When Your Gut Feels as Inflamed as Your Joints
If you live with RA, you may have noticed a connection between the health of your joints and your gut. This isn’t just a gut feeling. Emerging research suggests that there is a deep connection between RA and gut health, known as the joint-gut-axis (1). Most people with RA have intestinal dysbiosis (2); a disturbance in the gut microbiome which disrupts nutrient absorption and the body’s energy balance.
Some medications used to treat RA can amplify this microbiota disturbance. Corticosteroids can cause bloating, influence appetite and change how the body handles carbohydrates and sugars (3). NSAIDs can irritate the gastrointestinal lining and increase its permeability (4), and DMARDS such as methotrexate can disrupt the absorption of key micronutrients such as B12 (5). These combined effects can contribute to increased episodes of bloating, stomachache and nutrient deficiency, leaving the gut and the body feeling sensitive.
The good news? There are science-backed ways to restore balance.
NICE and EULAR are public bodies that make sure that people with RA get the best possible medical care based on what has been proven to work. They create expert guidelines to treat RA safely and effectively. NICE recommends that people with RA should “adhere to the principles of a Mediterranean diet (more bread, fruit, vegetables and fish; less meat, butter and cheese)”(6). This style of eating supports microbial diversity, reduces inflammatory cytokines, and reduces symptoms such as bloating, diarrhea and stomachache.
Increasing dietary fibre from whole plant foods nourishes beneficial gut bacteria, while reducing refined sugar and ultra-processed foods can ease bloating and stabilise energy. Gradually increasing soluble fibre, eating smaller but more regular meals, and incorporating probiotic foods can be especially helpful to combat gut sensitivity worsened by medication.
The challenges
Healthy eating is more than a diet. It’s a lifestyle choice and it requires some work to maintain! If you live with RA, you may have noticed that it’s harder to maintain a healthy diet. Pain, fatigue and even stiffness can make shopping, meal preparation and cooking more difficult. Low mood, medication side effects and flares may also influence your food choices. It’s very easy to rely on quick, less nutritious meals.
How I can help
With training in human nutrition and health psychology, and research expertise in the obstacles and enablers to healthy eating, I draw on evidence of what truly works to help clients build sustainable, long-term healthy eating habits. I also share access to a resource library, curated specifically for people with RA- so that you can make informed decisions about what food you put on your plate!
Work with me
Work together with me to explore your current eating habits, food choices, and daily routines, and identify changes that feel realistic and achievable for you. Through this shared process, we will build new habits and create an eating pattern that improves your energy levels, supports your gut, joints and long-term health.
References
- Zaiss MM, Joyce Wu HJ, Mauro D, Schett G, Ciccia F. The gut–joint axis in rheumatoid arthritis. Nat Rev Rheumatol. 2021 Apr;17(4):224–37.
- Qi XY, Liu MX, Jiang XJ, Gao T, Xu GQ, Zhang HY, et al. Gut microbiota in rheumatoid arthritis: Mechanistic insights, clinical biomarkers, and translational perspectives. Autoimmunity Reviews. 2025 Dec;24(12):103912.
- Berthon BS, MacDonald-Wicks LK, Wood LG. A systematic review of the effect of oral glucocorticoids on energy intake, appetite, and body weight in humans. Nutrition Research. 2014 Mar;34(3):179–90.
- Bjarnason I, Takeuchi K. Intestinal permeability in the pathogenesis of NSAID-induced enteropathy. J Gastroenterol. 2009 Jan;44(S19):23–9.
- Patel AV, Morgan SL, Green R, Danila MI, Merriman TR, Wanzeck K, et al. Vitamin B12 status and hyperhomocysteinemia in patients with Rheumatoid arthritis treated with methotrexate and folic acid. The American Journal of the Medical Sciences. 2024 Mar;S0002962924011479.
- NICE. Rheumatoid arthritis in adults: management [Internet]. 2020. Available from: https://www.nice.org.uk/guidance/ng100/chapter/Recommendations