Rheumatoid arthritis impacts nearly 2% of Australians and is most common in older adults over 75, especially women. It can go hand in hand with other conditions such as heart or lung disease, malignancies, osteoporosis and cognitive decline or dementia.
Less well known is that many patients could be malnourished; a common problem in older adults that often goes unnoticed and can lead to an accelerated downward spiral in health outcomes, exacerbating existing conditions, recovery times and risk of mortality.
More than joints
Unlike osteoarthritis, caused by wear and tear on the joints, rheumatoid arthritis is one of the many and growing autoimmune diseases that cause the body to attack itself. In this case, the immune system picks on the lining of the joints, causing swelling and inflammation.
As well as the joint pain that makes it hard to do the daily activities we all take for granted, like cooking, cleaning, gardening and recreation, the systemic inflammation can cause a range of problems including tiredness, depression and sleeping difficulties.
Its whole body impact is associated with gastrointestinal problems, poor appetite and weight loss – key markers of malnutrition which has been associated with higher all-cause mortality in this patient group. Medications for rheumatoid arthritis can also cause gastrointestinal issues, impacting the digestion and absorption of food and nutrients.
A third of patients with rheumatoid arthritis experience loss of muscle mass and strength – risk factors for sarcopenia – which along with malnutrition is associated with poorer outcomes in terms of functioning, mental health and mortality.
A recent study found that, among patients with rheumatoid arthritis, a whopping third of those who were malnourished had dementia compared with less than 2% of those who were not malnourished. Malnutrition was also associated with frailty, which in turn predicted poorer quality of life.
As the authors write, “The quality of life of the sick is the result of a single and unique interaction of the influence of the disease, the patient’s individual abilities, adaptation forces and coping processes of dealing with the disease.” Being malnourished certainly doesn’t help.
Yet there is little awareness and research into the role of nutrition in rheumatoid arthritis, prompting the authors to advocate for routine malnutrition screening of older adults with the disease. Addressing malnutrition would involve encouraging a nutrient dense diet, increasing energy to achieve a healthy body weight and ensuring adequate protein for healing and repair.
More broadly, a healthy lifestyle that includes a nutritious diet and low impact physical activity is recommended to help alleviate the disease’s trajectory and symptoms – as, indeed, for healthy aging generally.