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Nutritional care in Rheumatic

Diseases
Suryani As’ad

DEPARTMENT OF NUTRITION
FACULTY OF MEDICINE HASANUDDIN
UNIVERSITY
RHEUMATOID ARTHRITIS
Nutritional care in
RHEUMATOID ARTHRITIS
Articular involvement of the small and
large joints may limit ability to perform
activities of daily living (ADLs) including
shopping, preparing and eating foods.
Involvement of the temporomandibular
joint (TMJ) can impact the ability o
chew and swallow and necessitate
change in diet consistency
Nutritional care in
RHEUMATOID ARTHRITIS
The increase in metabolic rate secondary to
the inflammatory process leads to increased
nutrients needs
Taste alteration due to xerostomia, anorexia
due to medication , fatique and pain reduce
dietary intake.
Changes in the GI tract mucosa affect
ingestion, digestion and absorption
Increased cytokine production in RA may be
associated with reduced body mass, altered
energy intake, and metabolism
Energy
Determined using harris benedict formula for
REE
Stress factor in the range of 1.4-.1.35
An activity factor of 1.2 times REE for patient
with limited mobility receiving physical activity
and 1.3 for those receiving intensive physical
therapy
Patients weight should be monitored and
energy intake modified accordingly.
protein
Well-nourished individuals require at the
level of RDA for age and sex.
For poorly nourished patients or in
inflammatory state : 1.5-2.0g/kg/day
The more precise method using a
nitrogen balance study, between
nitrogen intake and N loss through urin
and other routes
lipids
Omega 3 and 6 fatty acids, either in
tablet form or as they occur in oils, have
increased popularity in the management
of RA because their role in inflammatory
pathways.
Need more evidences
Vitamins and minerals
No need for routine supplementation
Osteoporosis and osteomalacia are
frequently seen in patients with RA
Ca and Vit D malabsorption are
characteristic of advanced stage of the
disease.
Nutritional care in
OSTEOARTHRITIS
More prevalent in obese ---need to lose
weight
Excess weight puts an added burden on
the weight bearing joints.
Weight reduction even seems to
improve all of the joints
Intake of Ca and Vit D should satisfy the
RDA
Nutritional care in Gout
Uric acid is derived from the metabolism
of purine, which constitute a part of
nucleoprotein
In fact 85% of serum uric acid derived
from simple metabolite and purine
breakdown
Recommended to avoid or restrict
purine consumption
Nutritional care in Gout
Encouraged fluid intake of 3 l/day to
assist with excretion of uric acid and
minimize the possibility of calculi
formation
Carbohydrate enhance excretion of
urate
Lipid reduces urate excretion.
alcohol increases uric acid production
Nutritional care in Gout
Low-purine Diet
A typical diet contains from 600-1000
mg of purine daily
Restricted purine to approximately 100-
150 mg in severe or advanced case
Carbohydrate 50-5%, fat 30%,
cholesterol <300mg/day
Gout

Penyakit radang sendi akut, yang


biasanya melibatkan satu sendi saja
terutama ibu jari kaki

 Kadar asam urat


Klasifikasi
- Gout primer  akibat gangguan
metabolisme
- Gout sekunder  akibat dari penyakit
lain

- Sering terjadi pada laki-laki, perempuan


menopouse, obesitas, konsumsi
makanan yang berprotein tinggi
Terapi

Medikamentosa
Pengaturan makanan ( diet )
Diet Rendah Purin
* Tujuan :
1. Mengurangi pembentukan asam urat
2. Menurunkan berat badan bila
penderita terlalu gemuk dan
mempertahankannya dalam batas
normal.
Syarat – syarat :
1. Rendah purin,mengandung 120-150 mg
purin.
2. Cukup kalori, protein, mineral dan vitamin
3. Hidrat arang tinggi
4. Lemak sedang
5. Banyak cairan
Makanan yang boleh dan tdk boleh
diberikan
Gol.Bhn.Mkn. Mkn.yg.boleh Mkn.yg.tdk.boleh
Sumber H.A Semua -
Sumber P. Hewani Daging,ayam,ikan Sardin, kerang,
tongkol,tenggiri,telur jantung, hati, limpa,
,susu,keju 50gr/hr paru, otak, ekstrak
daging/kaldu,bebek,
angsa, burung
Sumber P. Nabati Kacang-kacangan -
atau tahu/tempe
50gr/hr
Gol.Bhn.Mkn. Mkn.yang.boleh Mkn.yg.tdk.boleh

Sumber Lemak Minyak dalam -


jumlah terbatas
Sayuran Semua sayuran -
sekehendak kecuali
asparagus,kacang
polong,buncis,kemb
ang kol,bayam jamur
maksimum.50 gr/hr
Buah Semua macam buah -
Minuman The,kopi,soda alkohol
Bumbu dll. Semua bumbu ragi