Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the joints, causing pain, swelling, and stiffness. Individuals with RA often express concerns about weight gain. This article explores factors contributing to this, from the disease itself to its management.
How Rheumatoid Arthritis Can Lead to Weight Gain
Chronic systemic inflammation, a hallmark of rheumatoid arthritis, significantly impacts metabolism. Inflammatory proteins like tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) can alter metabolic processes, influencing how the body stores fat and expends energy, potentially leading to increased fat accumulation.
Individuals with RA frequently experience persistent pain and debilitating fatigue, which can reduce physical activity levels. This decreased movement results in lower calorie expenditure, making weight gain more likely. Reduced physical activity can also lead to muscle loss, contributing to a slower metabolism.
Another aspect is rheumatoid cachexia, a condition where muscle mass is lost, but fat mass is maintained or even increased. This can lead to a higher body fat percentage without significant overall weight change. Rheumatoid cachexia is common in people with RA, affecting up to two-thirds of patients, and it can contribute to weight gain by altering body composition.
Medications and Weight Changes
Medications used to manage rheumatoid arthritis can also play a role in weight changes. Corticosteroids, such as prednisone, are potent anti-inflammatory drugs frequently prescribed for RA. These medications are known to cause increased appetite, fluid retention, and changes in fat distribution, often resulting in a rounded face (moon face) or fat deposits around the neck and upper back (buffalo hump).
Corticosteroids influence the body’s electrolyte and water balance and alter how it processes and stores carbohydrates, proteins, and fats. This can lead to significant weight gain, especially with higher doses or long-term use. Studies indicate that approximately 70% of individuals taking oral corticosteroids for more than 60 days report weight gain.
Other disease-modifying antirheumatic drugs (DMARDs), including certain biologics and conventional DMARDs like methotrexate, may also be associated with modest weight gain. Some research suggests that a slight weight gain with biologics might indicate reduced disease activity, indicating effective treatment. For most people, the weight changes associated with these medications are typically a few pounds, far less than those seen with corticosteroids.
Managing Weight with Rheumatoid Arthritis
Healthy eating principles can help manage weight with RA. Emphasizing nutrient-dense foods, controlling portion sizes, and reducing processed foods are beneficial. A Mediterranean-style diet, rich in vegetables, fruits, whole grains, and healthy fats from sources like olive oil and fish, may help reduce inflammation and support weight management.
Regular physical activity is important, even with the challenges of pain and fatigue. Low-impact activities, such as walking, swimming, cycling, tai chi, and yoga, can improve joint function and help with weight management. Strength training, using light weights or resistance bands, can also preserve muscle mass and improve overall fitness.
Open communication with healthcare providers, including rheumatologists, is helpful for discussing weight concerns and medication side effects. A physical therapist can assist in developing a safe and effective exercise plan tailored to individual needs and limitations. Consulting a registered dietitian can provide personalized dietary guidance.
Lifestyle factors like adequate sleep and stress management also influence weight and overall well-being. Prioritizing good sleep habits and employing stress-reducing techniques can contribute to better health outcomes. These combined strategies can support individuals with RA in managing their weight effectively.