For many years, rheumatoid arthritis was explained to me — and to many of the clients I now work with — as a condition that primarily affected the joints and was managed largely through medication.
The message was simple. The immune system is overactive, the joints become inflamed, and medication suppresses that inflammation. That explanation has always felt incomplete to me.
Because rheumatoid arthritis rarely behaves like a condition that is confined to the joints.
In clinic, I consistently see symptoms that extend far beyond musculoskeletal pain. Flares often follow periods of digestive upset, stress, poor sleep, or infection. Many clients describe bloating, food reactions, fatigue, or brain fog alongside their joint symptoms. And interestingly, when we work on gut health or address chronic infections or oral inflammation, their joints often improve too.
Over time, it becomes difficult to ignore that pattern.
Rheumatoid arthritis is not simply a joint condition. It is an immune and inflammatory condition that is influenced by the environment the immune system operates within — particularly the gut and the microbiome.
This broader view is now increasingly reflected in the research. A comprehensive 2025 review examining the role of nutrition in the development, management, and prevention of rheumatoid arthritis highlights how diet, gut microbiota, body weight, and inflammatory load all influence disease activity. Nutrition is not presented as a replacement for medication, but as an important adjunct that can meaningfully affect outcomes.
That distinction feels both accurate and clinically useful.
You can also listen to this episode of The Autoimmune RESET podcast, Rheumatoid Arthritis: Symptoms, Root Causes and Natural Therapies, where I explore this topic in more depth.
What I noticed in my own health
My own turning point did not come from finding a new supplement or cutting out more foods. By that stage, I had already tried most of the obvious things.
I was eating well, choosing anti-inflammatory foods, avoiding common triggers, and taking nutrients that should theoretically have helped. If you looked at my routine on paper, everything appeared sensible. And yet my joints still hurt.
I remember very normal, everyday tasks becoming uncomfortable — opening doors because my hands were stiff, typing for long periods at work because my wrists ached, that constant low-level soreness that never quite went away. It wasn’t dramatic, but it was persistent enough to affect daily life.
What frustrated me most was that it didn’t add up. I was doing everything “right,” so why did my body still feel inflamed?
Eventually, I realised I was asking the wrong question. Instead of thinking about what else I could add in, I started asking why my body wasn’t tolerating the healthy things I was already doing.
That question led me straight to my gut.
When I began supporting my digestion properly, working on gut lining integrity, and rebalancing my microbiome, things improved in a much steadier way. Food felt easier to tolerate, my energy became more consistent, and my joints were less reactive day to day. The random flares reduced.
Nothing extreme happened overnight, but my baseline improved. And with autoimmunity, that stability is often far more valuable than dramatic short-term changes.
That experience now shapes how I practise.
Why the gut is often the missing piece
One of the key mechanisms discussed in the recent review is gut dysbiosis and intestinal permeability.
In simple terms, when the gut microbiome becomes imbalanced or the gut lining is compromised, bacterial fragments and toxins can pass into the bloodstream. The immune system recognises these as threats and responds by increasing inflammation.
This process, sometimes called bacterial translocation, can keep the immune system on constant alert.
For someone living with rheumatoid arthritis, that background immune activation can be enough to trigger or prolong flares. Cytokines such as TNF-α and IL-6 increase, and joint inflammation follows.
In clinic, this often presents in very practical ways. Joint symptoms may worsen after digestive upset. Clients often report bloating, reflux, constipation, or loose stools alongside flares. Others suddenly feel reactive to foods they previously tolerated.
In many of these cases, the food itself is not the core issue. The gut environment is.
When we focus first on improving digestion, supporting bile flow, addressing microbial imbalances, and repairing the gut lining, foods frequently become easier to tolerate again. This allows us to move away from constant restriction and towards building resilience.
One example that stands out to me is a client who loved golf. It was an important part of his routine and something he genuinely enjoyed, but his inflammatory arthritis was starting to limit his ability to play.
He was already on medication and doing everything he had been advised to do, yet he still experienced regular pain and stiffness.
Rather than immediately removing more foods, we focused on gut health first. We worked on digestion, microbial balance, and lowering overall inflammatory load. His nutrition became supportive rather than restrictive.
Over time, his symptoms gradually improved. His stiffness reduced, his energy increased, and he was able to return to playing golf comfortably. Eventually, under medical supervision, he was able to come off his medication and remains symptom-free.
I never present outcomes like this as guarantees, but they do illustrate how addressing the underlying environment can meaningfully change how the immune system behaves.
The role of dietary patterns
The research is fairly consistent when it comes to dietary patterns.
