5 Foods That Can Make Rheumatoid Arthritis Worse

What you put into your body can affect how you feel. Skip these pro-inflammatory foods to help you avoid an RA flare.

Medically Reviewed

Foods high in unhealthy fats are linked to inflammation.

Getty Images

You may have heard that eating a well-balanced diet could help ease symptoms of rheumatoid arthritis (RA), such as joint pain, swelling, and stiffness.

But did you know there are also certain foods you should avoid? These foods can worsen your symptoms, increase the risk of complications, and affect the amount and type of RA medication you need to take.

Research backs up the power of food when it comes to managing your RA. In a 2020 study exploring the effects of the Mediterranean diet, researchers concluded that certain foods can lessen — or increase — RA symptoms. This backs up the belief that the right diet can be effective in helping to provide long-term RA relief.

You can use food choices to try to help control RA-related inflammation in your body that can cause pain and swelling in your joints as well as damage to your heart and other organs.

On one hand, you want to increase your intake of healthy anti-inflammatory foods like fish, fruits, nuts, and vegetables. At the same time, you want to avoid foods that promote inflammation when putting together a healthy diet.

Consider how many RA-aggravating foods you’re eating and find a healthy balance, says Joan Salge Blake, EdD, RDN, a clinical professor at Boston University’s Sargent College of Health and Rehabilitation Sciences.

Steer clear of these foods to help reduce inflammation and improve your RA.

986

Ultra-Processed Foods

Shutterstock

A so-called “clean diet” that restricts ultra-processed foods may lessen inflammation in the body. “Clean” foods are considered to be those that closely resemble what they looked like when they sprouted from the ground or on a tree branch — think fresh fruits and veggies. Ingredients are all recognizable, and there are few if any additives or preservatives. An added but important benefit of clean eating for people with RA? Weight loss, which can ease the burden on sore or strained joints.

987

Foods Packed With Saturated Fats

Thinkstock

The inflammation associated with RA can affect your heart as well as your joints, according to a review of existing research published in 2020. Inflammation caused by RA increases the risk for heart disease, notes the U.S. Centers for Disease Control and Prevention (CDC).

According to the American Heart Association (AHA), foods high in saturated fats — like cheese, red meat, and processed snacks made with saturated-fat-laden oil — can raise cholesterol and increase the risk for heart disease and stroke. These unhealthy fats are linked to inflammation, according to the Arthritis Foundation.

Limiting unhealthy saturated fat is important for heart health, and doing so may also help people with RA find some symptom relief, Dr. Salge Blake says.

988

Salty, Sodium-Rich Foods

Shutterstock

Sodium also increases stress on your heart by holding extra fluid in your body, which can raise your blood pressure, the AHA says. Meanwhile, the corticosteroid medications that many people take to treat RA can also cause the body to retain sodium, notes the Arthritis Foundation.

Salge Blake recommends trying to limit the amount of sodium you consume to 1,500 milligrams (mg) each day. “Americans, on average, are consuming over 3,000 mg daily, so try to ratchet your intake down a bit,” she says. And beware when ordering in or eating out: According to the AHA, Americans get most of their salt from processed foods and restaurant meals.

989

Sugary Foods and Drinks

High-sugar diets may also play a role in developing and worsening autoimmune conditions like RA. For instance, a 2021 review of existing studies recommended excluding sugar and sweeteners from your diet to reduce your risk for RA and inflammation-related symptoms. Although the findings to date don’t find that sugar causes RA, they do suggest there is a connection. Inspect food labels for sugar — remember it can also go by other names, such as fructose and sucrose.

990

Alcoholic Drinks

Gary S. Chapman/Getty Images

The Arthritis Foundation cautions that alcohol should be consumed only in moderation (less than one glass of wine or beer a day), if at all. Research in this area is ongoing, and some doctors may recommend even stricter limitations. Talk to your doctor about what is best for you.

However, research does show that heavy drinking may increase inflammation in the body, Salge Blake says. Many of the medications that help relieve joint pain don’t mix well with alcohol. These include nonsteroidal anti-inflammatory drugs (NSAIDs) which raise the risk for stomach problems such as bleeding and ulcers when you drink. And if you’re taking methotrexate (Trexall), you should avoid alcohol entirely to reduce your risk for liver damage. 

