Edith is a 33-year-old college teacher and mother of two. She is an active smoker with periodontal disease. Six months ago, she presented with chronic additive symmetrical polyarthritis, involving the wrists, hands, knees, and toes. Edith has morning stiffness for about an hour; symptoms improve with movement and worsen with rest. She has taken several NSAIDs with no major changes. At examination, the doctor noted inflammation in the joints. Laboratory tests showed mild normocytic normochromic anemia, elevated erythrocyte sedimentation rate, and high C-reactive protein. She was positive for rheumatoid factor and antibodies to cyclic citrullinated peptide (ACPAs). Marginal erosions in the metacarpophalangeal joints were found by X-ray imaging. Edith was diagnosed with rheumatoid arthritis. Based on polyarthritis, positivity of antibodies and erosions, it was determined to be a severe case, and she was started on DMARDs and corticosteroids. Nutrition Assessment Patient is 33-year-old woman with a recent diagnosis of rheumatoid arthritis. Anthropometric Data Ht 5´8” (1.73m); Wt 152 lb (69 kg) (lost 6 lb over past 2 months) BMI 5 23 Biochemical data: Hgb 10.5 g/dL Food and Nutrition History: Changes in food preparation due to difficulty in shopping and cooking. Caloric intake: 1600 kcal/day (less than energy requirements) EER 2070 kcal (30 kcal/kg) and 104 g protein (1.5 g/kg BW for acute phase).
Nutrition Diagnostic Statements
1. Presence of iron deficiency anemia as evidenced by a serum hemoglobin of 10.5 g/dL. (NI-5.10.2)
2. Inadequate energy intake as evidenced by involuntary weight loss. (NI-2.1) (NC-3.2) Nutrition Interventions 1. 2000 kcal diet, 104 g protein; emphasis on vegetables and whole grains, oily fish and fat free dairy. 2. Regular intake of green leaves and legumes as source of iron and folic acid; lean meats two or three times a week, increase consumption of extra-virgin olive oil to 1-2 oz daily as salad dressing.
3. Omega-3 fatty acid supplementation (3000 mg daily).
4. Advice to cease smoking and perform moderate intensity physical activity
5. Education to improve Edith´s cooking skills with a variety of easy recipes. Nutritional Monitoring and Evaluation Monthly weight measurements; although Edith’s BMI is currently adequate in spite of her weight loss, it is important to stop weight loss. Repeat Hgb exam 3 months from date. Evaluate energy, protein, iron and vitamin intake. If arthritis is not active, adjust protein to 1 g/kg BW.