Living with rheumatoid arthritis may mean making changes to your lifestyle. Your RA pain and symptoms will be treated with medication but there are many steps you can take to improve self-management. These include remaining active, maintaining a healthy weight, eating healthily and looking after your joints through carefully balancing exercise with rest.

Eating healthily

The best dietary advice for people with rheumatoid arthritis is to eat a healthy, well-balanced diet, low in saturated fats, cholesterol, sugars and salt but high in fibre and complex carbohydrates such as green vegetables, beans, wholegrain foods and pulses. Other healthy eating tips are also important such as drinking plenty of water and eating a recommended five fruit and/or vegetables a day. Vital to repairing your bones and muscles, is protein. It is important to get enough proteins in your diet, which helps maintain muscle strength. Protein can be found in beans, poultry, fish, and lean red meats.

Many people believe that what they eat affects their rheumatoid arthritis. However, there is no particular diet you can follow that will instantly relieve your symptoms. There are some foods that do produce chemicals in the body, which aggravate arthritis in some people. Other people may be allergic to certain foods. It is worth keeping a food diary to record what you eat and the symptoms for that day. Flare-ups may be linked to food allergies, so find out which foods you should actively be avoiding.

People with rheumatoid arthritis may have an increased risk of cardiovascular disease. Therefore it is even more important for those with rheumatoid arthritis to eat healthily to reduce that risk. The same guidelines apply to everyone at risk of heart disease.

If you have rheumatoid arthritis, you are also at a higher risk of developing osteoporosis (a disease that causes the bones to fracture more easily). This increased risk is due to the side effects of certain medications (e.g. corticosteroids) and another factor may be that people with RA may be less active so doing less weight-bearing exercise.

To help prevent osteoporosis it is important that you get enough calcium and vitamin D, which can be found in oily fish, yoghurt and skimmed milk.

Anaemia or lack of iron, causes fatigue in people and is very common in people with rheumatoid arthritis. The best source of iron is red meat. However, it is important to get iron from a variety of sources. Green leafy vegetables such as spinach, pulses and fish are also excellent sources of iron.

Certain dietary supplements may be beneficial. Cod liver oil or fish oil (omega-3 fatty acids) may help to reduce inflammation and swelling in arthritic joints.

Unfortunately, the stiffness and soreness caused by RA can make it difficult for people to prepare and cook healthy food. There are many ways to make meal preparation easier such as using a food processor to chop vegetables or purchasing lightweight pans with easy-grip handles.

For more information on healthy eating or to make an appointment with a nutritionist, visit the Irish Nutrition and Dietetic Institute (INDI) website (www.indi.ie). Further information on a healthy diet can be found on the Arthritis Ireland website (www.arthritisireland.ie ).

Resting your joints

Rheumatoid arthritis itself causes fatigue, and the strain of dealing with pain and limited activities also can make you tired. You should take short breaks in between tasks during your daily routine.

The amount of rest depends on how severe your symptoms are. With severe symptoms, you may need to rest for a few minutes several times a day to relax. It is important not too push yourself to the point of exhaustion. Make sure you plan your day with plenty of breaks in between activities. Try and prioritise the most important tasks for the day.

On the other hand, be careful not to rest too much. Prolonged periods of joint inactivity can lead to more stiffness and can cause weakening of underused muscles.

If you are not getting enough sleep try to cut down on tea, coffee and other caffeinated drinks, as well as the amount of alcohol you drink. Simple stretching exercises before bed may also help improve your sleep. Gentle exercise or complementary therapies such as meditation and yoga or deep/rhythmic breathing techniques, can also be effective in helping you sleep.

Protecting your joints

It is important to protect your joints. Changing the way you carry out certain activities can help do this – normal movements can sometimes put pressure on the joints. An occupational therapist can advise you on joint protection techniques. There are a number of ways you can protect your joints:

• Each day try to move each joint through its full pain-free range of motion. A physiotherapist will advise you how to carry out this exercise.
• Be careful how you use your hands. Avoid any positions that push your fingers towards your little finger i.e. prolonged gripping. Try to avoid gripping your fist too tightly.
• If you are working on a computer for long periods of time, use wrist or elbow supports.
• When standing make sure that your work surface is at an appropriate height to avoid stooping.
• Use your strongest joints for holding objects – your palms and forearms instead of your fingers.
• Avoid keeping your joints in the same position for long periods of time.
• Use devices such as kitchen whisks, whenever possible to avoid using your hands.

Taking regular exercise

Taking regular exercise is important to improving muscle flexibility and strength. However, the amount of exercise you do is dependent on how active your disease is. Ideally, a physiotherapist should advise you on the types of exercises that will help your condition.

Exercise often takes three forms – stretching, strengthening, and conditioning. Stretching exercises are simple to do and involve holding and maintaining a joint and muscle for 10-30 seconds. Strength exercises involve strengthening the muscles, which support your joints.

Conditioning exercises, also known as aerobic exercise, raise your heart rate and allows your muscles to work more efficiently. They can also help to reduce pain and improve wellbeing. People with rheumatoid arthritis can enjoy many different types of aerobic exercise; walking, cycling, yoga and pilates.

Swimming is especially good for people with joint problems in the knees, ankles, or feet.

You should however try and avoid any high-impact activities that put a lot of strain on your joints such as jogging or heavy weight lifting.

Weight reduction

Being overweight places an extra burden on weight-bearing joints such as your knees and hips. Rather than trying fad diets or quick-fix slimming methods, it is better to lose weight in a healthy controlled manner by adopting a long-term healthy balanced diet.

To function normally, your body needs a variety of vitamins and minerals. Your rheumatoid arthritis may limit the amount of exercise you can do, so it is important that you adapt your diet according to your energy needs. If you are less active, you will probably need to consume fewer calories. However, it is important that you do not lose out on vitamins and minerals. Making simple changes to your diet can help you. For example, by eating wholemeal bread instead of white bread you get more fibre and other minerals (eg. thiamin and zinc) in your diet. Reducing the amount of fat and sugar in your diet is essential to reducing your weight. For example, instead of frying foods, try grilling, or add an artificial sweetener to your coffee instead of sugar.

The Arthritis Ireland website (www.arthritisireland.ie ) has an important information booklet on diet and arthritis, and also contains valuable advice on reducing your weight.

Further support

Arthritis Ireland organises self-management programmes on a regular basis for individuals with all types of arthritis. Details of these events can be found on the Arthritis Ireland website (www.arthritisireland.ie ). For further support with rheumatoid arthritis, Arthritis Ireland currently has 13 branches nationwide across Ireland.