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Nutrition Intervention: Rheumatoid Arthritis

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Title: Nutrition Intervention: Rheumatoid Arthritis


1
Nutrition Intervention Rheumatoid Arthritis
Katelyn Dold
_____________________________
_____________________________
2
Objectives
  • Understand the development of Rheumatoid
    Arthritis
  • Be able to identify different diagnosis for
    Rheumatoid Arthritis
  • Introduction to common RA medications
  • Describe the nutritional intervention on patients
    with Rheumatoid Arthritis
  • Understand current research in Rheumatoid
    Arthritis
  • Be able to identify ethical issues in treatment

3
Types of Arthritis
  • More than 100 different types
  • Carpal Tunnel
  • Lymes Disease
  • Two major types
  • Osteoarthritis
  • Rheumatoid Arthritis

Arthritis Foundation (2011)
4
How does RA differ from other types of Arthritis?
  • Rheumatoid Arthritis affects the joints on both
    sides of the body. RA causes joint pain,
    stiffness, and fatigue.
  • Osteoarthritis is caused by a loss of cartilage
    in a joint. Osteoarthritis is often caused by
    wear and tear damage on a joint.

Nelms, et al. (2010)
5
What is Rheumatoid Arthritis?
  • An autoimmune disease
  • Leads to inflammation of the joints and
    surrounding tissues
  • http//www.webmd.com/rheumatoid-arthritis/ra-tv?ca
    tId10vidId091e9c5e802e881e
  • An autoimmune disease
  • Leads to inflammation of the joints and
    surrounding tissues
  • An autoimmune disease
  • Leads to inflammation of the joints and
    surrounding tissue
  • An autoimmune disease
  • Leads to inflammation of the joints and
    surrounding tissues
  • An autoimmune disease
  • Leads to inflammation of the joints and
    surrounding tissues

Nelms, et al. (2010)
Nelms, et al. (2010)
6
Where it Can Occur Demographically?
  • Estimated 1.3 million people in the United States
  • 1 of the adult population diagnosed
  • More common in women than men
  • Common in adults 30-60 years old

Arthritis Foundation (2011)
7
Where it Can Occur Physically?
  • Can occur in any joint of the body
  • Very common in hand and knee joints
  • Often occurs on both sides of the body equally
  • Nelms, et al. (2010)

8
What Causes Rheumatoid Arthritis?
  • Main cause unknown
  • The bodys immune system mistakenly confuses the
    surrounding healthy tissue as foreign and attacks
    on the healthy joints
  • May be linked to sex, age, family, smoking

Nelms, et al. (2010)
9
How Rheumatoid Arthritis differs from a normal
joint?
  • Inflammation characterized by swelling,
    stiffness, warmth, and severe pain in the joint
  • As the stages progress, the pannus can fill the
    synovial cavity and invade the joint

Escott-Stump, S. (2008)
10
What are Risk Factors?
  • Most common in women than men
  • 31
  • Between the ages of 30 and 60
  • Can occur in older teensJuvenile Arthritis
  • Family History
  • Increased risk
  • Smoking
  • Increased risk

Saevarsdottir (2011)
11
Signs Symptoms
  • Joint Pain
  • Joint Swelling
  • Rheumatoid Nodules
  • Fatigue
  • Morning Stiffness
  • Fever
  • Weight loss
  • Flare-Ups

Nelms, et al. (2010)
12
How Rheumatoid Arthritis is Diagnosed?
  • Symptoms must be present for at least six weeks
  • Clinical indicators must be preformed and tested
    positive through blood tests
  • Symptoms come and go sporadically making it
    difficult to diagnose Rheumatoid Arthritis

Escott-Stump, S. (2008)
13
2010 RA Classication Criteria
  • Score-based test for RA based on 4 areas
  • Joint involvement
  • Serology test results
  • Acute phase reactant test results
  • Patient self-reporting of signs and symptoms
  • A score of 6 of 10 or greater must be met for a
    classification of definitive RA.

Wheeless. (2011)
14
Joint Involvement
  • Joint involvement consists of swelling or
    tenderness upon examination. Points are counted
    as follows
  • 1 large joint (shoulders, elbows, hips, knees,
    ankles) 0 points
  • 2-10 large joints 1 point
  • 1-3 small joints 2 points
  • 4-10 small joints 3 points
  • More than 10 joints 5 points

Wheeless. (2011)
15
Serology Test
  • At least 1 serology test result is needed for
    classification.
  • Negative RF and negative ACPA 0 points
  • Low-positive RF or low-positive ACPA 2 points
  • High-positive RF or high-positive ACPA 3 points

Wheeless. (2011)
16
Acute Phase Reactant Test
  • At least 1 test acute-phase reactant test result
    is needed for classification.
  • Normal CRP and normal ESR 0 points
  • Abnormal CRP or abnormal ESR 1 point

Wheeless. (2011)
17
Patient Self Reporting
  • Patient-reported duration of synovitis
    signs/symptoms of joints
  • Shorter than 6 weeks 0 points
  • 6 weeks or longer 1 point

