Diet quality and its relationship with pain in patients with rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease that predominantly affects the joints, leading to progressive functional decline. It is often associated with rapidly progressing weight loss, sarcopenia, and malnutrition—particularly in older adults—as well as with psychosocial disturbances. In this context, dietary quality emerges as a key modulator in both disease progression and pain perception. This case report presents a 59-year-old female with a 20-year history of RA, currently under pharmacological treatment with methotrexate, celecoxib, and tramadol, and undergoing physiotherapy with irregular adherence. Despite presenting with a body mass index (BMI) of 28.2 kg/m², she is underweight due to a significant weight loss of approximately 21% of her usual body weight over the past two years. She exhibits partial edentulism, reduced appetite, and insufficient caloric and protein intake. Clinical signs of sarcopenia were observed, along with a poor dietary intake in terms of quality, quantity, and diversity—particularly low in dietary fiber, omega-3 fatty acids, and anti-inflammatory foods such as oily fish, seeds, and vegetables. Pain was assessed using the West Haven-Yale Multidimensional Pain Inventory (WHYMPI), which revealed severe pain levels, low engagement in social activities, and minimal caregiver support—factors contributing to a deteriorated emotional state. This study explores dietary therapy alternatives aimed at effective pain management and improving nutritional status, while preventing further complications. These strategies are intended to complement ongoing pharmacological and rehabilitative treatments.