Anti-inflammatory approaches — particularly the Mediterranean-style diet and diets rich in omega-3 fatty acids — are associated with lower inflammatory markers, improved symptoms, and better overall health outcomes in people with rheumatoid arthritis.
In practice, this usually means focusing on whole foods, vegetables, fruit, legumes, olive oil, oily fish, nuts, and adequate protein, while reducing highly processed foods, excess sugar, and inflammatory fats.
This is rarely about perfection. It is about consistency.
However, it is also important to recognise that diet works best when the gut is functioning well. If digestion and microbial balance are compromised, even healthy foods can feel irritating. Supporting the gut first often makes dietary changes more effective and sustainable.
The overlooked role of oral health
Another area that is often overlooked is oral health.
The mouth is one of the immune system’s primary interfaces with the external environment. Chronic gum inflammation or periodontal disease allows bacteria to enter circulation repeatedly, which can contribute to systemic inflammation.
Certain oral bacteria have even been linked to immune processes involved in rheumatoid arthritis.
For this reason, I now routinely ask clients about bleeding gums, dental infections, or ongoing oral issues. Addressing these can sometimes make a noticeable difference to overall inflammation.
It is a reminder that immune triggers do not only come from the gut or from food.
What I focus on in practice
After years of working in this space, both personally and professionally, I find that progress rarely comes from extreme measures.
Instead, it comes from doing the fundamentals well.
Supporting digestion and gut barrier function, eating in a broadly anti-inflammatory way, prioritising omega-3 fats, maintaining stable blood sugar, addressing infections where present, and paying attention to oral health may not sound complicated, but they are often the interventions that create the most sustainable change.
These foundations create an internal environment in which the immune system feels less reactive.
If you would like to explore this further
If there’s one thing both the science and my experience keep pointing back to, it’s this: when rheumatoid arthritis feels stubborn or unpredictable, the answers are often upstream — in the gut, the microbiome, and the immune signals being generated every single day. This is exactly why I use advanced microbiome testing in clinic.
If you want to understand what’s actually happening inside your gut — not guess, not trial-and-error — the Microbiome Explorer test gives a detailed picture of bacterial balance, diversity, inflammatory markers, and patterns that can drive immune activation. It’s often the missing context for why symptoms persist, foods feel reactive, or inflammation won’t fully settle. This test is ideal if you want insight, clarity, and data to guide next steps — whether you work with me or another practitioner. You can learn more about the test here.
Or apply to work with me directly
If you’re ready for a more personalised, joined-up approach — where gut health, nutrition, immune regulation, oral health, and lifestyle are looked at together — you can apply to work with me 1:1.
I work with people who are done chasing symptoms and want to understand their body properly, using evidence-led testing and a structured, realistic plan that fits real life. You can apply here.
And if you are not quite ready for testing or private support, but would like a clear place to start, you can download my free guide, The Autoimmunity Recovery Plan. It outlines the exact foundations I focus on with clients — from reducing inflammatory load and supporting digestion to stabilising blood sugar and rebuilding resilience — and gives you practical first steps you can implement straight away. You can download it here.
Often, progress does not come from doing more. It comes from understanding your body better and working from the right starting point.
Written by Victoria “VJ” Hamilton, Registered Nutritionist (BSc Biochemistry & Immunology), IFM Certified Functional Medicine Practitioner and founder of the Autoimmune Nutrition Clinic.
Reference
Polyzou M, Goules AV, Tzioufas AG. The role of nutrition in the development, management, and prevention of rheumatoid arthritis: A comprehensive review. 2025. PMCID: PMC12736090.
Frequently asked questions
Can diet improve rheumatoid arthritis?
While diet cannot replace medication, research shows anti-inflammatory dietary patterns and gut health support can reduce inflammatory load and improve symptoms.
Is gut health linked to rheumatoid arthritis?
Emerging research suggests gut dysbiosis and intestinal permeability may contribute to immune activation and flares.
What foods should I avoid with rheumatoid arthritis?
Highly processed foods, excess sugar, and inflammatory fats may worsen symptoms, while Mediterranean-style eating is generally supportive.
VJ Hamilton, BSc, RNT
VJ Hamilton is a Registered Nutritionist (BANT) and an expert in autoimmune disease. VJ combines her knowledge from her medical science degree in Biochemistry & Immunology with Nutritional Therapy to offer a thorough and personalised approach to support her clients based on the most current scientific research. VJ runs a virtual and in-person nutritional therapy and functional medicine practice, The Autoimmunity Nutritionist, specialising in gut skin and immune health.