Additional reporting by Brian Dunleavy

Foods and Beverages to Avoid with Arthritis

Some foods and drinks may increase the risk of arthritis or make symptoms worse, for instance, highly processed foods and sweetened drinks.

If you have arthritis, making the right dietary choices can not only help manage your symptoms but also reduce the risk of complications, help boost your overall well-being, and improve your quality of life.

There are over 100 types of arthritis, but osteoarthritis (OA) is the most common. Other types include rheumatoid arthritis (RA), psoriatic arthritis (PsA), and gout.

They all involve some degree of inflammation.

What you choose to eat and drink with arthritis may affect your symptoms and overall well-being. Here, learn about some foods and beverages to avoid if you have arthritis.

1. Added sugars

Everyone can benefit from limiting their sugar intake, and especially if they have arthritis. Added sugars are found in candy, soda, ice cream, and numerous other foods, including barbecue sauce, salad dressings, and ketchup.

In a study involving 217 people with RA, participants noted that among 20 foods, sugar-sweetened soda and desserts seemed most likely to worsen their symptoms.

What to know about added sugars

2. Processed and red meats

Some research links red meat and processed meat to inflammation, which may increase arthritis symptoms.

For example, people who eat a lot of processed and red meats may have higher levels of interleukin-6 (IL-6), C-reactive protein (CRP), and homocysteine. These are markers of inflammation.

The study in 217 people with RA mentioned above also found that red meat commonly worsened RA symptoms.

A 2019 review concluded that plant-based diets that exclude red meat may improve arthritis symptoms.

Meanwhile, research published in 2022 found a link between a higher risk of RA and consumption of processed meats, compared with fish and seafood. However, the authors found no link between RA and red meat or poultry.

More research is needed.

Is it healthy to eat meat?

3. Gluten-containing foods

Gluten is a group of proteins in wheat, barley, rye, and other cereals. Some research has linked it to increased inflammation and suggests that going gluten-free may ease arthritis symptoms.

People with celiac disease also have a higher risk of RA than those without celiac disease.

Some limited research has suggested that a gluten-free, vegan diet might reduce disease activity and improve inflammation.

However, more research is needed to confirm whether a gluten-free diet will benefit people with arthritis.

Can gluten affect arthritis?

4. Highly processed foods

Ultra-processed items — such as fast food, breakfast cereal, and baked goods — tend to be high in refined grains, added sugar, preservatives, fructose, and other potentially inflammatory ingredients, all of which may worsen arthritis symptoms.

Research suggests that highly processed foods may increase your risk of RA by contributing to inflammation and obesity, which is also a risk factor for RA.

What’s more, in a study in 56 people with RA, those who ate higher amounts of ultra-processed food showed increased heart disease risk factors, including higher levels of glycated hemoglobin (HbA1c), a long-term marker of blood sugar control.

As such, processed foods may worsen your overall health and increase your risk of other diseases.

How to swap highly processed foods for healthier options

6. Certain vegetable oils

Diets high in omega-6 fats and low in omega-3 fats may worsen symptoms of knee pain, which is common with OA and RA.

These fats are necessary for health, but an imbalance may increase the risk of inflammation.

Omega-3 is present in oily fish, oily seeds, and green vegetables, while omega-6 occurs in margarines, vegetable shortening, and cooking oils such as corn and safflower.

Ensuring a balance between these types of oils may improve arthritis symptoms.

Tip: Use olive oil as an example of an oil that is low in omega-6 FA, while increasing fatty fish intake to help optimize omega-6 to omega-3 ratio.

Are vegetable and seed oils bad for you?

7. Foods high in salt

Cutting back on salt may be good for people with arthritis.

Foods high in salt include shrimp, canned soup, pizza, certain cheeses, processed meats, and numerous other processed items.

A 2019 mouse study found that arthritis was more severe in mice that consumed a high salt diet than in those whose diet had less salt.

Research has also suggested that a high sodium intake may be a risk factor for autoimmune diseases like inflammatory arthritis in people. One factor could be that salt stimulates immunological processes that lead to inflammation.

