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Navigating Ramadan with Rheumatoid Arthritis: Part 1

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Blog by Dr Shirish Dubey & Hifsa Mahmood

As we look forward to the holy month of Ramadan, some of you will be wondering whether you should fast or not. There are, of course, exemptions from fasting – one of those being people who are ill or have medical conditions. 

Instead of fasting, you could choose to honour Ramadan through charity, such as by feeding a less privileged person. I know that a lot of you will want to fast, in keeping with good religious practice whilst also ensuring you can maintain good health. It is imperative that you ensure medications are taken regularly, and the dosing schedule is maintained. There may be a need to adjust daily schedules so medicines can be taken between the evening meal of Iftar (sunset) and the morning meal of Suhoor (dawn). Fortunately, we are in winter with approximately 11 hours between sunrise and sunset but the days will gradually get longer.

Medications that are taken twice a day such as Sulfasalazine or Mycophenolate can be taken with Suhoor or after Iftar. Medications that are taken once a day or less can be taken at a convenient time. Injections such as biologics are less of an issue since these are usually once a week or sometimes even less frequently. Painkillers such as Paracetamol are a bigger problem since the dosing schedule is usually 4 times daily. Anti-inflammatory agents can be adjusted around the fasting times and longer acting versions that last for 12 hours or 24 hours can be chosen. Where possible, longer acting versions of painkillers should be preferred and it is worth having a discussion with your health practitioner to get the prescriptions sorted well in advance to avoid any last-minute stress.

The purpose of Ramadan is to improve the spiritual and physical state and to fortify your relationship with God (Allah). It’s important that we ensure that we are not ignoring our physical health whilst looking after the spiritual.

Further information from the British Islamic Medical Association can be found here. Keep an eye out on Part 2 during Ramadan.

Dr Shirish Dubey (Consultant Rheumatologist) and Hifsa Mahmood (Specialist Clinical Pharmacist, Oxford University Hospitals NHS FT).

Questions People with RA Often Ask

“I really want to fast during Ramadan, but I’m worried about managing my RA medication. How do people usually handle their dosing schedule while fasting?”

Many people adjust their medication timings so they fit between Iftar (sunset) and Suhoor (dawn). Twice daily medicines like sulfasalazine or mycophenolate can be taken with either meal, while once daily medications are usually easier to schedule. Injections such as biologics are less of an issue because they’re weekly or less frequent. The key is planning ahead and speaking with your healthcare team so you can make safe adjustments without disrupting your treatment.

“Painkillers are tricky because they’re usually taken several times a day. Is there any way to manage that while fasting?”

Medications like paracetamol, which are normally taken four times a day, can be challenging during fasting hours. Longer acting versions of anti inflammatory medicines may be an option, but this is something to discuss with your clinician well in advance. Sorting prescriptions early to avoid last minute stress and ensuring your pain management plan still works within fasting hours will help. Your healthcare team (or local pharmacist) will be able to advise you on options for painkillers that you would not need to take with food.

“I want to fast for spiritual reasons, but I’m scared it might worsen my symptoms. How do people balance faith and physical health during Ramadan?”

As this blog explains, Islam allows exemptions for people with medical conditions; and alternative acts of worship, like charity, can be a way to honour your faith if you are unable to fast. If you choose to fast, the focus is on protecting your health while honouring your faith. That means maintaining medication schedules, planning ahead, and being honest with yourself about how your body is coping. Ramadan is meant to strengthen both your spiritual and physical wellbeing, not compromise either.”

We hope this advice helps you! Share your tips and experience with us on Facebook, Twitter or Instagram– we’d love to hear them!

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