like many other people, you may be wondering whether an allergy to a specific food is causing your RA. Several cases have been described in the medical literature in which an individual’s arthritis improved after specific foods were eliminated from the person’s diet. Milk products (foods containing lactose), corn, cereals, shrimp, and foods containing nitrates have all been implicated. Formal research protocols studying large numbers of patients, however, have found that food allergy or food intolerance is not common in people with RA. Dr. Panush, for example, estimates that fewer than 5 percent of people with RA have a food allergy or intolerance that contributes to their arthritis. In addition, this situation rarely occurs in people whose blood tests reveal the presence of rheumatoid factor.
After reading this, you may be tempted to experiment by eliminating certain foods from your diet. If you recognize a link between a specific food and your symptoms, it is reasonable for you to stop eating that food, as long as the remainder of your diet meets good nutritional guidelines. Discuss all major diet changes with your physician or dietitian.
In recent years, very low calorie weight reduction diets have become more popular, in part through advertisements pitched by television and movie celebrities. Medical studies have shown that RA symptoms improve in some people who go on such a diet, although the improvement is usually temporary, and the reason for the improvement is poorly understood. Prolonged use of such a diet without medical supervision is not advised and may be dangerous because very low-calorie diets can cause the body to lose protein and decrease muscle size. Maintaining adequate energy and muscle function is extremely important in the long-term treatment of arthritis. These goals are reached only through a diet that contains the proper amount and combination of nutrients.
Researchers are hoping to extend the temporary improvement of very low-caloric diets to diets that limit the intake of saturated fat. (The fat in animal products is the main source of saturated fat in most diets. Some vegetable oils such as coconut and palm oil are also high in saturated fats.) Limiting saturated fats has no adverse effects and many benefits for health.
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Side Effects of Oral Corticosteroids
The side effects of oral corticosteroids tend to be of two types: those that are immediate and those that occur as a consequence of long-term use. The frequency of these side effects varies in accordance with dose, length of treatment, and the individual. In general, small daily doses (5 mg of prednisone, for example) cause few side effects, whereas larger doses (more than 20 mg of prednisone daily) are commonly associated with side effects if continued for more than a month. Corticosteroids injected into the joints rarely cause any of the side effects. Nausea, bloating, and changes in mood are the most common immediate side effects of oral corticosteroid therapy. Long-term use can affect the muscles, bones, eyes and hormones as well as making the person susceptible to infection. Many of the side effects resulting from long-term use will subside after corticosteroid treatment is discontinued. If a person develops a serious infection, the infection needs to be treated and the person gradually taken off the corticosteroids if possible.

Cautionary Notes
Before starting oral corticosteroid therapy discuss the following with your physician:
•  A history of diabetes, glaucoma, high blood pressure, heart disease, osteoporosis, thyroid problems, stomach ulcer, or tuberculosis or positive tuberculin skin test.
While taking this medication:
•  Contact your physician if you notice fever or chills; cough; sore throat; blurred vision; increased frequency, duration, or severity of headaches; eye pain; increased thirst; frequent urination; increased weakness.
• Take with meals, preferably breakfast.
• Avoid alcohol and tobacco products.
• Never stop corticosteroids abruptly. This can be hazardous if you have been on corticosteroids for an extended period. If you run out of medication, call your doctor immediately. Corticosteroid use must be supervised by a doctor, and discontinuation of it must also be supervised by a doctor.
• If you have a surgical or another medical procedure planned, inform your doctor that you are on corticosteroids. Your doctor may want to increase your dose temporarily. This is called stress dosing.
• If you have been on corticosteroids for more than one month, wear a medical identification tag that states that you have RA and lists the medications you are taking. This will provide valuable medical information if you are ever in an accident or become so ill that you are unable to speak for yourself.
• If you have severe nausea, vomiting, or diarrhea, you may not be absorbing your medication and should alert your physician immediately.
Pregnancy and breastfeeding. Corticosteroid use is considered relatively safe during pregnancy.
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