A COMMON BUT LITTLE KNOWN complication of RA is malnutrition. In fact, it is estimated that more than 40% of Rheumatoid Arthritis patients are malnourished.
My first thought would be that RA can cause such overwhelming fatigue and pain that it would be difficult to muster the energy to prepare and then eat a meal. Just to make a sandwich requires unwrapping the bread, putting the slices on a plate, wrapping the bread bag back up, opening containers and adding spreads, meat or veggies, closing containers, putting them away. Sitting down at the table with your sandwich and eating it. Sounds easy enough. But if you are so wiped out by the extreme fatigue of RA or your hands are swollen and ache deeply in a way that is hard to explain, making a sandwich can be an overwhelming task. It is a task that can be skipped. And it frequently is. Additionally, it is difficult to rally the energy to go to the grocery store, get out of the car, walk in, select items, pay for them, go back to the car, put the groceries in, get in yourself, drive home, carry the groceries inside, and put them away. Exhausting thought. Nap time.
Next on my personal list of why RA patients are malnourished are drugs. Many of the DMARDs (Disease Modifying Anti-Rheumatic Drugs) have side effects. Some of them go away once your body becomes accustomed to the drug, others don’t. Nausea is a big one on my list. I am thinking of my friend, methotrexate. I do believe most of the DMARDs can cause nausea. Mine comes and goes. Now I give myself methotrexate by injection and with the dose tweaked down by 2.5mg, I usually don’t have any nausea. When I started methotrexate, diarrhea as well as nausea were big problems. It is better for me now. Nausea, alone, is enough to kill an appetite and it is no help for food shopping success.
Doctors add protein wasting to our list of why RA patients become malnourished. The chronic inflammation that RA sufferers endure produces chemicals that interfere with metabolism and causes muscle wasting and then muscle weakness. Muscle strength weakens. Loss of grip strength is an example. This wasting does not occur in the fatty tissue. The fat may stay as the muscles become flabby. Doesn’t seem fair. Those with muscle wasting may look plump enough but their muscles are deteriorating. Moving them in the direction of a downward spiral.
Understand that eating a balanced diet is as important as taking your drugs. Moving those muscles is important, too. The how-to is a little more challenging.
RA treatment drugs can cause nutrient deficiencies. Folic acid is a necessary supplement when taking methotrexate. A B vitamin complex is helpful. Calcium and vitamin D are especially helpful for those on corticosteroids or not. RA patients are at increased risk for osteoporosis in any case. Antioxidants, such as vitamin C, are also important.
There is more but this is enough for now. Think fish oil. No, don’t think that. Think juicy, fresh strawberries, slices of Havarti, bread that is fresh and crusty. An afternoon nap. That’s where I am headed.