Palindromic rheumatism (PR) is a rare type of inflammatory arthritis characterized by sudden, recurring attacks of joint pain and swelling. Between these attacks, symptoms disappear, and the affected joints return to normal without lasting damage. Although there is no cure for arthritis, including PR, medical treatment and lifestyle changes, including dietary adjustments, can help manage symptoms and improve quality of life. Foods rich in anti-inflammatory nutrients may help with gout and other types of inflammatory arthritis. However, diet alone cannot cure or treat arthritis or gout.
This article explores dietary recommendations for individuals with palindromic rheumatism, drawing on research related to inflammatory arthritis and anecdotal evidence linking specific foods to PR flare-ups.
The Role of Diet in Inflammatory Arthritis
Several types of arthritis, including gout and rheumatoid arthritis (RA), involve inflammation in the body. Controlling inflammation could lead to a reduction in the severity of symptoms. Evidence suggests that certain diets may have an anti-inflammatory effect. Diets focusing on whole foods and including fewer processed foods and meats may help reduce inflammation. A balanced diet includes plenty of vegetables, fruits, whole grains, fatty fish, and olive or other plant-based oils. Diets that focus on these changes may positively affect inflammation and make joints feel and function better.
The Arthritis Foundation suggests that eating a Mediterranean diet is a good way to boost overall health and reduce inflammation due to its focus on whole foods. Several studies have shown evidence of the Mediterranean diet’s positive effect on inflammation. A 2021 study suggested this diet was associated with lower inflammation in older adults. A 2020 meta-analysis noted that diets, such as the Mediterranean diet, that focus on eating vegetables, fruits, and olive oil while limiting meat intake can help with inflammation.
Identifying Trigger Foods in Palindromic Rheumatism
Sixteen patients (10 males, 6 females) were diagnosed as having PR during 1994-8 in one center. Their mean age was 45 +/- 6, duration of symptoms prior to diagnosis was 4 +/- 1.4 years, and frequency of PR attacks were 3.1 +/- 1.8/month. All patients were instructed to make a list of the food that was consumed daily and to specify the dates of PR episodes. In 5 patients (31%) there was an association between episodes of PR and certain foods that were consumed within 36 hours prior to PR episodes. These were fish (2 patients), eggs, canned vegetables and processed cheese (each in one case). Elimination of the relevant food from each patient's diet resulted in complete cessation of the PR attacks in two of the cases, while the other three had milder, infrequent attacks. Four patients were rechallenged with the offending food. In all cases it resulted in recurrence of the PR attacks. In some PR patients ingestion of certain foods, specific for each case, can trigger the typical attack.
Read also: The Hoxsey Diet
Anti-Inflammatory Foods to Incorporate
While individual foods may have a small anti-inflammatory effect, for best results, a person can focus on their diet as a whole rather than just adding a few foods to their regular diet.
Here are some foods that may be beneficial:
Fatty Fish
People who follow a Mediterranean diet include oily or fatty fish, like salmon or tuna, as part of their regular diet. Studies have shown that the fatty acids found in these fish may help reduce overall inflammation. A 2018 study concluded that people with RA who consumed fish twice or more weekly had significantly lower disease activity scores than people who never consumed fish or ate it less than once per month. Eating fatty fish regularly may help reduce inflammation in people with RA. However, people with gout should focus on eating low purine-rich fish. Moreover, they should only occasionally eat moderate purine-rich fish which include: mussels, scallops, shrimp, crab, oysters, squid, lobster. Grilled Salmon with Vegetables: Salmon is rich in omega-3 fatty acids, which have anti-inflammatory properties. Pair it with a side of steamed or roasted vegetables for a nutritious meal.
Olive Oil
Olive oil is a staple of the Mediterranean diet. It may help with inflammation throughout the body. The Arthritis Foundation notes olive oil contains certain chemicals that may reduce the inflammatory response, similar to ibuprofen. A 2018 study examined olive oil’s anti-inflammatory properties and its effects on the heart. Researchers noted olive oil might be helpful for inflammation and heart health. However, they also noted that many studies are poorly designed and insufficient to fully prove olive oil’s effects. Use olive oil instead of other oils and fats. In addition to healthy monounsaturated fat, it contains a compound called oleocanthal that reduces inflammation and acts like ibuprofen in alleviating pain.
