If I eat certain foods, will my rheumatoid arthritis symptoms improve? Answer

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1 August 17, 2010 Rheumatoid arthritis Question Rheumatoid arthritis diet: Do certain foods reduce symptoms? If I eat certain foods, will my rheumatoid arthritis symptoms improve? Answer By April Chang-Miller, M.D. That's a million-dollar question. Despite years of study, no conclusive evidence exists to show that particular foods make rheumatoid arthritis symptoms flare up or decrease. Some research has shown a link between eating certain fish oils and reducing joint inflammation in people with rheumatoid arthritis, but more research is needed to assess this possible benefit. It's smart to consider how your lifestyle might play a role in the ups and downs of rheumatoid arthritis. Being too heavy, for example, stresses your weight-bearing joints, increasing joint pain, stiffness and inflammation. You can also stay away from any food that seems to make your symptoms worse. But don't exclude whole food groups or large numbers of foods without consulting a registered dietitian or your doctor. Tips for protecting your joints Use these joint protection techniques to help you stay in control of your rheumatoid arthritis pain. By Mayo Clinic staff Joint protection is a proven strategy to help you manage rheumatoid arthritis pain and perform daily activities more easily. Arthritic joints can't tolerate as much stress as healthy joints can, so pushing, pulling or twisting motions can be painful. Think about ways you can avoid unnecessarily stressing your joints. Don't be tempted to work through your rheumatoid arthritis pain; you may just make the pain worse and increase the potential that joint deformities will develop.

2 Joint protection: Tips for managing rheumatoid arthritis pain To avoid unnecessary joint strain and increased rheumatoid arthritis pain, consider these tips for protecting your joints. Move each joint through its full pain-free range of motion at least once a day This will help you maintain the active motion of your joints. The amount you're able to move each joint without pain may vary from day to day take care not to overdo it. Keep movements slow and gentle forcing a motion past the point of a tolerable stretch can damage your joints. Learn to understand and respect your rheumatoid arthritis pain Understand the difference between the general discomfort of rheumatoid arthritis and the pain from overusing a joint. By noting when an activity causes joint pain, you can then avoid repeating that movement or think of ways that you can modify the task. Pain that lasts more than an hour after an activity may indicate that the activity was too stressful. Remember that you're more likely to damage your joints when they're painful and swollen. Be careful how you use your hands You use your fingers in many ways during your day-to-day activities. You can perform most tasks in easier ways that put less deforming forces on your joints. Avoid positions that push your other fingers toward your little finger. For instance, avoid tasks that require forceful or prolonged gripping or pinching. Finger motions should be in the direction of your thumb whenever possible. For example, when opening jars use a gripping aid and direct the force through the palm of your hand rather than just through your fingers. There are several types of jar opening devices available. Avoid making a tight fist. Use tools with thick or ergonomically designed handles, which make the tools easier to hold. Avoid prolonged pinching items between your thumb and your fingers. Hold a book, plate or mug in the palms of your hands. If you're reading for long periods, use a book holder. Instead of a clutch-style purse, select one with a shoulder strap. Use good body mechanics The way you position your body largely affects how much strain you put on your joints. Proper body mechanics allow you to use your body more efficiently and conserve energy. When you're sitting, the proper height for a work surface is 2 inches below your bent elbow. Make sure you have good back and foot support when you sit. Your forearms and upper legs should be well supported, resting level with the floor.

3 If you type at a keyboard for long periods and your chair doesn't have arms, consider using wrist or forearm supports. An angled work surface for reading and writing is easier on your neck. When you're standing, the height of your work surface should enable you to work comfortably without stooping. Increase the height of your chair to decrease stress on your hips and knees as you get up and down. To pick up items from the floor, stoop by bending your knees and hips. Or sit in a chair and bend over. Carry heavy objects close to your chest, supporting the weight on your forearms. Maintain good posture when standing or sitting. Poor posture causes uneven weight distribution and may strain your ligaments and muscles. Use the strongest joint available for the job Save your smaller, weaker joints for the specific jobs that only they can accomplish. Throughout the day, favor large joints. For example, carry objects with your palm open, distributing the weight equally over your forearm. Slide objects along a counter or workbench rather than lifting them. When opening cabinets or heavy doors, use a loop that you can pull with your wrist or forearm to decrease stress on your fingers. Avoid keeping your joints in the same position for a prolonged period of time Don't give your joints the chance to become stiff keep them moving. When writing or doing handwork, release your grip every 10 to 15 minutes, or when your hand feels fatigued. On long car trips, get out of the car, stretch and move around at least every one or two hours. While watching television, get up and move around every half-hour. Balance periods of rest and activity during the day Effectively managing your workload throughout the day can help you avoid overworked joints. Take time to organize your daily tasks. Work at a steady, moderate pace and avoid rushing. Rest before you become fatigued or sore. Alternate light and moderate activities throughout the day. And take periodic stretch breaks. Exercise helps ease arthritis pain and stiffness As you consider starting an arthritis exercise program, understand what's within your limits and what level of exercise is likely to give you results. By Mayo Clinic staff

