Clinical Rheumatology

, Volume 6, Issue 3, pp 391–398 | Cite as

Malnutrition in rheumatoid arthritis

  • R. CollinsJr.
  • T. L. Dunn
  • J. Walthaw
  • P. Harrell
  • G. S. Alarcon


A nutrition study was conducted in thirty-eight hospitalized rheumatoid arthritis (RA) patients. Twenty-seven (71.1%) had a high likelihood of malnutrition (LOM). Laboratory and anthropometric data suggest that multiple vitamin, calory, and protein deficiencies are present. Age, female sex and a poor grip strength correlated with some indices of malnutrition. Fifteen of 18 patients with a high LOM had a bad outcome whereas 3 of 7 patients with a low LOM had a bad outcome. Malnutrition per se may be a contributing factor to increased morbidity and mortality in RA.

Key words

Rheumatoid Arthritis Malnutrition Anthropometrics 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Weinsier, R.L., Hunker, E.M., Krumdieck, C.L., et al. Hospital malnutrition: a prospective evaluation of general medical patients during the course of hospitalization. Am J Clin Nutr 1979, 32, 418–426.Google Scholar
  2. 2.
    Hunter, A.M.B., Carey, M.A., Larsh, H.W. The nutritional status of patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1981, 124, 376–381.Google Scholar
  3. 3.
    Nixon, D.W., Heymsfield, S.B., Cohen, A.E. Protein-calorie under-nutrition in hospitalized patients. Am J Med 1980, 68 683–690.Google Scholar
  4. 4.
    Bayles, T.B., Richardson, H., Hall, F.C. The nutritional background of patients with rheumatoid arthritis. N Engl J Med 1943, 229, 319–324.Google Scholar
  5. 5.
    Hall, F.C., Myers, W.K. Diet in chronic arthritis. Arch Intern Med 1935, 55, 403–410.Google Scholar
  6. 6.
    Eising, L. Dietary intake in patients with arthritis and other chronic diseases. J Bone Joint Surg 1963, 45–1, 69–81.Google Scholar
  7. 7.
    Robinson, W.D., Block, W.D. Protein metabolism in rheumatoid arthritis. J Lab Clin Med 1947, 32, 1551–1552.Google Scholar
  8. 8.
    Helliwell, M., Coombes, E.J., Moody, B.J., Batstone, G.F., Robertson, J.C. Nutritional status in patients with rheumatoid arthritis. Ann Rheum Dis 1984 43, 386–390.Google Scholar
  9. 9.
    Emery, P., Panayi, G., Symmons, D., Brown, G. Mechanisms of depressed delayed-type hypersensitivity in rheumatoid arthritis: the role of protein energy malnutrition. Ann Rheum Dis 1984, 43, 420–434.Google Scholar
  10. 10.
    Burnham, R., Russell, A.S. Nutritional status in patients with rheumatoid arthritis. Ann Rheum Dis 1986, 44, 788–789.Google Scholar
  11. 11.
    Sun, D.C.H., Roth, S.H., Mitchell, C.S., et al. Upper gastrointestinal disease in rheumatoid arthritis. Am J Dig Dis 1974, 19, 405–410.Google Scholar
  12. 12.
    Pettersson, T., Wegelius, O., Skrifvars, B. Gastrointestinal disturbances in patients with severe rheumatoid arthritis. Acta Med Scand 1970, 188, 139–144.Google Scholar
  13. 13.
    Dyer, N.H., Kendall, M.J., Hawkins, C.F. Malabsorption in rheumatoid arthritis. Ann Rheum Dis 1971, 30, 626–630.Google Scholar
  14. 14.
    A Committee of the American Rheumatism Association: 1958 Revision of Diagnostic Criteria for Rheumatoid Arthritis. Arthritis Rheum 1959, 2, 16–20.Google Scholar
  15. 15.
    Ritchie, D.M., Boyle, J.A., McInnes, J.M., et al. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med 1968, 37, 393–406.Google Scholar
  16. 16.
    Kellor, M., Frost, J., Silberberg, N., et al. Hand strength and dexterity: norms for clinical use. Am J Occup Ther 1971, 25, 77–83.Google Scholar
  17. 17.
    Steinbrocker, O., Traeger, C.H., Batterman, R.C. Therapeutic criteria in rheumatoid arthritis. JAMA 1949, 140, 659–662.Google Scholar