Berries
Berries contain polyphenol compounds, which may have beneficial anti-inflammatory effects. They also provide several vitamins, minerals, and antioxidants that protect the body against free radicals - molecules that can damage cells and organs. A 2018 journal article highlights research suggesting that the polyphenols in blueberries, raspberries, strawberries, and pomegranates may help reduce pain and inflammation in people with arthritis. A study from the same year asked people with RA to say how certain foods affected their RA. Blueberries and spinach were the most likely to improve symptoms. The Arthritis Foundation recommends that people with gout eat cherries to lower their risk of gout flare-ups. The anthocyanins in the fruit - the pigments that give them their purple-red color - have antioxidant and anti-inflammatory properties. When it comes to fruit in general, people with gout may wish to consume moderate amounts. The results of research into the effects of fruit sugar, or fructose, on uric acid levels are mixed. Some studies report an association between gout and eating fruit, while others show a lowered risk of gout. People can try to include several types of fresh or frozen berries in their daily diet to benefit from their nutrients. Fresh Fruit: Berries, oranges, and apples are easy to grab and packed with vitamins and antioxidants that can help reduce inflammation.
Read also: Walnut Keto Guide
Citrus Fruits
The nutrients in citrus fruit may play a role in limiting oxidative stress and helping reduce inflammation. Citrus fruits, such as oranges, lemons, and grapefruits, are good sources of folate, vitamin C, and other vitamins and minerals. The Arthritis Foundation states that vitamin C decreases uric acid levels and may help prevent gout flares. Grapefruits and oranges are high in vitamin C but low in fructose, which contributes to higher uric acid levels. Studies suggest consuming at least 500 milligrams of vitamin C per day, according to the Arthritis Foundation.
Green Tea
People can drink green tea hot or cold, take it as a supplement, or add green tea powder to smoothies and other foods. A major component of it, epigallocatechin-3-gallate (EGCG), may help with inflammation. According to a meta-analysis from 2016, researchers found that EGCG may help reduce inflammation in the body. Researchers noted that additional studies are necessary to fully understand EGCG’s impact on inflammation and its potential for people with inflammatory arthritis and gout. A 2016 study examined the effects of green tea on RA symptoms and disease markers in older adults. People who took green tea supplements - either alone, with exercise, or with the drug infliximab - showed significant improvement in RA symptoms and other disease markers.
Broccoli
Broccoli is a dark green cruciferous vegetable that contains vitamins A and C and phytonutrients. Phytonutrients are compounds from plants that may help reduce inflammation and the risk of developing cancer. Broccoli also contains a compound called sulforaphane. Sulforaphane may help block the inflammatory process and slow cartilage damage in people with osteoarthritis. Eating plenty of cruciferous vegetables may also prevent RA from developing.
Whole Grains
According to a 2018 meta-analysis, consuming whole grains can help reduce systemic inflammation. However, additional studies are needed to fully understand its effects. Whole grains provide fiber, protein, and other nutrients. Common examples of whole grains include: oats, quinoa, barley, brown rice. Oats, whole wheat, brown rice, quinoa and other whole grains may lower levels of CRP and reduce the risk of heart disease, which is elevated in people with RA. Whole grains are higher in nutrients and fiber than refined grains. Plus, many products with refined grains contain ingredients that are not healthful, such as added sugars and saturated fats. Quinoa Salad with Mixed Greens: Quinoa is a great source of protein and fiber, and mixed greens provide essential vitamins and antioxidants. Look for salads with a variety of colorful vegetables.
Beans
Beans provide fiber and protein with minimal fat. They have several nutrients that can promote heart health, help with weight management, and reduce inflammation. People can include beans in cooked dishes, blend them into dips, and add them to a salad. Peas and beans. These legumes are a great source of protein, which is important for muscle health - and people with RA are prone to muscle loss. What’s more, peas and beans are practically fat free, contain antioxidants, and some are rich in folic acid, magnesium, iron, zinc and potassium, all known for their heart and immune-system benefits.
Read also: Weight Loss with Low-FODMAP
Alliums
Garlic, onions, leeks, and shallots are members of the allium family, which contain the antioxidant quercetin. Research is underway to investigate whether quercetin can reduce inflammation in conditions such as RA. According to the Arthritis Foundation, alliums also contain diallyl disulfide, which may reduce cartilage-damaging enzymes. They also add flavor to dishes, making them easy to include in the diet.
