Medical Nutrition Therapy

CHAP # (TOPIC) (# SEMESTER, SY --) | (CORPUS, J., FRANCISCO, A., GONZAGA, K.) | (MM/DD/YY)

RHEUMATIC & MUSCULOSKELETAL

DISORDERS PARTS OF MUSCULOSKELETAL
SYSTEM
TOPIC OUTLINE

1 Overview of Musculoskeletal System

2 Etiology and Pathophysiology of

different Musculoskeletal Disorders

3 Nutrition Support Therapy for

Musculoskeletal Disorders: Anti-
Inflammatory Diet

RHEUMATIC AND MUSCULOSKELETAL

DISEASES

RMD’s are usually caused by immune

dysregulation, infections, or gradual
deterioration of its parts. Some of them are
autoimmune while others are of unknown
origin. They are typically progressive, painful
and can limit function

PARTS AND FUNCTIONS

BONES: Supports body, protect organs &
tissues, store calcium & fat, and produce
blood cells
CARTILAGE: a type of connective tissue,
prevent bones from rubbing against each
other
JOINTS: the part of the body where two or RMD’S AND THE INFLAMMATORY
more bones meet to allow movement PROCESS
MUSCLES: can contract and allow bodily
movement Inflammatory process occurs to protect and
repair tissue damaged by infections, injuries,
LIGAMENTS: made of tough collagen toxicity and wounds via accumulation of fluid
fibers, ligaments connect bones and help & cells, and it subsides once the problem is
stabilize joints. solved. Osteoarthritis can result to an
TENDONS: connect muscles to bones. uncontrolled and long-lasting inflammation
Made of fibrous tissue and collagen, that causes more damage than repair.
tendons are tough but not very stretchy.

Corpus, J., Francisco, A., Gonzaga, K. 1

 Medical Nutrition Therapy
CHAP # (TOPIC) (# SEMESTER, SY --) | (CORPUS, J., FRANCISCO, A., GONZAGA, K.) | (MM/DD/YY)

OSTEOARTHRITIS: PATHOPHYSIOLOGY CLINICAL FINDINGS

1 Changes in joint shape

A chronic joint disease which involves the
loss of weight-bearing articular (joint) 2 Breaking of Articular Cartilage
cartilage, and it can result to stiffness, pain,
swelling, loss of motion, changes in bone 3 Osteophytes or Bone Spurs
shape, abnormal bone growth which results
to osteophytes (bone spurs) 4 Cartilage or bone fragments in synovial
fluid

RISK FACTORS NUTRITION MANAGEMENT

1 Repetitive Joint Injury Balanced diet with appropriate kcal for
weight management loss or maintenance of
2 Genetic Susceptibility weight
3 Smoking Anti-inflammatory diet

4 Aging Supplementation with omega-3 PUFA

5 Sex (being a female) Adequate calcium and vitamin D

Consideration of Glucosamine and
6 Obesity
chondroitin

MEDICAL MANAGEMENT
DRUG THERAPY: NSAID’s, corticosteroids,
topical & other pain relievers
HEALTH BEHAVIOR CHANGES: exercise,
weight control, rest and relief from stress on
joints
NON-DRUG PAIN RELIEF: heat and cold,
massage, transcutaneous electrical nerve
stimulation

ANTI-INFLAMMATORY DIET

Useful for the treatment of inflammatory

diseases including RMD’s, it resembles the
Mediterranean diet. Inclusion of fresh foods,
abundance of fruits and vegetables, protein
sources from chicken, fish, legumes, nuts,
and essential FA and dietary fiber. Least
amounts of processed foods, fast foods, and
minimal amounts of sugar (fructose &
sucrose.

Corpus, J., Francisco, A., Gonzaga, K. 2

 Medical Nutrition Therapy
CHAP # (TOPIC) (# SEMESTER, SY --) | (CORPUS, J., FRANCISCO, A., GONZAGA, K.) | (MM/DD/YY)

GENERAL PRINCIPLES OF ANTI-INFLAMMATORY DIET

RHEUMATOID ARTHRITIS: Viral or bacterial infection

PATHOPHYSIOLOGY
Hormonal factors
A debilitating and frequently crippling auto-
immune disease with overwhelming Genetic susceptibility
personal, economic, and social effects. More
common in women, with a peak onset of 20-
45. It affects the interstitial tissues, blood JOINT SYMPTOMS
vessels, cartilage, bones, and ligaments, as
well as the synovial membranes that line 1 Warmth
joint surfaces. RA is a chronic, autoimmune,
systemic disorder in which cytokines and the 2 Redness
inflammatory process plays a role.
3 Swelling
ETIOLOGY/CAUSES 4 Pain

Inflammation 5 Stiffness
Auto-immune disorder
6 Loss of function

Corpus, J., Francisco, A., Gonzaga, K. 3

 Medical Nutrition Therapy
CHAP # (TOPIC) (# SEMESTER, SY --) | (CORPUS, J., FRANCISCO, A., GONZAGA, K.) | (MM/DD/YY)

ARTICULAR SYMPTOMS UNIQUE ASPECTS OF ENERGY

METABOLISM IN RHEUMATOID
1 Chronic inflammation in synovial ARTHRITIS
membranes
ELEVATED RESTING ENERGY
2 Damage to joint cartilage and bone EXPENDITURE – RA causes cachexia, a
metabolic response characterized by loss of
3 Weakening of surrounding muscles,
muscle mass and elevated resting energy
ligaments, and tendons
expenditure.