4 Exercise is crucial for people with arthritis. It increases strength and flexibility, reduces joint pain, and helps combat fatigue. Of course, when stiff and painful joints are already bogging you down, the thought of walking around the block or swimming a few laps might make you cringe. You don't need to run a marathon or swim the pace of an Olympic competitor to help reduce the symptoms of your arthritis. Even moderate exercise can ease your pain and help you maintain a healthy weight. When arthritis threatens to immobilize you, exercise keeps you moving. Not convinced? Read on. Why exercise is vital Exercise can help you improve your health and fitness without hurting your joints. Along with your current treatment program, exercise can: Strengthen the muscles around your joints Help you maintain bone strength Give you more strength and energy to get through the day Make it easier to get a good night's sleep Help you control your weight Make you feel better about yourself and improve your sense of well-being Though you might think exercise will aggravate your joint pain and stiffness, that's not the case. Lack of exercise actually can make your joints even more painful and stiff. That's because keeping your muscles and surrounding tissue strong is crucial to maintaining support for your bones. Not exercising weakens those supporting muscles, creating more stress on your joints. Check with your doctor first Talk to your doctor about how exercise can fit into your current treatment plan. What types of exercises are best for you depends on your type of arthritis and which joints are involved. Your doctor or a physical therapist can work with you to find the best exercise plan to give you the most benefit with the least aggravation of your joint pain. Exercises for arthritis Your doctor or physical therapist can recommend exercises that are best for you, which might include:

5 Range-of-motion exercises These exercises relieve stiffness and increase your ability to move your joints through their full range of motion. Range-of-motion exercises involve moving your joints through their normal range of movement, such as raising your arms over your head or rolling your shoulders forward and backward. These exercises can be done daily or at least every other day. Strengthening exercises These exercises help you build strong muscles that help support and protect your joints. Weight training is an example of a strengthening exercise that can help you maintain your current muscle strength or increase it. Do your strengthening exercises every other day but take an extra day off if your joints are painful or if you notice any swelling. Aerobic exercise Aerobic or endurance exercises help with your overall fitness. They can improve your cardiovascular health, help you control your weight and give you more stamina. That way you'll have more energy to get through your day. Examples of low-impact aerobic exercises that are easier on your joints include walking, riding a bike and swimming. Try to work your way up to 20 to 30 minutes of aerobic exercise three times a week. You can split up that time into 10-minute blocks if that's easier on your joints. Other activities Any movement, no matter how small, can help. If a particular workout or activity appeals to you, don't hesitate to ask your doctor whether it's right for you. Your doctor might give you the OK to try gentle forms of yoga and tai chi. Tai chi may improve balance and help prevent falls. Be sure to tell your instructor about your condition. Exercise helps ease arthritis pain and stiffness Tips to protect your joints Start slowly to ease your joints into exercise if you haven't been active for a while. If you push yourself too hard, you can overwork your muscles. This aggravates your joint pain. Consider these tips as you get started: Apply heat to the joints you'll be working before you exercise. Heat can relax your joints and muscles and relieve any pain you have before you begin. Heat treatments warm towels, hot packs or a shower should be warm, not painfully hot, and should be applied for about 20 minutes. Move your joints gently at first to warm up. You might begin with range-of-motion exercises for five to 10 minutes before you move on to strengthening or aerobic exercises.

6 Exercise with slow and easy movements. If you start noticing pain, take a break. Sharp pain and pain that is stronger than your usual joint pain might indicate something is wrong. Slow down if you notice inflammation or redness in your joints. Trust your instincts and don't exert more energy than you think your joints can handle. Take it easy and slowly work your exercise length and intensity up as you progress. Don't overdo it You might notice some pain after you exercise if you haven't been active for a while. In general, if your pain lasts longer than two hours after you exercise, you were probably exercising too strenuously. Talk to your doctor about what pain is normal and what pain is a sign of something more serious. If you have rheumatoid arthritis, ask your doctor if you should exercise during general or local flares. One option is to work through your joint flares by doing only range-of-motion exercises, just to keep your body moving. Exercise programs for people with arthritis Check with your doctor about exercise programs in your area for people with arthritis. Hospitals and clinics sometimes offer special programs, as do local health clubs. The Arthritis Foundation conducts exercise programs for people with arthritis in many parts of the United States. Programs include exercise classes in water and on land - and walking groups. Contact your local branch for more information. Arthritis pain: Do's and don'ts Will physical activity reduce or increase your arthritis pain? Get tips on exercise and other common concerns when coping with arthritis symptoms and arthritis pain. By Mayo Clinic staff You get all kinds of advice about exercise, medication and stress reduction, but how do you know what will work best for you? Here are some do's and don'ts to help you figure it out. Basics Whatever your condition, you'll have an easier time staying ahead of your pain if you: Talk to your doctor about all your symptoms, arthritis related or not. Sometimes seemingly unrelated problems are, in fact, connected. Give your doctor complete information about all your medical conditions, not just arthritis.