Meanwhile, a 2015 study linked a high sodium intake to an increased risk of RA. The study looked at data for 18,555 people.

How much salt do you need?

8. Foods high in AGEs

Dietary advanced glycation end products (AGEs) are molecules created through reactions between sugars and proteins or fats. They exist naturally in uncooked animal foods and are formed through certain cooking methods.

Foods that are high in AGEs include:

• high protein, high fat animal foods that are fried, roasted, grilled, seared, or broiled, such as:
  • bacon
  • pan-fried or grilled steak
  • roasted or fried chicken
  • broiled hot dogs
• fries
• American cheese
• margarine
• mayonnaise

When AGEs accumulate in high amounts in your body, oxidative stress and inflammation may occur. Oxidative stress and AGE formation are linked to disease progression in people with arthritis.

People with inflammatory arthritis — such as RA — may have higher levels of AGEs in their bodies than those without. AGE accumulation in bones and joints may play a role in the development and progression of OA.

Replacing high AGE foods with nutritious, whole foods like vegetables, fruits, legumes, and fish may reduce the total AGE load in your body.

What are AGE foods and how can you swap them out in your diet?

1. Red wine and other alcohol

It’s true that red wine contains resveratrol, an antioxidant that may have health benefits. However, any alcohol use has its downsides.

More research is needed to confirm the role that alcohol plays in arthritis, but scientists don’t recommend drinking alcohol as a way to prevent arthritis or manage its symptoms.

For instance:

• Drinking alcohol once a week or more may increase the risk of OA.
• Alcohol consumption increases levels of uric acid in the body, which can contribute to gout.
• A 2019 study suggested that alcohol intake may increase spinal structural damage in people with axial spondyloarthritis.
• Research from 2021 found a link between developing alcohol consumption and RA in females, although not in males.

In brief, it’s best to limit your alcohol consumption as it may worsen arthritis symptoms.

What’s the link between alcohol and RA?

2. Sugar-sweetened drinks

Sugary beverages, like sodas, may significantly increase your risk of arthritis.

In a study in 1,209 adults ages 20–30, those who drank fructose-sweetened beverages five times per week or more were three times likelier to have arthritis than those who consumed few to no fructose-sweetened drinks.

Drinks containing fructose may also lead to an increase in uric acid levels, which can worsen gout.

Sodas and other sweetened drinks contain sugar, aspartame, and phosphoric acid, which can also affect the body’s ability to absorb calcium, which is necessary for bone health.

Is fructose in fruit bad for you?

3. Coffee

According to the Arthritis Foundation (AF), it’s not clear whether coffee is good for people with arthritis or not. On the one hand, it contains antioxidants that may help reduce inflammation. On the other hand, people should be mindful of the caffeine content.

If you like a cup of coffee, it’s best to:

• consume no more than 1–2 cups per day
• avoid drinking coffee too soon before bedtime
• avoid adding too much sugar, syrup, or cream to coffee

How does caffeine affect your body?

4. Milk

Some people find that milk and other dairy products trigger an inflammatory reaction, but this is not true for everyone. If you can tolerate milk, it is a good source of vitamin D and calcium.

Choose low or zero-fat dairy products to lower the risk of weight gain and unhealthy fats.

What are the pros and cons of cow’s milk?

What foods make arthritis worse?

Foods that may make arthritis worse include highly processed foods, foods with added salt and sugars, foods high in advanced glycation end products (AGPs), such as bacon, and a diet with a high ratio of omega-6 fats to omega-3s.

What foods are good for arthritis?

A balanced diet that provides a range of antioxidants and other nutrients is most likely beneficial for anyone with arthritis. This means a focus on fresh fruits and vegetables, whole grains, and healthy oils, such as olive oil. Consider trying a Mediterranean Diet.

What fruits and vegetables are not good for arthritis?

Some people say that eggplants, tomatoes, potatoes, and peppers seem to worsen arthritis pain and inflammation. These are all part of the nightshade family and contain solanine. However, there is no scientific evidence to confirm this, and these foods offer a range of essential nutrients.

Some experts say that citrus fruits, such as lemons, may not be helpful, but other evidence suggests the flavonoids in citrus fruits may be beneficial due to their anti-inflammatory properties. More research is needed.

