A5. An assessment of the diets of people with rheumatoid arthritis

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Background A proportion of people with rheumatoid arthritis (RA) use diet as a form of therapy for their condition. There is no firm evidence to confirm the mechanisms by which nutrition affects the disease process or symptoms but the research in this area has suggested a number of theories. It is proposed by some that the nutritional status of RA subjects is compromised due to their symptoms or the drug treatments they use. Alternatively, nutrition is proposed to influence the inflammatory process that is central to this condition. Finally, the ’Food Allergy Theory’ suggests that the symptoms of RA may be the result of food allergy/intolerance in some people. This study aimed to investigate the specific actions RA subjects take with regard to diet and the nutrient composition of these specialized diets. The effects that these habits have on nutritional status have also been discussed. Methods An ex-post facto study was completed with subjects being recruited from an arthritis self-help group by means of a postal questionnaire. Fifty-four subjects responded to the questionnaire and 25 of these went on to complete a 3-day diet diary. These subjects were divided into two study groups: those who believed that diet had no effect on their condition or symptoms (Diet Group 1) and those who believed it did have some effect (Diet Group 2). Results Food avoidance and supplementation were the most common dietary habits reported by people with rheumatoid arthritis, with 50% of respondents reporting supplementation and 67% food avoidance. The nutrient intakes from food of the two study groups differed significantly, with Diet Group 2 generally achieving or exceeding the Reference Nutrient Intakes (RNIs) ( DoH, 1991) and the National Food Survey references (NFS) ( MAFF, 1996) more often that Diet Group 1. Additionally, Diet Group 2 had fewer nutrient intakes below the RNIs ( DoH, 1991) and the NFS references ( MAFF, 1996). Furthermore, when expressed in terms of nutrient density, Diet Group 2 had greater nutrient intakes per 1000kcals for the majority of nutrients, suggesting a more nutrient-dense diet. Conclusion Individuals who have an interest in diet and nutrition and believe it affects their condition appear to have a more nutrient-dense, well-balanced, healthier diet than those who do not have any such belief.