What do dietitians do to help manage patients with rheumatic disease? Dietitians are well integrated, for example, in the practice of nephrology and diabetes, but few are active in the specialty of rheumatology. However, dietitians are recognized as part of the team of providers designated to care for patients with rheumatic disease by the ACR.
The Association of Rheumatology Health Professionals (ARHP) does have dietitian members; although the number is small, their membership bridges a wide spectrum of interests and activities. Who are these members?
Meet Your Colleagues
Our members include an academic dietitian who teaches and conducts scientific research, a clinical dietitian who became a physician’s assistant and who now works in a rheumatology practice, and a third member who has a private practice and who has developed a website and blog devoted to arthritis. We interviewed three of these members in an effort to clarify the role of the dietitian in the management of rheumatic diseases.
Kelsey Mangano, PhD, RD, assistant professor of clinical laboratory of nutritional sciences at the University of Massachusetts, Lowell, is a researcher and teacher. She has an interest in how polyunsaturated fatty acids can forestall age-related loss of muscle and bone.
Dr. Mangano is currently concluding an investigation of dietary protein food groups and whether they are differentially associated with bone and muscle strength. She does not believe that there is any specific anti-arthritis diet, but she supports the use of the Mediterranean diet because some literature suggests it can reduce inflammation and help palliate symptoms of rheumatoid arthritis. She acknowledges that more randomized clinical studies are needed in this area, and until there are studies that can show direct cause and effect, she believes modification of patients’ diets will not likely be fully embraced as a treatment modality in rheumatology. She is calling for future funding to create and conduct nutrition research studies in the field of rheumatology.
Tammy Kucia, RD, PA-C, works in a busy rheumatology practice as a physician’s assistant and has maintained her registered dietitian’s license and her certification for weight loss management. She finds her background in nutritional science helpful in her current practice and concurs that diet plays an important role in symptom management, particularly in obese patients with osteoarthritis. She tries to communicate as much nutritional information to her patients as possible. Although in her former dietitian practice she was able to council patients extensively, she reports that now she often can spend no more than three minutes with a patient during a clinic visit.
Cristina Montoya, RD, CDE, splits her time as a clinical dietitian in a hospital seeing a variety of patients and in a private practice with a focus on arthritis. She is passionate about raising the awareness of the role of the dietitian and diet in the field of rheumatology. She has developed a website and a blog to promote diet to help arthritis patients.
Ms. Montoya believes that dietitians have more to offer their rheumatology patients than weight loss management. She believes the dietitian has a role in educating patients about nutritional deficiencies, particularly when a patient wants to use an elimination diet to control their symptoms.
Dr. Mangano supports the use of the Mediterranean diet because some literature suggests it can reduce inflammation & help palliate symptoms of rheumatoid arthritis.
In addition to seeing obese patients with osteoarthritis, she also gives guidance to patients who suffer from xerostomia and periodontal disease, and to patients with esophageal dysmotility disorders and dysphagia. According to Ms. Montoya, in these clinical situations, a dietitian can educate patients about foods to avoid or diets of different textures with the goal of ensuring the patient has a nutritionally well-balanced diet. She helps ill patients make better food choices and develop a personalized menu plan.
In her efforts to promote diet as a treatment modality for symptom management, Ms. Montoya has encountered some skepticism regarding the limited amount of scientific data to support her efforts. She believes, however, that the body of evidence is growing in this field.
Education Is Key to Management
In conclusion, the interviewees agreed about the important role of the dietitian in helping educate and manage rheumatology patients, particularly in the specific context of treating obese patients with underlying osteoarthritis, in patients who suffer from xerostomia and its sequelae or in patients with dysphagia and esophageal dysmotility.
Some research exists to suggest that the Mediterranean diet may help arthritis patients control their symptoms, but current studies are too limited to strongly support a specific anti-arthritis diet. All of our interviewees also agree that further basic investigations, as well as new carefully designed clinical trials assessing the relationship of nutrition and rheumatic disease, are needed and would be of great interest.
Deanna Yamamoto is an adult nurse practitioner in rheumatology and a member of the ARHP Practice Committee, which contributed to the article development.