What are the 10 most inflammatory foods?

Foods may cause inflammation if they contain the following ingredients:

• added sugar, including fructose
• artificial sweeteners, such as aspartame
• saturated fats, for instance, in cheese and pizzas
• omega-6 fatty acids, present in many vegetable oils and salad dressings
• refined carbohydrates, present in white flour products, fries, and many breakfast cereals
• monosodium glutamate (MSG), a flavor enhancer
• gluten (for some people), present in wheat, barley, and rye products
• casein (for some people), present in dairy products
• alcohol
• fried or grilled meats, as they contain AGPs

Can you eat chicken with arthritis?

The AF recommends chicken as a substitute for red meat. Boiled chicken is the best option, as roasted or fried chicken can be high in AGEs, which can worsen inflammation. Some research from 2022 did not find any link between eating poultry and the risk of RA.

If you have arthritis, a healthy diet and lifestyle may help improve your symptoms.

Research suggests avoiding certain foods and beverages, including highly processed foods, red meat, fried foods, alcohol, and anything with added sugars.

Keep in mind that lifestyle factors like your activity level, body weight, and smoking status are also vital to managing arthritis.

Was this helpful?

Find a community that understands

There’s no reason to go through a psoriatic arthritis diagnosis or long-term journey alone. With the free PSA Healthline community, you can join a group and participate in live discussions, get matched with community members for a chance to make new friends, and stay up to date on the latest PsA news and research.

Join now!

Was this helpful?

Rheumatoid arthritis: do not neglect the diet!

Problem in brief

Rheumatoid arthritis develops as a consequence of a systemic immune-inflammatory response in genetically predisposed individuals under the influence of external and internal triggers, including food components. The main pathological processes in this disease include an intense inflammatory response with a violation of the mechanisms of regulation of immune processes and the production of various pro-inflammatory mediators. Studies of possible risk factors for the development of rheumatoid arthritis have traditionally focused on triggers such as microbial and viral agents, smoking, poor environment, hormonal imbalance and chronic stress, paying much less attention to nutritional factors, which in fact are potential initiators of the disease due to the activation of epigenetic mechanisms. However, recent research suggests that many habitual dietary components (such as table salt) activate various key mechanisms in the pathogenesis of rheumatoid arthritis.

Review published February 2018 in RMD Open on the role of nutrition in rheumatoid arthritis. Despite the emergence of a sufficient amount of data confirming the role of nutritional factors in the development of various chronic diseases, this issue is still controversial. The lack of a unified position among clinicians had a direct impact on the most active consumers of information about the role of diet – patients with rheumatoid arthritis themselves. The authors sought to update such an important issue, simultaneously summarizing the key scientific data. The work was supported by the European League Against Rheumatism.

Pro-Inflammatory Foods

The term “pro-inflammatory foods” is increasingly being used in dietary guidelines to reduce intake of long-chain omega-3 fatty acids and include more omega-6 polyunsaturated fatty acids in the diet. In animal experiments, it has been proven that high consumption of animal fats is not only associated with the risk of developing rheumatoid arthritis, but also increases resistance to various pharmacological agents. Most modern Western diets focus primarily on their role in preventing obesity, in which insulin resistance often develops, a disorder that surpasses the pathological role of pro-inflammatory cytokines in severity.

Limitations and recommendations

By itself, pharmacotherapy for rheumatoid arthritis (methotrexate use) is a factor that worsens the nutrition of patients due to side effects (nausea, stomatitis, dyspepsia, diarrhea, etc.). The iatrogenic malnutrition observed in this case creates a vicious circle in the development of rheumatoid arthritis. In addition, non-optimized use of glucocorticosteroids (exceeding the volume, duration of use and choice of treatment time) can lead to an increase in body weight and cause the development of diabetes mellitus. Therefore, rheumatologists should encourage patients to reduce their carbohydrate intake during corticosteroid treatment.

During pregnancy, when hormonal changes are inevitable, in patients with obvious epigenetic signs of rheumatoid arthritis, adherence to the Mediterranean diet can reduce the risk of developing metabolic syndrome.

