The dietary modifications serve as a guide to making healthy food choices to maintain a healthy body weight, including foods which reduce inflammation and exclude foods which can trigger pain.

Arthritis is a common medical condition characterized by inflammation of one (monoarthritis) or multiple joints (2-4 joints involved- oligoarthritis, >5 joints involved- polyarthritis). Although any joint of the body may be affected, the most frequently affected ones are the knuckles, ankle, wrist, and knee. Arthritis affects more than 350 million individuals worldwide. In India, the prevalence of arthritis is higher than that of several other well-known diseases including diabetes, AIDS, and cancer, affecting more than 180 million people.

There are several types of arthritis, few common ones are:

Osteoarthritis:

Osteoarthritis (OA) is the most common type of arthritis. It is a degenerative disease caused by changes in the cartilage within a joint. It has a strong connection to ageing and is the main contributor to pain and disability in the elderly. The knee and hip joints are the principal large joints involved while elbow, shoulder and ankle joints are less frequently involved. The most common risk factor for OA is hereditary or genetic. Obesity, smoking, ageing, trauma to the joint and occupational factors are also linked with OA.

Signs and symptoms:

Joint pain with swelling, stiffness and restriction of movement are the characteristic symptoms of OA.
Sometimes a sound called ‘crepitus’ can be heard from the joint.

Rheumatoid Arthritis:

Rheumatoid arthritis (RA) is an autoimmune disease (i.e., the body’s healthy cells are attacked by its immune system) with a higher chance of occurrence in twins and first-degree relatives of patients. It is characterized by symmetrical polyarthritis with the involvement of small and large joints associated with symptoms outside the joint such as heart, lungs, eyes, and nerves. The symptoms of RA follow an intermittent pattern of exacerbations and remissions, i.e., the symptoms sometimes get worse and sometimes the symptoms get better. RA commonly begins with the involvement of small joints of the hands, feet, and wrists. Women are more susceptible to getting RA than males. Smoking and heredity are common risk factors for RA.

Signs and symptoms:

RA typically presents with pain, swelling, tenderness and stiffness of small joints of hands, wrist, and feet on both sides symmetrically.
Morning stiffness (> 1 hour) is seen in the majority of cases.
Aggravation of pain from stress is a very common feature of RA.
Associated symptoms include fever, weight loss, fatigue, increased susceptibility to infection, muscle wasting, anaemia, nodules on forearm, ankles, toes (rheumatoid nodules), dry eye, (keratoconjunctivitis sicca), neuropathy, bronchitis, pericarditis.

Psoriatic Arthritis:  

Psoriatic arthritis is an autoimmune condition seen in patients with a current or history of skin disease- psoriasis. Psoriasis is a skin disease characterized by dry itchy skin and silvery scales. Men and women are equally affected by psoriatic arthritis. Genetic and environmental factors, stress, and trauma are the triggering factors of the disease.

Signs and symptoms:

Pain, swelling and tenderness in wrists, fingers, knees, ankles. Sometimes the buttocks and back may be involved.
Sometimes there is swelling of an entire finger or toe known as dactylitis.
Cracking, pitting, white spots, and separation of nails from the nail bed may occur. It is known as nail dystrophy.
This may or may not be associated with skin lesions of psoriasis i.e., dry red itchy skin with silver scales.
Redness, pain, and swelling of the eyes may be present.

Gout:

Gout is a very painful arthritis of one joint at a time, often the big toe. It is due to the collection of uric acid crystals in the joint when there are high levels of uric acid in the blood (hyperuricemia) for a prolonged period. Uric acid is a product of the digestion of purine in foods. Apart from hyperuricemia, other risk factors for gout include high alcohol intake, hypertension, and high cholesterol.
Signs and symptoms:
Sudden and rapid onset of severe pain described as ‘worst pain ever’.
Extreme pain on touch, cannot even let the bedding rest on the joint.
Swelling of the joint with red, shiny skin.
There could be a fever, confusion, or weakness.
The symptoms worsen during an acute gout attack, then there are periods when there are no symptoms.
Later in the course of the disease, irregular nodules known as ‘tophi’ form on hands, fingers, forearm, elbows, heel, and sometimes ear.

Management of arthritis

Lifestyle changes in the management of arthritis:
Lifestyle changes are intended to improve the quality of life and slow the progress of disease.
Stay physically active: Moderate to low-intensity exercise is recommended regularly. This will bring improvement in physical performance and reduce the risk of other chronic diseases like diabetes, hypertension etc. At least 150 minutes per week of moderate to low-intensity physical activity like walking, cycling, and swimming is recommended.
Reduce weight: Obesity is a risk factor for arthritis. Reducing weight will decrease the pressure on joints in overweight individuals. This will reduce joint pains, improve performance, and slow the progression of disease.
Stop smoking and alcohol consumption to keep acute attacks in check.
Protect your joints: Arthritis worsens from joint injuries. So, choose physical activities that are easy on joints such as walking, swimming, and cycling.
Stress management: Stress can worsen arthritis symptoms. Techniques to reduce stress such as meditation, deep breathing, getting enough sleep, brisk walks, leisure activities and hobbies must be adopted.

Dietary modifications in the management of arthritis:

The dietary modifications serve as a guide to making healthy food choices to maintain a healthy body weight, including foods which reduce inflammation and exclude foods which can trigger pain.
The following dietary advice must be considered:
A balanced diet rich in fruits, vegetables, and whole grains.
Omega-3 fatty acids found in fish can help reduce inflammation.
Nuts such as walnuts, pistachios, and almonds help to reduce inflammation.

Red and purple fruits like blueberries, cherries, and raspberries have anthocyanins which have an anti-inflammatory effect.
Olive oil has healthy fats and helps in reducing pain.
Vegetables like tomatoes, eggplant, and potatoes must be avoided as they may flare arthritis pain in some patients.
Limiting processed foods and sugary drinks can help manage weight.
Take an adequate amount of water.

For patients suffering from gout, foods with high purine are excluded from the diet. These include all meats, fish, organ meats i.e., kidney, brain, liver, beans, peas, lentils, spinach, cauliflower, mushroom, seafood, beer, and alcohol.

While arthritis can be a challenging condition to live with, various strategies can help individuals manage their symptoms and maintain a healthy lifestyle. By understanding the different types of arthritis, their causes, early diagnosis, and implementing lifestyle changes and treatments, individuals with arthritis can improve their quality of life and stay healthy. Remember to consult a healthcare professional for personalized advice and guidance.