Nuts
Full of healthful monounsaturated fat, nuts are recognized for their heart-protective properties and important nutrients. Try pine nuts, pistachios, hazelnuts and almonds. Walnuts are particularly good for people with RA because they’re high in omega-3 fatty acids. Nuts and Seeds: Almonds, walnuts, and chia seeds are great sources of healthy fats and protein. They can provide a quick energy boost and help manage inflammation.
Foods to Limit or Avoid
People with gout often have high levels of uric acid, which results from the breakdown of purines in foods such as red meat, organ meat, and some seafoods. It is important to note that while certain foods may help manage inflammation, a person is unlikely to get their desired results by simply replacing or adding a few anti-inflammatory foods.
Consider limiting or avoiding the following:
- Alcohol, such as beer and liquor
- Soda
- Organ meats
- Some fish and seafood including anchovies, sardines, herring, mussels, codfish, scallops, trout, and haddock
Additional Lifestyle Strategies
In addition to dietary changes, people may find that other lifestyle strategies may help support their joints and minimize symptoms. Some of these include:
- Being physically active
- Maintaining a moderate weight
- Choosing low impact activities, exercises, and sports, such as swimming or walking
- Reducing and managing stress
- Getting plenty of quality sleep and rest
Practical Meal and Snack Ideas
Here are some specific meal and snack ideas incorporating anti-inflammatory foods:
- Grilled Salmon with Vegetables: Salmon is rich in omega-3 fatty acids, which have anti-inflammatory properties. Pair it with a side of steamed or roasted vegetables for a nutritious meal.
- Quinoa Salad with Mixed Greens: Quinoa is a great source of protein and fiber, and mixed greens provide essential vitamins and antioxidants. Look for salads with a variety of colorful vegetables.
- Chicken and Vegetable Stir-Fry: Opt for a stir-fry with lean chicken and a mix of vegetables like broccoli, bell peppers, and snap peas. This dish is packed with nutrients and low in unhealthy fats.
- Lentil Soup: Lentils are high in protein and fiber, making them a great choice for sustained energy. A hearty lentil soup with vegetables can be both comforting and nutritious.
- Avocado and Tomato Sandwich: Avocados provide healthy fats, while tomatoes are rich in antioxidants. Choose whole grain bread for added fiber and nutrients.
- Fresh Fruit: Berries, oranges, and apples are easy to grab and packed with vitamins and antioxidants that can help reduce inflammation.
- Nuts and Seeds: Almonds, walnuts, and chia seeds are great sources of healthy fats and protein. They can provide a quick energy boost and help manage inflammation.
- Greek Yogurt: Plain Greek yogurt is high in protein and probiotics. Add some fresh fruit or a drizzle of honey for a delicious and nutritious snack.
- Vegetable Sticks with Hummus: Carrot and celery sticks paired with hummus make for a crunchy and satisfying snack that's rich in fiber and healthy fats.
- Oatmeal: A bowl of oatmeal topped with nuts, seeds, and fresh fruit can provide sustained energy and help reduce inflammation.
Meal Prepping for Easier Management
Meal prepping can be a lifesaver on tough days. Here are five anti-inflammatory meals you can prepare in advance and store in your freezer:
- Turkey and Vegetable Chili: Packed with lean protein, fiber, and anti-inflammatory spices.
- Lentil and Vegetable Stew: High in fiber, protein, and anti-inflammatory nutrients.
- Quinoa and Black Bean Stuffed Peppers: Rich in plant-based protein, fiber, and antioxidants.
- Baked Salmon with Sweet Potatoes and Broccoli: High in omega-3 fatty acids, fiber, and vitamins.
- Chickpea and Spinach Curry: Rich in protein, fiber, and anti-inflammatory spices.
Remember to label and date each container, divide meals into individual portions, and use freezer-safe containers or bags to prevent freezer burn.
Stocking a Palindromic Rheumatism-Friendly Pantry
Keeping your pantry stocked with healthy, quick, and easy-to-grab foods is a great way to ensure you always have nutritious options on hand. Here are some staples you might consider:
- Whole Grains: Oats, Quinoa, Brown Rice, Whole Grain Pasta
- Canned or Packaged Goods: Canned Beans, Canned Tuna or Salmon, Canned Tomatoes, Nut Butters
- Nuts and Seeds: Almonds, Walnuts, Chia Seeds, Flaxseeds
- Snacks: Whole Grain Crackers, Dried Fruits
- Cooking Essentials: Olive Oil or Coconut Oil, Spices and Herbs
- Beverages: Green Tea, Herbal Teas
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