The use of tumor necrosis factor inhibitors as a therapy for rheumatoid arthritis is gradually becoming the standard treatment for this disease. However, despite the impressive potential of this therapy, its consequences can be an increase in body weight and metabolic disorders.

Microbiome and Diet

Microbiome modification in rheumatoid arthritis, both in animal and clinical models, is recognized as a potential therapeutic option. For example, probiotics have been shown to reduce blood levels of interleukin-6. Probiotics contain live healthy bacteria such as Bifidobacteria, Bacteroides-Porphyromonas-Prevotella, Bacteroides fragilis , and Eubacterium recttale-Clostridium coccoides , which are significantly reduced in the gut microbiome of patients with rheumatoid arthritis. On the contrary, bacteria such as Prevotella copri , were found in 75% of patients with newly diagnosed rheumatoid arthritis, and are currently considered a trigger for this disease.

A healthy diet rich in dietary fiber helps normalize the intestinal microbiome, reduce immune reactivity and reduce systemic inflammation. In this context, one of the main metabolites of dietary fiber fermentation under the influence of intestinal microflora – short-chain fatty acids – are considered as an anti-inflammatory factor for the immune system and intestinal epithelium.

Vitamin D

One of the important aspects of nutrition in rheumatoid arthritis, based on the principles of evidence-based medicine, is the balance of vitamin D. in the skin when exposed to ultraviolet rays), a more acceptable practice for supplementing vitamin D levels is through a dietary supplement. Recent studies suggest that an additional high intake of vitamin D and omega-3 fatty acids throughout the year in patients with rheumatoid arthritis is associated with better follow-up treatment outcomes.

Rheumatoid cachexia/anorexia

In fact, any continuous, uncontrolled or chronic inflammatory process in rheumatoid arthritis presumably leads to a change in body composition – sarcopenia. Rheumatoid cachexia, although rarely observed due to balancing body weight with adipose tissue, is still a poor prognostic criterion. About 75% of patients with rheumatoid arthritis report a relationship between nutrition and the severity of their symptoms; about 50% resorted to dietary modification in an attempt to alleviate symptoms.

Another cause of cachexia/anorexia in patients with rheumatoid arthritis may be associated psychiatric disorders that can affect their lifestyle and have detrimental consequences. In this regard, nutritional supplements consisting of various amino acids, sources of neurotransmitters, which, in turn, contribute to the regression of depression and other manifestations of mental disorders, are useful. This highlights the importance of personalized dietary advice.

Pins

Thus, the importance of nutrition in rheumatoid arthritis is due to a number of factors that affect the progression and outcome of the disease. Considering that not all patients seek specialized advice from a nutritionist, as well as the complexity of multidisciplinary cooperation, monitoring the state of the musculoskeletal system in rheumatoid arthritis often becomes the responsibility of a rheumatologist.

Alexander Guziy

How to eat with rheumatoid arthritis to reduce pain and stiffness in the joints

What is important to know about nutrition in rheumatoid arthritis

1. Nutrition for rheumatoid arthritis is one of the tools that, in combination with medication and a healthy lifestyle, can alleviate the condition. But it is impossible to cure with the help of diet alone.
2. 
   Almost all scientific evidence about foods or diets is hypotheses that require further research. There is no unambiguously proven benefit from any product.
3. After the introduction of a new product in the diet, inflammation may worsen. If this occurs, discontinue the product and inform your healthcare professional.

What Diet Really Affects

Properly chosen diet, which was compiled by the doctor taking into account the characteristics of the patient’s body, can help reduce inflammation, reduce pain and compensate for the deficiency of vital elements. The table shows the benefits of a proper diet for rheumatoid arthritis.

Is fasting good for rheumatoid arthritis? Here’s what some studies say:
, began to feel better – pain, inflammation and morning stiffness decreased. This was confirmed by laboratory indicators of inflammation [4].

👉 A 2020 review found that a low-calorie diet can reduce symptoms of rheumatoid arthritis by inhibiting the activity of the NLRP3-inflammasome, one of the molecules that triggers the inflammatory response. And improving well-being during fasting is a short-term effect that does not affect the disease itself in any way [5].

