Weight gain can be limited by watching what you eat mainly.  We do not recommend severe calorie restricted diets, rather a sensible approach to eating:  eat regular meals, avoid skipping meals, control portion size, avoid sugary and high carbohydrate foods.  I ask my patients to include protein in every meal.  Protein promotes a feeling of fullness or satiety whereas a high carbohydrate meal will leave you feeling hungry sooner.  Include healthy snacks as well.  Ideas for healthy small meals include cucumber and low fat yogurt, grilled cheese or paneer, celery sticks or raw vegetables with yogurt dips.  Eating salds with grilled chicken or fish is ahealthy option.

Exercise ay be difficult if you are in pain but try to increase your activity level.  A walk 3-4 times a week even for 20 minutes at a time can boost your metabolism .  We have also found great success in low impact exercises such as our yoga programs which improve disease activity and promote a sense of well being.

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The call came on this year’s World Arthritis Day on 12 October, with experts saying that early diagnosis and treatment of RA has the potential to slow and even stop disease progression. The Emirates Arthritis Foundation is leading the call with the roll out of an arthritis awareness campaign over the weekend. The campaign involved bringing key arthritis experts in the Emirates together with patients and the general public to increase awareness of rheumatoid arthritis and its burden.

RA has a tendency to be misdiagnosed and overlooked due to its low prevalence, Dr. Mofti continued, but it is important for the general public and medical communities to be aware of the early warning signs.

Studies indicate that approximately one percent of the global adult population suffers from RA⁽¹⁾, and there is evidence that patients with RA have autoantibodies – a type of protein manufactured by the immune system directed to attack the body itself – and minor levels of inflammation for up to 10 years before presentation⁽²⁾.

“Clinical features of rheumatoid arthritis include stiffness, most commonly in the morning, joint swelling, tiredness, fever and unexplained weight loss, and irreversible joint damage that, without intervention, can lead to loss of function,” said Dr . Humaira Badsha, Consultant Rheumatologist at Al Biraa’ Arthritis and Bone Clinic and Founding Member of the Emirates Arthritis Foundation.

Joint damage occurs at the onset of the disease, and permanent joint destruction can occur rapidly in early stages, so it is critical for people who show early symptoms of RA to see a specialist as soon as possible to begin effective treatment, Dr. Badsha continued.

RA is a chronic disease causing pain, stiffness, swelling, and loss of function in the joints ⁽³⁾.In most cases the disease strikes during the most productive years of adulthood, between the ages of 20 and 40 ⁽⁴⁾. RA is a painful, progressive and lifelong disease that, if left untreated, can lead to loss of physical function, permanent disability and deformity.

Statistics suggest that within two to three years of onset, approximately 20 to 30 percent of RA patients find themselves unable to work due to disability, and within 10 years that number increases to at least half of arthritis sufferers ^{(4), (5)}.

“It’s not just the physical toll that we need to be concerned about, but also the huge emotional impact on sufferers of the disease. Not being able to work and contribute to a family or to society is a huge burden to bear for sufferers and is a direct result of RA, so effective diagnosis and treatment can help ease that burden too,” concluded Dr. Badsha.

The Emirates Arthritis Foundation RA awareness campaign, sponsored by Pfizer, took place on October 13 and 14 in the Mall of the Emirates.

-Ends-

References:

(1) Badsha H, Kong KO, Tak PP. Rheumatoid arthritis in the United Arab Emirates. Clin Rheumatol. 2008;27:739-742.

(2) Emery, P Treatment of rheumatoid arthritis, British Medical Journal 2006;21:152-155

(3) Lee DM, Weinblatt ME. Rheumatoid arthritis. Lancet. 2001;358:903-911

(4) World Health Organisation Chronic Diseases and Health Promotion http://www.who.int/chp/topics/rheumatic/en/ (Accessed September 2011)

(5) Sokka T. Work disability in early rheumatoid arthritis. Clin Exp Rheum. 2003;21 (Suppl.31) S71-S74

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Link to youtube video with Dr. Badsha and Katrina Thorneley from Emirates Arthritis Foundation

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Generally it is thought that arthritis is not caused by any one type of food.  Certain individuals can be sensitive to one particular type of food.  If you think that dairy products, orange juice, or one particular food consistently increases your symptoms you may try to eliminate it from your diet. Beware however, of trying to eliminate too many foods from your diet.  You may then be unable to get nutrition from a healthy, balanced diet.  Beware of fad diets which claim to cure arthritis.  Diet is extremely valuable to patients with gout but even in these people additional treatment with medications may be needed.