7 Ask your doctor for a clear definition of the type of arthritis you have. Find out whether any of your joints are already damaged. Everyday routines Do some gentle exercise in the evening; you'll feel less stiff in the morning. When you're technically doing nothing watching TV or sitting at your desk, for instance be sure to: Adjust your position frequently. Periodically tilt your neck from side to side, shake out your hands, and bend and stretch your legs. Pace yourself. Take breaks so that you don't overuse a joint and cause more pain. Exercise When you have arthritis, movement can decrease your pain, improve your range of motion, strengthen your muscles and increase your endurance. What to do Choose the right kinds of activities those that build the muscles around your joints but don't damage the joints themselves. Focus on stretching and strength training. Include low-impact aerobic exercise, such as walking, cycling or water exercises, for improving your mood and helping control your weight. What to avoid Running Jumping Tennis High-impact aerobics Repeating the same movement, such as a tennis serve, again and again Inactivity, which can lead to muscle atrophy and further decrease joint stability

8 Medications Several medications are available for arthritis pain relief. Most are relatively safe, but no medication is completely free of side effects. Talk with your doctor to formulate a medication plan for your specific pain symptoms. What to do First, rest. Mild, occasional pain may need nothing more than rest and the application of cold or heat. Rest the painful joint, and apply cold packs to relieve pain or hot packs to ease stiff and achy joints and muscles. For occasional pain. Take over-the-counter (OTC) acetaminophen (Tylenol, others) or aspirin tablets every four hours to relieve occasional pain triggered by activity your muscles and joints aren't used to such as gardening after a winter indoors. For longer periods of pain. Take OTC ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others) a day for one or two days if pain related to unaccustomed activity persists. Follow the dosing directions on the package. Ibuprofen and naproxen are classified as nonsteroidal anti-inflammatory drugs (NSAIDs) because they reduce inflammation as well as pain. Technically, aspirin is also an NSAID, but it's typically used for purposes other than reducing inflammation. When you anticipate pain. Try taking one dose of acetaminophen, ibuprofen or naproxen a few hours before you start an activity that's likely to cause joint pain. When pain persists. Consult your doctor if these medications aren't relieving your pain. What to avoid Overtreatment. Talk with your doctor if you find yourself using acetaminophen, aspirin or NSAIDs regularly. Undertreatment. Don't try to ignore severe and prolonged arthritis pain. It may mean you have joint damage requiring daily medication. Focusing only on pain. Depression is more common in people with arthritis. Doctors have found that treating depression with antidepressants and other therapies reduces not only depression symptoms, but also arthritis pain. Physical and emotional integration It's no surprise that arthritis pain has a negative effect on your mood. If everyday activities make you hurt, you're bound to feel discouraged. But when these normal

9 feelings escalate to create a constant refrain of fearful, hopeless thoughts, your pain can actually get worse and harder to manage. What to do Therapies that interrupt destructive mind-body interactions include: Cognitive behavioral therapy. This well-studied, effective combination of talk therapy and behavior modification replaces ineffective coping strategies, such as emotional withdrawal and medication overuse, with effective ones. Lifestyle changes. Being overweight can increase complications of arthritis and contribute to arthritis pain. Making incremental, permanent lifestyle changes resulting in gradual weight loss is often the most effective method of weight management. And if you smoke, find a way to quit. Smoking causes stress on connective tissues, which leads to more arthritis pain. Journaling and other coping skills. The emotional release of journaling about your feelings, as well as using other coping skills, can result in decreased sensation of pain. Acupuncture. Some people experience pain relief through acupuncture treatments, when a trained acupuncturist inserts hair-thin needles at specific points on your body. What to avoid Smoking. If you're addicted to tobacco, you may use it as an emotional coping tool. But it's highly counterproductive: the toxins in smoke cause stress on connective tissue, leading to more joint problems. Catastrophizing. Negative thoughts are self-perpetuating. As long as you keep dwelling on them, they keep escalating until you believe the worst. Using negative thoughts to cope with pain can actually increase your risk of disability and pain. Instead, focus on adaptive therapies like distraction or calming statements.

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