👉The authors of the 2020 systematic review of nutrition in rheumatoid arthritis do not recommend total fasting . Even though patients on low-calorie diets felt better, this may be a placebo effect. Further research is needed [6].

​Doctor’s commentary: Nutrition for rheumatoid arthritis

How to know which foods are compatible with your therapy

The best question to ask is your doctor. Information about the products can be found in the instructions for the medicinal product:

• In the sections “Special Instructions” or “Drug Interactions” there will be a list of products that are not recommended to be taken with the drug.
• The section “Method of application” tells how to take the drug with food. It depends on how well the medicine is absorbed and how quickly the therapeutic effect comes.

Tea, coffee, and energy drinks should not be taken while taking certain anticancer drugs because they contain the psychoactive substance theophylline. The drug reduces the ability of the kidneys to excrete theophylline, which can lead to an overdose: headache, insomnia, irritability, and heart rhythm disturbance will appear.

Manufacturers of genetically engineered biologicals recommend avoiding alcohol during treatment to avoid liver toxicity and other side effects.

Meat

Active inflammation increases protein consumption. Therefore, with rheumatoid arthritis, patients have a protein deficiency in the body. Meat contains many amino acids and proteins that can make up for this deficiency. Clinical guidelines and English-language studies recommend eating meat for rheumatoid arthritis. Boiled, stewed, steamed or in the oven.

There are conflicting opinions about the benefits of red meat, but there is no direct evidence that it can worsen well-being [2].

Fish

Oily fish contains omega-3 polyunsaturated fatty acids, which inhibit the synthesis of substances that cause inflammation, – prostanoids (PGE2), leukotrienes (LTB4), eicosanoids. Scientists suggest that in patients who eat oily fish several times a week, disease activity decreases [11, 8]. The following types of fish were studied in the studies:

• trout;

• sardines;

• salmon;
• sea ​​bass;
• mackerel.

Fruits, vegetables and berries

It is assumed that the more fruits, vegetables and berries in the diet, the inflammation is less pronounced . In patients who took blueberry juice along with drugs, the content of interleukin-1 alpha and beta decreased. This is another substance responsible for inflammation. And also increased the content of interleukin receptor antagonists. In patients taking citrus extracts, pain decreased and the level of C-reactive protein , which is produced in the acute phase of inflammation, decreased. Green leafy vegetables, such as spinach, also reduced symptoms. In addition, they are rich in folic acid, a deficiency of which is observed in rheumatoid arthritis. However, in two studies, patients experienced worsening of symptoms after adding tomatoes to their diet [8].

Dairy products

Dairy products are a source of protein, calcium and vitamin D [8]. So they can to prevent the destruction of bone tissue that accompanies arthritis [1].

Nuts

Nuts are thought to reduce inflammation because they contain polyphenols and monounsaturated fatty acids. There are no clinically relevant studies demonstrating the benefits of nuts in rheumatoid arthritis [8].

Spices

Adding cinnamon, ginger, red pepper and turmeric to the diet is believed to reduce pain and inflammation . Experiments with animals showed positive results [8].

Coffee and tea

Studies have shown that patients who drink coffee do not feel worse . All assumptions that coffee can increase inflammation and morning stiffness in the joints have not been confirmed [8].

Legumes

A diet that includes legumes, oily fish, green leafy vegetables and fruits has shown good results – patients have decreased inflammation attacks [10].

Olive oil

Scientists suggest that olive oil, which contains various types of fatty acids, polyphenols and vitamin E, can reduce inflammation [10].

Salt

Salt is supposed to activate the cells that trigger the inflammatory response. Therefore, 90,047 study authors recommend that 90,050 patients with rheumatoid arthritis consume less salt [8].

Sugar

Patients with rheumatoid arthritis have an increased risk of developing diabetes, myocardial infarction and stroke. Therefore, scientists recommend to refuse or reduce sugar in the diet to prevent cardiovascular diseases [8].

Alcohol

In 2013, scientists tried to prove the benefits of alcohol in rheumatoid arthritis, but the study failed [9]. The Arthritis Foundation of the United States does not recommend drinking alcohol because it is enhances inflammation reactions and worsens the condition of patients with autoimmune diseases [4]
.