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If you have rheumatoid arthritis (RA), you may need to pay more attention to your diet for these three reasons:

  1. Some RA medications block nutrients your body needs.  For instance, methotrexate can block folic acid, and corticosteroids block calcium absorption.
  2. RA causes chronic inflammation in your body, which may mean you need more calories and protein than someone who doesn't have RA.
  3. If your RA makes cooking difficult, you might start choosing foods that you don't have to cook. That's fine as long as they're nutritious, but they often have more empty calories, fat, and salt.

Folic Acid/Folate

Folic acid is a B vitamin that promotes health and supports your body’s metabolism. Folic acid also plays a crucial role in pregnancy, where it helps prevent some birth defects. In its natural form, folic acid is called folate.

Some common RA drugs such as methotrexate (Rheumatrex, Trexall) and sulfasalazine (Azulfidine) interfere with how the body uses folic acid. Eating more foods with folic acid, such as spinach, collards, broccoli, garbanzo beans, lentils, peas, and oranges, can help. Some foods, such as orange juice, are fortified with folic acid. Some people may need to take folic acid supplements. 

Ask your doctor or dietitian how much folic acid you need to help prevent medication side effects during methotrexate treatment. 

Calcium

Corticosteroids can make it harder for your body to use calcium. That can lead to weak bones and the bone disease osteoporosis. RA can also put you at risk for weak bones in other ways. RA makes your immune system hyperactive, which may lead to bone loss. 

Being active is important in keeping up bone strength, but RA can make it feel more difficult. Exercise can help keep your bones strong, in addition to helping relieve the symptoms of RA. 

Food sources of calcium include dairy products, canned sardines and salmon, almonds, broccoli, kale, and fortified orange juice and cereal.

How much calcium do you need? The recommendations are 1,000 milligrams a day for adults under age 50 and 1,200 milligrams for people 51 and older. Your doctor might recommend a higher amount or suggest that you take calcium supplements.

Vitamin D

Vitamin D is also key in strengthening bones and preventing osteoporosis. Without enough vitamin D, your body can't use the calcium from your diet.

Among people who have RA, those with low vitamin D levels tend to have more active RA symptoms.

Low vitamin D may also play a role in developing rheumatoid arthritis. Studies have found that women who get more vitamin D seem less likely to get RA. However, vitamin D isn't proven to prevent or treat RA. 

Some milk, orange juice, and breakfast cereals are fortified with vitamin D. Natural sources include egg yolks, salmon, tuna, and sardines. Your body also makes vitamin D when it's exposed to sunlight.

The general recommendations for vitamin D are 600 international units (IU) per day for adults under 70 and 800 to 1000 IU for people 70 and older. Ask your doctor about how much you should get a day and the best way to get it. Higher doses may be needed to correct a deficiency.