Behind a diagnosis of rheumatism lie various diseases that affect the joints. The right diet is an important element in the treatment of patients with rheumatic diseases – all of them can benefit from a change in diet. They have significantly fewer symptoms and may be able to reduce their medication dose.
What is rheumatism?
Rheumatism is the umbrella term for a large number of rheumatic diseases, which show around 400 different forms and various courses. Children and adolescents are affected just as much as younger adults and older people. The World Health Organization defines rheumatism as a large number of diseases that have in common that they occur in the locomotor organs (joints), are almost always accompanied by pain and are often associated with restricted movement. These mainly include
- inflammatory rheumatic diseases (e.g. rheumatoid arthritis),
- degenerative diseases of the joints and spine (e.g. osteoarthritis),
- metabolic diseases with rheumatic symptoms (e.g. gout),
- soft tissue rheumatic diseases (e.g. fibromyalgia).
Rheumatoid arthritis is a chronic inflammatory autoimmune disease of the joints. The persistent inflammation leads to damage and destruction of the synovial membrane and the surrounding structures such as cartilage, bone and soft tissue. Pro-inflammatory messenger substances such as cytokines and eicosanoids keep the inflammatory process going. Eicosanoids are formed in the body from arachidonic acid, most of which is taken in through food. Arachidonic acid is contained only in animal foods, not in plant foods.
Osteoarthritis is the most common joint disease worldwide. In this rheumatic disease, the cartilage in the joints wears away, the protective layer is lost and this causes the bones to rub against each other. Those affected often have severe pain. The joint becomes stiffer and consequently less mobile. Cartilage breakdown leads to inflammation of the surrounding tissue. Connective tissue and muscles suffer as a result; a protective posture is often adopted, so that other joints are in turn placed under greater strain. Osteoarthritis is considered a degenerative joint disease. Practically all joints can be affected. Osteoarthritis frequently occurs in the knee, hip, shoulder joints, hands and fingers and in the feet. 
Gout is a metabolic disease – more precisely, a disorder of purine metabolism. Purines occur in foods, especially in meat, sausage and offal. They are also present in the human body itself, as a component of cells. When cells disintegrate or are broken down, more purines are released. Purines are normally broken down into uric acid and excreted via the kidneys. In gout, too much uric acid accumulates in the blood, so that uric acid deposits form. These are small uric acid crystals that form in the synovial membrane. Anyone who continuously takes in a large amount of purines with food can develop gout if they have the corresponding predisposition. A change to a low-purine diet therefore plays an important role in the treatment of the disease. Untreated gout can lead to kidney failure. The pain attacks of people with gout usually occur at night or in the early hours of the morning and are usually very severe. The affected joint is typically extremely sensitive to touch and painful to move. It is also swollen, red or bluish in colour and hot. The very first gout attack usually manifests itself with violent joint pain in the big toe. Doctors call this podagra. Other joints that are also often affected are the midfoot joints, ankle and knee joints, and the metacarpophalangeal joints of the thumb. About 80 per cent of gout patients are men. The disease usually breaks out between the ages of 40 and 60. The right diet, a healthy lifestyle and medication help to lower uric acid levels and so prevent gout attacks. 
Rheumatism cannot be cured – however, the right diet and targeted physiotherapy can have a positive effect on the course of the disease. It makes sense to adjust the diet with the treating doctor immediately after diagnosis and once medication has been established. Nutritional counselling is also very helpful at the beginning. A little patience is needed: the effect of nutritional therapy only sets in after about three months.
Diet in rheumatoid arthritis
Nutritional therapy is an important addition to drug therapy and should be started at the same time. The basis is a vegetarian diet with plenty of vegetables and fruit and daily consumption of reduced-fat milk and reduced-fat dairy products. Numerous studies show that a vegetarian diet reduces morning stiffness, the number of swollen joints, pain and in some cases also the inflammatory markers in the blood. Rheumatoid arthritis leads to an increased risk of osteoporosis (bone loss). Low-fat milk and dairy products therefore play a major role in the diet. They contain a lot of calcium, which is important for building and maintaining bone. At the same time, however, attention must be paid to the amount of phosphate in foods. Foods with a low phosphate content are to be preferred, because phosphate inhibits the body’s absorption of calcium. Animal foods in particular contain phosphate.
In addition to vegetables and low-fat dairy products, fish should also be eaten twice a week. Patients who plan their menu accordingly take in significantly less pro-inflammatory arachidonic acid. It is a fourfold unsaturated fatty acid in the omega-6 group. Its content is particularly high in lard, liver, egg yolk, tuna, liver sausage and in pork and high-fat dairy products. Plant foods, on the other hand, supply no arachidonic acid. Furthermore, mayonnaise, safflower oil and sunflower oil should be struck off the list of foods – they contain a high proportion of linoleic acid (an omega-6 fatty acid). Omega-3 fatty acids, by contrast, are beneficial to health because they are considered anti-inflammatory. They are plentiful in oily sea fish such as tuna, herring, salmon, sardines or mackerel, but also in walnuts. Linseed oil and oils from hemp, walnuts and rapeseed are recommended. 
Dietary tips
The main focus of a change in diet is to reduce inflammatory activity in the body. The following list does not replace comprehensive nutritional counselling by appropriately trained professionals. However, patients can use it for orientation.