EXTRA-ARTICULAR SYMPTOMS WHOLE BODY PROTEIN CATABOLISM –

destructive form of muscle metabolism that
1 Generalized bone loss translates to muscle wasting.
LOW BODY CELL MASS – which results to
2 Rheumatoid cachexia
increased fat mass.
3 Changes in GI mucosa
NUTRITION MANAGEMENT
4 Anemia

Sjogren’s syndrome Whole foods, balanced diet

5
Avoidance of possible food allergens
6 Cardiovascular disease
Adequate B vitamins
Note: Extra-articular means outside of or
other than a joint. Adequate calcium and vitamin D

Supplementation with omega 3 PUFA

Anti-inflammatory diet

Intermittent fasting and vegetarian diet may

be helpful during an acute phase

Note: Protein requirements for individuals

who are poorly nourished or who are in the
inflammatory phase of the disease are 1.2 to
1.5kg per body weight

Note: Fat should contribute to less than 30%

of the total energy intake

Note: Omega FA primarily from fish and

alpha linolenic acid (found in flaxseed,
soybean oils, and green leaves) has been
shown to reduce inflammation in RA

Corpus, J., Francisco, A., Gonzaga, K. 4

 Medical Nutrition Therapy
CHAP # (TOPIC) (# SEMESTER, SY --) | (CORPUS, J., FRANCISCO, A., GONZAGA, K.) | (MM/DD/YY)

GOUT: PATHOPHYSIOLOGY OTHER ACQUIRED CAUSES OF

HYPERURECEMIA
Gout is one of the oldest disease recorded
INCREASED URATE PRODUCTION
in history.
Nutritional Excess ethanol or fructose
A crystal deposition disease in which the
intake
clinical symptoms are caused by the
formation of monosodium urate (MSU) Hematological Myeloproliferative or
crystals in the joints and soft tissues. lymphoproliferative
disorders, polycythemia
Predominantly affects men.
Drugs Ethanol, cytotoxic drugs, vit.
Associated with CVD and renal diseases. B12 (treatment of pernicious
anemia)
Persistent accumulation of MSU crystals
causes joint damage through mechanical Miscellaneous Hypertriglyceridemia,
effects (pressure erosion) leading to chronic obesity, psoriasis
symptoms of arthritis. In chronic gout, DECREASED RENAL EXCRETION OF
classic sites are the big toe, wrists, fingers, URATE
joints, elbow, ankle, knee, & the helix of the
ear. Renal Hypertension, polycystic
kidney disease, chronic
renal failure
Metabolic or Dehydration, lactic acidosis,
endocrine ketosis, hypothyroidism,
hyperparathyroidism
Miscellaneous Obesity, sarcoidosis,
toxemia of pregancy
Drugs Ethanol, cyclosporine
(Sandimmune), thiazides,
furosemide (Lasix) and other
loop diuretics,
ethambutol (Myambutol),
pyrazinamide,
Aspirin (low-dose), levodopa
(Larodopa),
CAUSE/ETIOLOGY nicotinic acid (Nicolar)
In most mammals, uric acid is further
degraded by the enzyme urate oxidase NUTRITION MANAGEMENT
(uricase), to allantoin, which is more soluble
than uric acid, and hence more readily Avoid alcoholic beverages and fructose
excreted by kidneys. In humans and higher or sugar-sweetened soft drinks
primates, the gene encoding for uricase is
Ensure a high-fluid intake, especially water
nonfunctional and due to this evolutionary
and skim milk, nonfat milk, low-fat yogurt,
event, uric acid levels are higher in humans
than in many other mammals.

Corpus, J., Francisco, A., Gonzaga, K. 5

 Medical Nutrition Therapy
CHAP # (TOPIC) (# SEMESTER, SY --) | (CORPUS, J., FRANCISCO, A., GONZAGA, K.) | (MM/DD/YY)

Consumption of low-fat diet and dairy SLE Risk Factors

products, supplementation of vitamin C, and
drinking of pure black coffee is protective for
Sex – more common in women
people with gout
Age – more common in child-bearing age
Weight loss is helpful if needed
(15 to 45)
Avoid foods with high purine such as Race – most common in Hispanics, African
anchovies, bouillon, brains, broth, Americans, and Asian Americans
consommé, gravy, sardines, mussels,
scallops, etc.
Dairy products (milk or cheese), eggs, SIGNS AND SYMPTOMS
vegetable protein, and coffee appear to be
protective, possibly because of the alkaline 1 Extreme fatigue
ash effect of these foods
2 Painful or swollen joints

