FACT SHEET:
Rheumatoid Arthritis & Diet
How to prevent and treat RA with nutrition
Key points
-
Global incidence and prevalence rates are increasing.(1)
-
International guidelines(3) focus on treatment with disease-modifying antirheumatic drugs (DMARDs), which are not without significant risks and side effects.
-
It is more common in women, smokers, and those with poor dental health, poor sleep, unhealthy diets, obesity, and/or family history of RA (2).
-
Optimal diets are high in fruits, vegetables, whole grains, omega-3 fats, and nuts while low in other fats, salt, sugar, red, and processed meats (4).
-
An optimal diet is anti-inflammatory, and reduces the risk of comorbidities.

Rheumatoid arthritis (RA) causes significant disability (1) and increases risk of all-cause mortality, cardiovascular disease, infection, respiratory illness, osteoporosis, and cancer (2).
Pathomechanisms That Are Influenced by Diet:
Inflammation
Obesity
- Visceral adipose tissue increases cytokine production and chronic systemic inflammation
- Increased clearance diminishing bioavailability of anti-TNF drugs
- Increased ESR values
- Increased risk of CVD comorbidity
Plant-based diet
- Reduced neutrophils, monocytes, and platelets
- Increased dietary fiber
- Decreased risk of CVD comorbidity
Intestinal Flora
Anti-Proteus mirabilis antibodies elevated in RA
- Molecular mimicry
Prevotella copri and TMAO
- Thrive on choline and carnitine from meat, poultry, fish, eggs
- Reduced effectiveness of DMARDs
- Increased inflammation
- Increased risk of CVD comorbidity
- Decreased risk of CVD comorbidity
Plant-based diet
- Decreased TMAO
- Increased dietary fiber, SCFA
- Decreased risk of CVD comorbidity
The Scientific Evidence
Epidemiological Evidence
- 2017 NHANES Survey found multivariable odds ratios (OR) as follows: obese, 3.26 (P <0.001) and, interestingly, insufficient vitamin A intake 0.70 (P = 0.036). Univariate OR for excess (toxic) vitamin A intake was 4.22 (P = 0.048), and inadequate copper intake 1.42 (P = 0.019) (5).
- While carotenoid conversion to vitamin A is adjusted based on need, preformed vitamin A from supplements and animal-derived foods may be absorbed in excess.
- In 2004, Pattison et al. found that, “Among patients, the level of red meat intake was higher (P = 0.04) and that of vitamin C was lower (P = 0.03) compared with intake among controls, but no difference in total energy intake was observed.” (6)
Evidence from RCTs and Corresponding Meta-Analyses
- There are few RCTs for diet and RA. In a small 2001 RCT, 40.5% of patients randomized to 9 months on a vegan diet free of gluten met ACR20 improvement criteria, compared with just one patient in the non-vegan control group (7).
- Recently, Lederer et al. demonstrated significant decreases in markers of inflammation, including neutrophils, monocytes, and platelets in a small group of healthy omnivores after 4 weeks on a controlled vegan diet compared with a controlled mixed diet control group (8).
General Recommendations
Eat predominantly or entirely from a wide variety of whole plant foods:
- Maximize the intake of high-quality plant foods such as vegetables, whole grains, legumes, fruits, nuts, seeds, herbs, and spices; your health will benefit from every step towards more whole plant foods.
- Eliminate or limit all processed foods, refined carbohydrates, and sugar-sweetened foods and beverages.
- Eliminate or limit red and processed meat products (such as burgers, sausages, bacon, ham, salami, dried meat, canned meat, and pastrami).
- Eliminate or limit other animal products such as poultry, fish, eggs, cheese, and dairy.
- Make sure to cover potentially critical nutrients with a wide variety of plant foods, enriched foods/drinks, or supplements (especially vitamin B12 and vitamin D); find more information in our Nutrition Library.
Disease-Specific Recommendations
- Limiting sugar intake may be important for management of RA.
- While omega-3 fats appear to be beneficial, plant-based and algae-based sources may be preferable due to environmental contaminants and a possible role for TMAO in RA.
- Some RA patients may see improvement with elimination of dietary gluten.
For more details on how to implement a whole food, plant-based diet, have a look at our brochure.