A rheumatic disease, or what is commonly called as arthritis is the inflammation of the joints and also affects the skeletal muscles, bones, ligaments, cartilages and tendons for both males and females (Smeltzer & Bare).
The goals and strategies involved in the treatment of the disease consists of suppressing the inflammation and the autoimmune response of the patient through pharmacologic therapy, controlling the patient’s pain by joint protection and easing pain with splint use, thermal modalities and relaxation techniques, and maintenance or improvement of the joint’s mobility through the implementation of exercise programs for joint motion and strengthening the muscles and the patient’s overall health (Smeltzer & Bare).
In addition, other goals and strategies include the maintenance or improvement of the patient’s functional status through utilization of adaptive techniques and devices, increasing the patient’s knowledge of the disease process by providing and reinforcing patient teaching, and promotion of self-management by the patient’s compatibility with the therapeutic regimen by emphasizing this compatibility (Smeltzer & Bare). Pharmacologic treatment for patients with this disease includes medications like salicylates, NSAIDS, and disease – modifying antirheumatic drugs (Kee, Hayes, and McCuistion).
However, given that the patient does not want to take any pharmacologic measures, dietary manipulation will be utilized and this involves the exclusion of food items in the diet and the intake of specific minerals. However, dietary manipulation is not greatly acknowledged as one of the therapeutic management for arthritis, mainly because there are no enough researches that can prove its efficiency (Rayman and Pattison). However, some research show that around 30% to 40% of the rheumatoid patients can benefit from excluding foods individually identified during the reintroduction phase of an elimination diet.
Albeit it might be mentioned in passing during a nurse’s health teaching on which food items to avoid, which to eat in moderation, and which to eat in great amounts, there is no wide acceptance of this strategy yet (Rayman and Pattison). Several therapeutic diets are available for use by patients with rheumatoid arthritis. The exclusion diet, the elemental diet, the fasting and vegan diet, and the Mediterranean diet, are among them.
The exclusion diet is based on the evidence that the removal of certain food items in the patient’s diet can benefit the patient as evidenced by 36% of the patients claimed that they were much better after the food exclusions and 39% asserted feeling better, after the study that was conducted (Rayman and Pattison). These were supported with objective measurements that showed a decrease in pain and in the number of painful joints, a reduction in morning stiffness, a decrease in the time it took to walk 20 yards, improvement in grip strength, among many others (Rayman and Pattison).
Some of the food items that cause worse symptoms are corn, wheat, bacon or pork, oranges, milk, eggs, and beef (Rayman and Pattison). The elemental diet requires the intake of monosaccharide and disaccharides, amino acids, and medium-chain triglycerides, with the addition of vitamin and mineral supplements (Rayman and Pattison). This diet has shown to stimulate enhancements in the subjective measures of arthritis symptoms and it was asserted that when weaned from the diet the usual symptoms return. However, the effectiveness of the diet is surpassed by the poor tolerance of the patients.
The fasting and the vegan diet seems to have an anti-inflammatory effect and offers relief of pain during fasting and the presence of pain when eating is resumed (Rayman and Pattison). Hence, fasting is followed by a vegan diet as an alternative. The ‘Mediterranean diet’ is named as such because it reflects the certain patterns of eating that is employed by countries in the Mediterranean basin and it is comprised of plant foods like fruits, vegetables, wholegrain cereals, fish and poultry with the olive oil as the main source of lipid (Rayman and Pattison).
Several reasons can explain why these diets can help alleviate symptoms in a patient with rheumatoid arthritis. The food items that are to be eliminated are those in which the patient is allergic or intolerant to and can reduce IgG antibody levels and moreover, reduction in food intake can help decrease gastrointestinal permeability to bacteria and other antigens (Rayman and Pattison). In addition, the change in the gut’s flora and the exclusion of lectins in legumes can also help alleviate the symptoms.
The 50 year old patient suffering from rheumatoid arthritis can be given one of the aforementioned dietary manipulations if she chooses not to take anti-inflammatory, immunosuppressive medication. The diet that can best fit her would be the fasting or vegan diet because of its anti-inflammatory effect that can serve as an alternative to the drugs that the patient is not taking. The patient would be advised to fast and to follow fasting by a pure vegetarian diet.
This diet is to exclude all kinds of meat which includes fish and chicken meat, and all other products that are made from animals, like eggs, cheese, milk, and honey (Kovacs). It is first best to inform that patient of all the other dietary manipulations that are available for patients with rheumatoid arthritis and justify the selection chosen for the patient and how this will help alleviate her symptoms and can somehow be an alternate to taking drugs. However, the patient should be notified of the possible side effects of this diet and the consequences of not taking the recommended drugs to her illness.
Given her vegan diet, it is still needed that the patient consume and have a balanced diet. The patient should be given a diet plan which consists of the proper balance of protein, carbohydrates, fruits and vegetables. The most common vegan food that can be utilized for the patient’s diet are tofu, black-eyed peas, broccoli, soy yogurt or milk, Spinach and whole wheat bread, among many others (Kovacs). These can supply the adequate protein needs of the patient and hence, she can still receive a balanced diet in spite of having utilized the vegetarian diet.
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