Wheeless. (2011)
18
Stage I Rheumatoid Arthritis
  • Synovial membrane hyperemic and edematous
  • Joint effusions with high cell count
  • No destructive changes in X-Rays
  • May show swelling or osteoporosis
  • Wheeless. (2011)

19
Stage II Rheumatoid Arthritis
  • Inflamed synovial tissue proliferates and begins
    to grow into joint cavity
  • Gradually destroys cartilage
  • Narrowing of joints due to loss of cartilage

Wheeless. (2011)
20
Stage III Rheumatoid Arthritis
  • Pannus of Synovium
  • Eroded cartilage and
  • exposed sub-chondral
  • bone
  • X-Rays show extensive
  • cartilage loss
  • Erosions around margins of the joint
  • Deformities may become apparent
  • Wheeless. (2011)

21
Stage IV Rheumatoid Arthritis
  • End-Stage Disease
  • Inflammatory process subsides
  • Subcutaneous nodules associated with severe
    disease

Wheeless. (2011)
22
Clinical Indications
  • Clinical/History Data
  • Height
  • Weight
  • BMI
  • Temperature
  • Food Allergies

Escott-Stump, S. (2008)
23
Clinical Indications
  • Lab Work
  • RBC
  • WBC
  • C-Reactive Protein
  • LE Prep
  • Crest (may be decreased)
  • ESR (increase w/ inflammation)
  • ANA
  • Rheumatoid Factor
  • Immunoglobulins (Cause of Sjogrens Syndrome)
  • Ceruloplasmin (may be increased)
  • Hematocrit and Hemoglobin
  • Serum Ferritin
  • Serum B12
  • Transferrin
  • Serum Folate, RBC Folate
  • Serum Copper
  • Albumin, Transthyretin
  • Glucose
  • BUN
  • Ca, Mg, Na, K

Escott-Stump, S. (2008)
24
Complications with RA
  • Effects on Skin
  • Rheumatoid Nodules
  • Inflammation of blood vessels can cause skin and
    surrounding tissue to appear as ulcer
  • Skin rashes
  • Eye Complications
  • Inflammation of whites in the eyes
  • Scleritis-more serious
  • Sjogrens Disease
  • Heart and Blood Vessel Disease
  • Collection of fluid between pericardium and the
    heart
  • Pericarditis
  • Lesions on the heart similar to Rheumatic nodules
  • Increased risk of heart attack and stroke
  • Vasculitis

WebMD. (2011)
25
Complications with RA
  • Diseases of the Blood and Blood Forming Cells
  • Anemia
  • High levels of blood platelets
  • Feltys Syndrome
  • Lung Problems
  • Pleuritis
  • Rheumatic nodule formation in the lungs
  • Interstitial lung disease
  • Pulmonary hypertension
  • Susceptibility to Infection
  • Treatment with biological agents may greatly
    increase the risk of serious infections in people
    with RA
  • Emotional Effects
  • Depression
  • One study showed that almost 11 of all people
    living with RA have moderate to severe depression

WebMD. (2011)
26
Treatment
  • No known cure as treatment
  • Medications
  • NSAIDS
  • DMARDS
  • Biologics
  • Steroids
  • Therapy
  • Physical Therapy
  • Occupational Therapy
  • Surgery

Nelms, et al. (2010)
27
Treatment Goals
  • RA gets worse as it progresses so it is important
    to
  • Reduce inflammation
  • Reduce joint pain
  • Protect from cartilage erosion
  • Maintaining proper function of joints
  • Prevention against growth of rheumatic nodules

Nelms, et al. (2010)
28
Medications
  • NSAIDS
  • Manage chronic pain, inflammation, and swelling
  • Aspirin
  • Ibuprofen
  • Acetaminophen
  • DMARDS
  • Slow the progression of joint damage
  • Rheumatrex
  • Arava
  • Neoral

Escott-Stump, S. (2008) WebMD. (2011)
29
Medications
  • Biologics
  • Genetically engineered proteins from human genes
  • Enbrel
  • Actemra
  • Humira
  • Corticosteroids
  • Decrease inflammation and reduce the activity of
    the immune system
  • Cortisone
  • Prednisone
  • Triamcinolone

Escott-Stump, S. (2008) WebMD. (2011)
30
Therapy
  • Physical Therapy
  • Focus on maintaining proper functions of the
    joints
  • Stimulating muscles, bones, and joints through
    exercise
  • Joint function, muscle strength, fitness level
  • Occupational Therapy
  • Help you maintain daily functions
  • Assess patients ability to perform daily
    activities

Ruderman. 2008
31
Surgery
  • When there is structural damage, medicines cannot
    fix that
  • Pain relief is the greatest benefit to orthopedic
    surgery
  • Improving fuctions
  • Repairing or replacing of weakened joints may
    help regain strength and activity level

WebMD. (2011)
32
Rheumatoid Arthritis Medical Nutrition Therapy
  • Reduce effects of pain
  • Reduce effects of swelling
  • Appropriate diet for Juvenile Arthritis to avoid
    progression into Rheumatoid Arthritis
  • Maintain nutritional status
  • Avoidance of acid producing foods, saturated
    fats, alcohol, caffeine, sugar and processed
    foods.

