Should People With RA Take Supplements?

Because you have rheumatoid arthritis (RA), you might need extra help to get all the vitamins and minerals that your body needs.

Your diet is key. It’s the best source of nutrients. Go for foods that are rich in fruits, vegetables, whole grains, and lean protein. You can ask your doctor if you also need to take supplements.

Folic Acid/Folate

What it is: It’s a B vitamin called “folic acid” in supplements and fortified foods, and “folate” in its natural form in many plant foods.

Why you need it: It supports your metabolism, and in pregnant women, it helps prevent some birth defects. Some common RA drugs like methotrexate (Rheumatrex, Trexall) and sulfasalazine (Azulfidine) interfere with how the body uses folic acid.

How much you need: Adults should get 400 micrograms of folate or folic acid daily. Two exceptions: Pregnant women should get 600 micrograms per day, and breastfeeding women should get 500 micrograms per day. Some experts recommend that adults with rheumatoid arthritis take 1 milligram of folic acid every day or 5 milligrams once a week.

How to get it: Foods rich in folic acid include asparagus, spinach, collards, broccoli, garbanzo beans, lentils, peas, and oranges. Some items -- such as orange juice, bread, and cereal -- are fortified with folic acid. The product label will say so.

Calcium

What it is: It’s a mineral that your bones and muscles need.

Why you need it: If you take corticosteroids for your RA, it’s harder for your body to absorb calcium from your diet. That can lead to osteoporosis, which make fractures more likely. RA itself can also lead to bone loss. 

How much you need: It depends on your age, gender, and whether you’re pregnant.

  • Adults younger than 50: 1,000 milligrams of calcium per day
  • Pregnant women: 1,300 milligrams  per day
  • Women age 51 and older: 1,200 milligrams  per day
  • Men age 71 and older: 1,200 milligrams a day

Your doctor might recommend an even higher amount, so ask what you need.

How to get it: You can get calcium from dairy products, canned sardines and salmon, almonds, broccoli, kale, and fortified products, such as orange juice, cereal, and some soy and almond milks (check the label).

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Vitamin D

What it is: A nutrient that your bones, muscles, and immune system need. Your doctor can check your vitamin D level with a blood test. 

Why you need it: Your body needs it to use the calcium you get from food or supplements. RA tends to be worse in people who are low in vitamin D, but it isn’t clear why.

How much you need: All adults up to age 70 should get 600 international units (IU) of vitamin D per day. Starting at age 71, you should get 800 IU per day. You may need more if you are low in vitamin D. Your doctor can check your vitamin D level with a blood test. 

How to get it: It’s added to almost all milk and to some orange juices, breakfast cereals, and soy and nut milks. (Check the label). Egg yolks, salmon, tuna, and sardines naturally have some vitamin D. Your body also makes vitamin D in sunshine, but because you’ll need to wear sunscreen to protect your skin, you might not want to rely on sun exposure for your vitamin D.

Omega-3 Fatty Acids

What they are: Omega-3 fatty acids are a type of healthy fat.

Why you need them: Omega-3s may help prevent heart problems linked to RA, and high doses might ease RA symptoms like morning stiffness. 

How much you need: There’s no RDA (recommended dietary allowance) for omega-3s, so ask your doctor what you need. Studies show that people with RA have lower-than-average levels of EPA and DHA, two omega-3 fatty acids.

How to get it: Your body can't make omega-3s. You can get EPA and DHA from salmon, tuna, sardines, and other fatty fish. (Many experts recommended eating fish at least twice a week.) Some plant foods, such as flaxseeds, leafy green vegetables, nuts, canola oil, and soy oil, have ALA, another type of omega-3 fatty acid.

Other Vitamins and Minerals

You may have heard that not getting enough vitamin C, vitamin E, magnesium, zinc, and selenium can affect RA symptoms. While your body needs all of these, there’s no proof that taking extra helps RA.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on January 15, 2017

Sources

SOURCES:

Ede, A. Arthritis & Rheumatism, 2001.

Pelajo, C. Autoimmunity Reviews, 2010.

Rennie, K. Journal of Human Nutrition and Dietetics, 2003.

Arthritis Today: “Vitamin and Mineral Guide: Folate.”

Johns Hopkins Arthritis Center: “Nutrition & Rheumatoid Arthritis.”

Edgar R. Miller III, MD, PhD, associate professor of medicine and epidemiology, Johns Hopkins University School of Medicine, Baltimore.

National Institute of Arthritis and Musculoskeletal Diseases: “What People With Rheumatoid Arthritis Need to Know About Osteoporosis.”

National Osteoporosis Foundation: “About Osteoporosis: Vitamin D and Bone Health.”

Office of Dietary Supplements, National Institutes of Health: “Folate,” “Calcium,” Vitamin D,” “Omega-3 Fatty Acids and Health.”

Natural Medicines Comprehensive Database: “Alpha-Linolenic Acid,” “Fish Oil,” “Vitamin D,” “Sulfasalazine.”

Arthritis Foundation: “Methotrexate: Managing Side Effects.”

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