3 Muscle pain
SYSTEMATIC LUPUS ERYTHEMATOSUS:
PATHOPHYSIOLOGY 4 Sensitivity to the sun

5 Unexplained fever
Lupus is a chronic (long-term) disease that
can cause inflammation and pain in any part 6 Skin rashes most commonly in the
of your body. It’s an autoimmune disease, face
which means that your immune system that
7 Mouth ulcers
usually fights infections attacks healthy
tissue instead. 8 Pale or purple fingers or toes from
Characterized by periods of remission and cold or stress (Reynaud’s syndrome)
relapse and may present with various 9 Headache
constitutional and organ-specific symptoms.
10 Chest pains
Production of autoantibodies directed
against nuclear (anti-dsDNA, anti-Sm, anti-
RNP) and cytoplasmic antigens affecting TREATMENT
several organs and tissues
General treatment – sun protection, diet &
nutrition, smoking cessation, exercise
CAUSE/ETIOLOGY
Organ specific treatment – use of steroids,
The cause of SLE is multi factorial, it NSAIDs, DSARDs, and biologics
involves multiple genes and environmental
Pharmacologic treatment – cytotoxic
factors such as infections, hormones, and
agents' cyclophosphamide and azathioprine;
drugs. In most cases, the origin of lupus is
their combination with corticosteroids
unknown.

Corpus, J., Francisco, A., Gonzaga, K. 6

 Medical Nutrition Therapy
CHAP # (TOPIC) (# SEMESTER, SY --) | (CORPUS, J., FRANCISCO, A., GONZAGA, K.) | (MM/DD/YY)

Nutrition Therapy for SLE

Protein adjustments – if the patient’s

kidney is compromised, protein requirement
are decreased.
Increase consumption of foods rich in
omega-3 and omega-6 fatty acids
Increase consumption of calcium,
vegetables, and fruits
Increase consumption of dietary fiber

Supplementation of Vitamin A

Supplementation of Vitamin D -
Photosensitivity, sunlight avoidance, the use
of sun protection, and low dietary intake, in
combination with medications prescribed to
treat the symptoms of the disease, may be
responsible for the observed low levels of
vitamin D
Decrease consumption of oils & fats
SPINAL ARTHRITIS: Pathophysiology
Spinal arthritis is inflammation of the facet
joints in the spine or sacroiliac joints
between the spine and the pelvis.
Sometimes, the inflammation may also
affect the sites where ligaments and tendons
attach to the bones of the spine. Regardless
of the exact location, arthritis in the back or
neck can be painful and often becomes
chronic.
Spinal arthritis may cause bone spurs —
overgrowths on the edges of the bones. In
the spine, bone spurs particularly affect
facet joints, making them grow larger. This
condition is called facet joint hypertrophy.
Although bone spurs on their own are not
harmful, they may narrow the passages for
the spinal cord and the nerves exiting the
spine. This can cause 2 conditions:
•Spinal stenosis – compression of the
spinal cord inside the spinal canal
•Radiculopathy – pinching of the peripheral
nerves as they exit the spine (sciatica is one
type of radiculopathy)
SA: Causes/Etiology
1 Wear and tear

2 Auto-immune diseases

3 Infections and other conditions

4 Heredity

5 Sometimes unknown

Corpus, J., Francisco, A., Gonzaga, K. 7

 Medical Nutrition Therapy
CHAP # (TOPIC) (# SEMESTER, SY --) | (CORPUS, J., FRANCISCO, A., GONZAGA, K.) | (MM/DD/YY)

RISK FACTORS CARE MANAGEMENT

1 Age 1 Stretching and strengthening

exercises (swimming can be helpful
2 Excess weight / obesity too)

3 Presence of certain conditions such 2 Deep breathing exercises

as diabetes, gout, psoriasis,
tuberculosis, irritable bowel 3 Sleeping in a hard bed in a supine
position may be helpful
syndrome and Lyme disease

SYMPTOMS NUTRITION THERAPY

1 Normal diet, gradual weight loss if

Back and neck pain, especially in the needed
lower back 2 Increase intake of foods rich in anti-
Stiffness and loss of flexibility in the oxidants: Vit. C and E, selenium
spine, such as being unable to straighten 3 Increase intake of omega-3 FA such
your back or turn your neck as fish oils, etc
Swelling and tenderness over the 4 Sufficient Calcium and Vitamin D are
affected vertebrae important
Feeling of grinding when moving the 5 Including food source of
spine phytochemicals may be helpful
Pain, swelling and stiffness in other 6 Preferred foods are recommended to
areas of the body (especially in stimulate appetite
inflammatory arthritis)
Whole-body weakness and fatigue (more
common in inflammatory arthritis)
Pain and numbness in your arms or legs
if the nerves are affected
Headaches (in case of arthritis in the
neck)

Corpus, J., Francisco, A., Gonzaga, K. 8