Escott-Stump, S. (2008)
33
RA Diets
  • Vegetarian or Vegan
  • Mediterranean and Cretan Style Diet
  • Elimination Diet

Smedslund, et al. (2010)
34
Vegetarian and Vegan Diet
  • High in antioxidants causing a reduction in pain
    and stiffness
  • Assist in decreasing risk of heart attack,
    stroke, and clogged arteries
  • Smedslund, et al. (2010)

35
Mediterranean and Cretan Style Diet
  • High in fruits, vegetables, cereals, and legumes
  • Low in red meat
  • High in fish oil
  • Beneficial protective effect due to high levels
    of unsaturated fat and antioxidants
  • Smedslund, et al. (2010)

36
Elimination Diet
  • Based on belief that a food antigen plays a role
    in the pathogenesis of a disease and that its
    elimination from the diet should result in
    symptom improvement
  • Removal of potential dangerous foods
  • Smedslund, et al. (2010)

37
Omega-3 Fatty Acid
  • Helps reduce inflammation
  • Helps reduce morning stiffness
  • Assist in avoidance of NSAIDS
  • Omega-3 Fatty Acids found in fish oil help reduce
    joint tenderness
  • Help increase mobility
  • Fish oil does not slow progression, just treats
    symptoms

Escott-Stump, S. (2008) Nelms, et al. (2010)
38
Omega-6 Fatty Acid
  • Reduces pain
  • Reduces swelling
  • Reduces morning stiffness
  • May take 1-3 months for benefits to appear

Erlich. (2011)
39
Antioxidants
  • Antioxidants defend against oxidation which
    damage membranes and cause the swelling
  • Reduce pain in joints

Vugt. (2008)
40
Vitamin B5
  • 2 g/day of Panthothenic Acid
  • Reduces morning stiffness
  • Reduces pain and severity
  • Reduces degree of disability

Erlich. (2011)
41
Vitamin B6
  • Chronic inflammation may lower Vitamin B6 levels
  • Improves immune responses
  • Huang clinical study

Erlich. (2011)
42
Vitamin C
  • Powerful antioxidant
  • Serves a role as a cofactor in collagen synthesis
  • The main protein in joint tissue and bone.
  • Plays a role in fighting infection and may work
    to control inflammation which is linked to
    infection.
  • Some believe infection can trigger flares of
    rheumatoid arthritis

Arthritis Foundation (2011)
43
Vitamin D
  • Low Vitamin D intake has been associated with
    alterations of genes including proliferation
  • Decreases extreme RA conditions
  • Decrease severity of osteoporosis
  • Strengthening bone

Saevarsdottir (2011)
44
Vitamin E
  • Strong antioxidant
  • Assist in avoidance of NSAIDS
  • The Womens Health Study

Karlson (2010)
45
Selenium
  • Deficiency leads to decreased response in immune
    system
  • Antioxidant properties that help protect cells
    against free radicals
  • Low levels of the mineral may increase the risk
    of developing Rheumatoid Arthritis

Canter et al. (2007) Saccone. (2011)
46
Iron
  • Anemia is a common problem in patients with
    Rheumatoid Arthritis
  • Decreased bone marrow response to EPO
  • Reduced EPO levels
  • Incurrent infection
  • Premature destruction of RBC

Al-Qenaei (2008)
47
Copper
  • Copper combines with salicylate, a compound found
    in aspirin, and improves the drug's
    pain-relieving ability
  • Copper is also essential for the body's
    manufacture of connective tissue, the ligaments,
    tendons and such that wrap around a joint like
    rubber bands and keep it stable.

Ehrlich (2011)
48
Current Research
  • Many current studies
  • Smedslund, et al described a study on
    Effectiveness and Safety for Rheumatoid
    Arthritis
  • RA patients as defined by the ARA critera
  • Primary outcomes considered were pain, joint
    stiffness, fatigue, functional status and adverse
    affects such as unwanted weight loss or GI
    Problems

Smedslund, et al. (2010)
49
Current Research
  • The study consisted of 77 patients comparing 4
    weeks on an elemental eating plan with an
    ordinary diet
  • Pain Scale
  • Physical Function
  • Morning Stiffness

Smedslund, et al. (2010)
50
Ethical Issues
  • MNT not proven to work
  • Home prescription
  • Supplements
  • Medications
  • RA diets VS. RA placebo
  • Causing erosion

51
Conclusion
  • No known cure for Rheumatoid Arthritis
  • Reduce risk factors that may link to RA
  • Nutritional intervention can help slow
    progression and reduce symptoms
  • Include many vital antioxidants, essential fatty
    acids, vitamins and minerals in diet

52
Questions?
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