- Wholegrain products for an optimal intake of dietary fibre, such as brown rice, wholemeal bread and wholewheat pasta (no white flour products)
- Bitter compounds have an anti-inflammatory effect and are present in herbs, salads and vegetables (drink green smoothies, chicory, dandelion, rocket etc.)
- Take in omega-3 fatty acids and avoid omega-6 fatty acids (pay attention to a favourable ratio)
- No fatty and red meat, above all no pork (because of the high arachidonic acid content), few eggs (max. 2 per week; note: eat egg-free pasta), prefer lean poultry
- Alcohol, especially wine, is permitted in moderation
- Choose low-fat dairy products: quark, yoghurt, milk – good for calcium and protein intake, prevents osteoporosis
- If overweight, reduce it – this additionally relieves the joints
- Supplementation with certain vitamins and minerals only after consulting the treating doctor: omega-3 fatty acids in the form of fish oil capsules, vitamin D (because of restricted mobility, patients go outdoors/into the sun too little), vitamin E.
Interesting: Studies have shown that patients need to take around 5.5 grams of fish oil per day for their symptoms to improve. This dose can hardly be achieved with a balanced diet. Supplementation with omega-3 fatty acids in capsule form can therefore be useful for people with rheumatoid arthritis. Symptoms, diagnosis and further treatment options for rheumatoid arthritis are described in detail in the article Rheumatoid arthritis – an autoimmune disease.
Diet in osteoarthritis
Overweight is a significant risk factor: every excess kilo on the scales must be lost, because the additional weight weighs heavily on the load-bearing joints of the feet, knees and hips. In addition, excess abdominal fat stimulates systemic inflammation, which also damages cartilage. Cartilage that has been destroyed is gone for ever – but an active change in diet can help to strengthen the remaining cartilage. Nutrients that strengthen cartilage include vitamin B6 (e.g. apples), vitamins B and C (spinach) and selenium (broccoli). They act as antioxidants against free radicals released during inflammation. Other important constituents with an anti-inflammatory effect are bitter compounds, flavonoids and mustard oils. The pigments from blueberries and oranges also contribute to a better state of health.
Dietary tips
Recommended foods that belong on the menu because they have an anti-inflammatory effect include, for example:
- Millet, potatoes, lentils, oat flakes
- Vegetables (broccoli, red peppers, radish, tomatoes, spinach)
- Omega-3 fatty acids: linseed oil, walnut oil and rapeseed oil, oily sea fish and walnuts; olive oil (rich in monounsaturated fatty acids) is also suitable for cooking
- Green tea because of its tannins
- Fat-free dairy products and milk
- Certain herbs such as nettle and spices such as turmeric, coriander, cumin and nutmeg improve blood flow to the synovial membrane.
- Bitter compounds from salads, fruit and vegetables and antioxidants inhibit inflammation
- The constituents of garlic (allicin), onions and allium vegetables have a demonstrable cartilage-protecting effect.
Not recommended, on the other hand, are:
- Saturated fatty acids and hydrogenated fats (crisps, sweets)
- Avoid cheese, sausage and a meat-rich diet (in particular, do without pork)
- Dried fruit
- Alcohol
- White flour products. Opt for wholegrain products instead.
Diet goes hand in hand with exercise therapy. Without movement, the nutrients do not reach the cartilage. Joints must be moved so that the synovial fluid can nourish the cartilage well. Despite their symptoms, people with osteoarthritis should on no account rest their joints. Moderate sports sessions (joint-friendly sports: swimming, Nordic walking) or targeted physiotherapy help to maintain mobility and counteract further cartilage breakdown.
Diet in gout
Purines from food increase uric acid levels in the blood via metabolism, and alcohol inhibits the excretion of uric acid by the kidneys. People with gout should continue to eat a low-purine diet – if possible doing without offal, meat and seafood – and strictly avoid alcohol, especially spirits and (alcohol-free) beer. An occasional glass of wine is fine. With regard to purines in pulses and vegetables, expert opinion has changed in recent years. Pulses, spinach, asparagus and brassicas are tasty and can be eaten without concern. US researchers have found that purines in plant foods have a positive influence on uric acid levels. The same dietary recommendation applies to people with gout as to everyone: a healthy and balanced wholefood diet. Fructose – not from natural fruit, but fructose added to drinks, ready meals and sweets – is now in focus as a trigger of gout attacks. Anyone who follows a rather low-carbohydrate but high-protein diet – preferably from low-fat dairy products – and increasingly relies on unsaturated fatty acids has a good chance of reducing uric acid levels in the blood.
Dietary tips
- Avoid purine-rich animal foods (meat, offal, seafood), but also fish such as anchovies, herring and sardines in oil
- 2 portions of fruit a day and plenty of vegetables
- Choose low-fat dairy products; eggs are low in purines
- Very rich and heavy meals should also be avoided, as should complete abstention from food (fasting), because uric acid levels rise rapidly
- Avoid fructose and fructose syrup in drinks and foods (such as fruit yoghurt or muesli)
- Drink at least two litres of fluid a day; coffee is allowed
- Stop drinking beer completely; have an occasional glass of wine instead
- Reduce excess weight slowly – through a healthy diet and plenty of exercise
- Physical activity helps to lower uric acid levels
The dietary tips given in this article do not replace comprehensive nutritional counselling by appropriately trained professionals. They serve as initial orientation. Anyone suffering from a rheumatic disease should discuss their change in diet with their treating doctor.