Diets

• Eliminate nightshades. One of the most common diet claims is that eliminating nightshades, which include potatoes, tomatoes, eggplants, and most peppers, relieves arthritis. This diet probably isn’t harmful, but there are no studies to support it.
• Alkaline diet. The alkaline diet presumes both OA and RA are caused by too much acid. Among the foods it excludes are sugar, coffee, red meat, most grains, nuts, and citrus fruits. It’s meant to be followed for just one month. It may be that people feel better because they lose weight, reducing stress on joints, which eases pain. This diet eliminates most vitamin C sources. There are no studies to support it.
• Dong diet. This restrictive diet relies heavily on vegetables, except tomatoes, and eliminates many of the same foods as the alkaline diet. There’s no evidence it affects arthritis..
• Vegetarian diet. Some people report improvement in symptoms, but evidence is mixed. One small study of people with RA showed improvement in four weeks, and follow-up studies of those who stayed on the diet showed continued improvement after one and two years. However, other studies have not shown benefits.  Eliminating red meat could help your general health but not proven to help arthritis
• Switching fats. One of the known correlations between food and arthritis is that omega-6 fatty acids increase inflammation, and omega-3 fatty acids reduce it. Limit intake of meat and poultry, and increase your intake of cold-water fish, such as sardines, mackerel, trout, and salmon. For salad dressings and cooking, substitute olive, canola, and flaxseed oils for corn, safflower, and sunflower oils.
• Gin-soaked raisins. Lots of people claim it works, but experts say there’s no evidence. Grapes and raisins do contain anti-inflammatory compounds, but not in amounts that would be therapeutic. The gin might dull pain, but drinking to excess sabotages health benefits of nutrients and vitamins, and introduces a whole new set of problems.
• Green tea. Drinking three to four cups of green tea a day could help people with RA. Studies funded by the Arthritis Foundation showed that giving the polyphenolic compounds in green tea to mice significantly decreased the incidence and severity of RA. Human studies have not yet confirmed the results.

• Fasting. Fasting produces improvement in arthritis patients but these benefits end and symptoms return when the fast ends.

Be aware that many supplements interfere with or enhance effects of medications you’re already taking. For example, a number of supplements increase the effects of blood-thinning medication.

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MedPage Today  (9/21, Walsh) reports that according to research presented at the American Society for Bone and Mineral Research conference, “women whose mean level of serum 25 hydroxy vitamin D…was at least 33 ng/mL were almost five times more likely to benefit from bisphosphonates than those whose levels fell below that cutoff,” and that “for each 1 ng/mL decrease in 25(OH)D level, there was a 5% decrease in likelihood ofresponding to treatment.”  Researchers noted, “This level [33 ng/mL] is higher than that recommended by the Institute of Medicine as adequate for the general population, and many patients have levels well below this, so vitamin D supplementation may need to be higher for this therapeutic outcome.”

Vitamin D Alone May Not Increase BMD.MedWire  (9/21, McIvor) reports a study  published in Osteoporosis International in which “the effects of high-dose vitamin D (6500 IU vitamin D3/day)” was compared against “the standard dose (800 IU vitamin D3/day) on BMD of the total hip and lumbar spine over one year.” At the end of the year, researchers found “substantial increases in serum 25-hydroxyvitamin D levels were achieved in both groups,” but did not find “no significant difference in BMD between the high and standard doses after one year, with neither groups experiencing a significant change over the year.”  The study authors also found “that the high-dose treatment was less efficient in reducing bone turnover than the standard dose.”

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Summaries of several late-stage trials, to be presented November at the annual American College of Rheumatology (ACR) scientific meeting in Chicago, were released on Thursday.

The new tofacitinib data confirmed earlier findings that the drug was effective and in general well tolerated.

The incidence of overall adverse events was similar for both drugs, but the proportion of patients who developed serious side effects, though small, was numerically higher in the tofacitinib groups.

“Impressive efficacy was demonstrated, with focus now expected to be on safety leading into its regulatory review,” Jeffrey Holford, an analyst at Jefferies & Co, said in a research note. “While the market was expecting a similar efficacy between the higher dose of tofacitinib and Humira, the strong performance of the lower dose is impressive.”

Pfizer plans to seek approval of the medicine by the end of the year.

Data from the 12-month ORAL Standard trial comparing tofacitinib and Humira involved 717 patients with moderate to severe disease who continued to take methotrexate.

One group took 5 mg of the Pfizer drug twice a day, a second group took 10 mg twice a day, while a third group received Humira injections every two weeks. A fourth group of patients received a placebo.

The effectiveness of tofacitinib and Humira was numerically similar by all measures, although the study was not designed to definitively assess superiority of one drug over the other.

“Based on the totality of the tofacitinib RA clinical development program, Pfizer believes the risk/benefit profile supports regulatory submission for both the 5 and 10 mg dose,” Pfizer spokeswoman Victoria Davis said.

Data also became available for the first time on Thursday on the incidence of overall mortality and infections across numerous late-stage trials of the Pfizer medicine, and from longer-term follow-up of patients.

That pooled analysis, involving more than 6,200 patients, showed a mortality rate with tofacitinib of 0.572 deaths per 100 patient years in the Phase III trials, and 0.641 deaths per 100 patient years in the long-term evaluations.

In all, 12 patients died out of more than 3,000 who received tofacitinib in the Phase III trials, with deaths of another 20 patients seen among more than 3,200 who were followed in longer-term studies.

Pfizer said the death rates were consistent with those typically seen with standard treatments meant to slow the progress of arthritis symptoms.

Tofacitinib belongs to a new class of drugs known as JAK inhibitors that block a protein associated with inflammation.

It would compete against a lucrative family of biotech treatments that block tumor necrosis factor. These treatments include Humira, one of the world’s biggest selling medicines, as well as Johnson & Johnson’s Remicade (infliximab) and Enbrel (etanercept), which is sold by Amgen Inc and Pfizer.

This medication does not have FDA approval and is not available for use in the UAE yet.

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