  18. 18.
    Heymsfield, S.B., McManus, C., Stevens, V., et al. Muscle mass: reliable indicator of protein-energy malnutrition severity and outcome. Am J Clin Nutr 1982, 35, 1192–1199.Google Scholar
  19. 19.
    Bishop, C.W., Bowen, P.E., Ritchey, S.J. Norms for nutritional assessment of American adults by upper arm anthropometry. Am J Clin Nutr 1981, 34, 2530–2539.Google Scholar
  20. 20.
    Weight and Height of Adults 18–74 Years of Age: United States, 1971–1974. National Health Survey, U.S. Department of Health, Education and Welfare, 1979, pp. 16–35.Google Scholar
  21. 21.
    Frisancho, A.R., Flegel, P.N. Relative merits of old and new indices of body mass with reference to skinfold thickness. Am J Clin Nutr 1982, 36, 697–699.Google Scholar
  22. 22.
    Recommended Dietary Allowances, National Academy of Sciences, Ninth Edition, Washington, D.C., 1980. pp. 46–50.Google Scholar
  23. 23.
    Mahalko, J.R., Johnson, L.K. Accuracy of predictions of long-term energy needs. J Am Diet Assoc 1980, 77, 557–561.Google Scholar
  24. 24.
    Grant, J.P., Custer, P.B., Thurlow, J. Current techniques of nutritional assessment. Surg Clin North Am 1981, 61, 437–463.Google Scholar
  25. 25.
    Forse, R.A., Shizgal, H.M. The assessment of malnutrition. Surgery 1980, 88, 17–24.Google Scholar
  26. 26.
    Golden, M.H.N. Transport proteins as indices of protein status. Am J Clin Nutr 1982, 35, 1159–1165.Google Scholar
  27. 27.
    Jeejeebhoy, K.N., Baker, J.P., Wolman, S.L., et al. Critical evaluation of the role of clinical assessment and body composition studies in patients with malnutrition and after total parenteral nutrition. Am J Clin Nutr 1982, 35, 1117–1127.Google Scholar
  28. 28.
    Mitchell, C.O., Lipschitz, D.A. Detection of protein-calorie malnutrition in the elderly. Am J Clin Nutr 1982, 35, 398–406.Google Scholar
  29. 29.
    Mitchell, C.O., Lipschitz, D.A. The effect of age and sex on the routinely used measurements to assess the nutritional status of hospitalized patients. Am J Clin Nutr 1982, 36, 340–349.Google Scholar
  30. 30.
    Bowman, B.B., Rosenberg, I.H. Assessment of the nutritional status of the elderly. Am J Clin Nutr 1982, 35, 1142–1151.Google Scholar
  31. 31.
    Garry, P.J., Goodwin, J.S., Hunt, W.C., et al. Nutritional status in a healthy elderly population: dietary and supplemental intakes. Am J Clin Nutr 1982, 36, 319–331.Google Scholar
  32. 32.
    Ballantyne, F.C., Fleck, A., Dick, W.C. Albumin metabolism in rheumatoid arthritis. Ann Rheum Dis 1971, 30, 265–270.Google Scholar
  33. 33.
    Smith, R.L., Davis, P., Thomson, A.B.R., et al. Serum ferritin levels in the anemia of rheumatoid arthritis. J Rheumatol 1977, 4, 389–392.Google Scholar
  34. 34.
    Mowat, A.C. Hematologic abnormalities in rheumatoid arthritis. Semin Arthritis Rheum 1971, 1, 195–219.Google Scholar
  35. 35.
    Baker, J.P., Detsky, A.S., Wesson, D.E., Wolman, S.L., Stewart, S., Whitewell, J., Langer, B., Jeejeebhoy, K.N. Nutritional Assessment: A comparison of clinical judgement and objective measures N. Eng J Med 1982, 306, 969–972.Google Scholar

Copyright information

© Acta Medica Belgica 1987

Authors and Affiliations

  • R. CollinsJr.
    • 1
    • 2
  • T. L. Dunn
    • 1
    • 2
  • J. Walthaw
    • 1
    • 2
  • P. Harrell
    • 1
    • 2
  • G. S. Alarcon
    • 1
    • 2
  1. 1.Department of Medicine (Division of Clinical Immunology and Rheumatology)University of Alabama at BirminghamBirminghamUSA
  2. 2.Department of Epidemiology, Schools of Medicine and Public HealthUniversity of Alabama at BirminghamBirminghamUSA

Personalised recommendations