Nutrition in juvenile idiopathic arthritis: A weighty issue?
“What should I eat to make my arthritis better?” “What foods make arthritis worse?” These are some of the most common questions I am asked by parents and children in clinic.
Unfortunately, few studies speak to this issue. Small-scale studies of adults with rheumatoid arthritis (RA) indicate that various diets (e.g., Mediterranean, vegan, vegetarian, elimination) show a trend toward decreased pain and improved physical function [1-4]. However, there have been no specific studies conducted in juvenile idiopathic arthritis (JIA).
We know that it is important for children with JIA to eat a balanced, healthy diet. This may be challenging for a number of reasons. Children with JIA may have nausea, fatigue and stomach pain, both from the disease itself and from the medications used to treat the arthritis. In addition, children with temporomandibular joint disorder (TMJ) may have difficulty chewing or swallowing food. It may also be hard for children to cut or handle food if they have active arthritis in their hands.
I have seen many children in my clinic become underweight or lose significant weight after being diagnosed with JIA. This poor growth was probably due to the disease and medications. In these scenarios we have referred children to nutrition services. Dietitians have been a wonderful resource to help these families develop recipes using foods the children will eat and encourage healthy eating habits. For example, we have had parents “hide” extra calories in smoothies and shakes.
On the flip side, obesity is an issue in today’s youth. Children with arthritis may have low activity, and steroids may increase appetite and cause weight gain. In addition to diet support, parents and children need to be educated about the importance of physical activity. Many parents are reluctant to let their child play, for fear of damaging the joint or causing pain. In my clinic, we provide reassurance and counseling about the importance of exercise. We will often involve physiotherapy to teach children and families exercises that can be done without causing damage to the joints.
These questions regarding diet and exercise are important for patients with arthritis. A recent study in diabetes showed that careful diet control can lead to remission of type 2 diabetes and withdrawal of antidiabetic drugs . As future studies in JIA focus on diet and/or exercise, I wonder if we will also see a time when diet changes can lead to disease remission.
- Kjeldsen-Kragh J, Haugen M, Borchgrevink CF et al. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet 1991; 338: 899-902.
- Sköldstam L, Hagfors L, Johansson G. An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Ann Rheum Dis 2003; 62: 208-214.
- Darlington LG, Ramsey NW, Mansfield JR. Placebo-controlled, blind study of dietary manipulation therapy in rheumatoid arthritis. Lancet 1986; 1: 236-238.
- Smedslund G, Byfuglien MG, Olsen SU, Hagen KB. Effectiveness and safety of dietary interventions for rheumatoid arthritis: a systematic review of randomized controlled trials. J Am Diet Assoc 2010; 110: 727-735.
- Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet 2017; Advance online publication. doi: 10.1016/S0140-6736(17)33102-1