Some people living with rheumatoid arthritis (RA) experiment with dietary changes, such as following the Mediterranean diet or cutting back on inflammatory foods, like red meat or gluten. In addition to eating for general RA health, taking certain dietary precautions is important if you’re using biologic medications.

RA is an inflammatory (inflammation-causing) autoimmune disease. Biologics are a type of disease-modifying antirheumatic drug (DMARD) used to treat RA. These medications work by targeting specific proteins in the immune system to reduce inflammation, ease RA symptoms, and slow joint damage. Common biologics include:

• B-cell inhibitors such as rituximab (Rituxan)
• Interleukin inhibitors such as tocilizumab (Actemra)
• Tumor necrosis factor (TNF) inhibitors such as adalimumab (Humira)

Because biologics weaken part of the immune system, they can lead to a higher risk of food poisoning. You may wonder, “What foods should I avoid while taking biologics?” To help you stay safe and healthy, this article discusses some of the top foods to steer clear of while on biologics.

1. Mold-Ripened Soft Cheeses

Soft cheeses made with mold are generally safe for most people. However, if you’re taking a biologic for RA, they can raise your risk of a fungal infection. It’s best to avoid soft, mold-ripened cheeses such as:

• Blue cheese
• Brie
• Camembert
• Feta
• Goat cheese

Instead, opt for hard cheeses made from pasteurized milk, like cheddar or Parmesan. If you notice mold growing on the cheese, it’s safest to throw it out.

2. Unpasteurized Dairy Products

Raw (unpasteurized) milk and products made from it pose a significant health risk for everyone, especially people on biologics. Pasteurization is a heat process that kills harmful germs in milk from cows, goats, or sheep.

Check the food label for the word “pasteurized” to ensure a product is safe to consume. Avoid buying dairy products (including cheese and ice cream) from farmers markets or roadside stands if you’re not sure how they were made.

3. Raw Eggs

Eggs are a great source of protein, but if you’re on a biologic for RA, be sure to eat them fully cooked. Skip runny yolks, such as in soft-boiled or over-easy eggs. Scrambled, hard-boiled, well-done fried eggs are safer choices. Be sure to eat them while they’re still hot.

Also watch out for foods that may contain raw eggs, such as:

• Homemade mayonnaise
• Some salad dressings
• Raw cookie dough or cake batter

If you’re at a restaurant and unsure how a dish is prepared, ask your server if it contains raw or undercooked eggs.

4. Undercooked Red Meat, Poultry, or Seafood

If you enjoy rare steak or raw sushi, you might be disappointed to learn that undercooked meat and seafood can carry harmful bacteria — and people taking biologics are more at risk of getting sick.

Make sure animal products are cooked to safe temperatures. Even food from high-end restaurants can be risky if not cooked thoroughly. At home, use a meat thermometer to check that the food has reached an internal temperature that reduces your risk of foodborne illness:

• Fish — 145 degrees Fahrenheit (F)
• Ground meat and sausage — 160 F
• Raw ham — 145 F
• Precooked ham (to reheat) — 165 F
• Pork chops — 145 F
• Turkey and chicken — 165 F

Let steaks, roasts, or chops (including beef, bison, veal, goat, lamb, and pork) and raw ham rest for three minutes after cooking before cutting in. This helps the heat finish killing any germs.

Clams, oysters, and mussels should be cooked until the shells open from the heat. Cook shrimp, scallops, crab, and lobster until the flesh becomes opaque.

5. Leftover Rice

It’s safest to eat rice shortly after you finish cooking it. If cooked rice has been stored in the refrigerator for 24 hours or more, reheat it thoroughly before eating. To prevent the risk of food poisoning from leftover rice, cook rice in small batches or prepare individually portioned steam-in-the-bag rice.

6. Well Water

Most home well water systems involve an extensive filtration system, but it’s always best to stay on the safe side when taking biologics. If you’re traveling to another country or visiting a rural area, be sure the water is safe to drink.

When in doubt, use bottled water or boil water for at least one minute and let it cool before drinking. Ice can also be unsafe if it’s made with unfiltered or untreated water, so it may be best to skip the ice if you’re not sure how it was made.

7. Fresh Sprouts

Although sprouts contain beneficial antioxidants and fiber, they can also be a source of bacteria. The shape and texture of sprouts can make them hard to clean and easy for bacteria to grow and hide. Raw sprouts like alfalfa sprouts may not be worth the risk if you’re on biologics that suppress the immune system and put you at a higher risk of food poisoning.

Additional Food Safety Tips

Practicing basic food safety tips can go a long way in helping you avoid infections while on biologics. Be sure to:

• Wash hands and cooking surfaces before preparing food.
• Keep raw foods separate from ready-to-eat items.
• Cook foods to the recommended temperatures.
• Store leftovers in the fridge or freezer right away.

In addition, talk with your rheumatologist about your medical history, current medications, supplements, and eating and drinking habits. You may not need to completely avoid alcohol while taking biologics, but it’s a good idea to ask your healthcare provider what’s safe for you. Some biologics, like infliximab (Remicade), may cause side effects like heartburn or skin flushing that may worsen with alcohol.

Not all biologics work the same way. Your healthcare provider’s guidance may be different if you have allergies or other health concerns. Understanding which foods carry more risk for you and learning how to handle them safely can help protect your health. For personalized advice or help creating a safe, balanced meal plan, ask your rheumatology provider for a referral to a registered dietitian nutritionist.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with rheumatoid arthritis.

Do you avoid certain foods because of your rheumatoid arthritis treatment? If you’re on biologics, do you notice a difference in your flare-ups or daily RA symptoms, like morning muscle stiffness and joint pain? Share your experience in the comments section or by posting on your Activities page.