Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis

What do we know about dietary perceptions and beliefs of patients with rheumatoid arthritis? A scoping review

Rheumatoid arthritis is a debilitating inflammatory condition which has a high disease burden. While there is emerging evidence that certain foods and diets could have anti-inflammatory properties and there are published 'anti-inflammatory' diets, there is very little understanding of patient beliefs and perceptions about the impact of diet on symptom management or attitudes to particular dietary interventions. This scoping review aims to summarize the existing literature around the beliefs that patients with rheumatoid arthritis hold regarding the impact of diet on disease activity and joint pain. It also examines the current state of evidence regarding the impact of specific dietary interventions on patient reported and objective parameters of RA disease activity. A search was conducted across seven databases for studies which included reporting on dietary beliefs related to disease management or investigations on the effect of particular diets on disease activity or joint pain. Articles were excluded if they examined extracted compounds or individual dietary supplements. Included studies were synthesized narratively. We retrieved 25,585 papers from which 68 were included in this review: 7 assessed dietary beliefs, 61 explored dietary interventions. The available literature on patient beliefs has been largely limited to quantitative studies with limited qualitative exploration. The Mediterranean, fasting and vegan diets appear to have the most benefit with regards to rheumatoid arthritis outcomes for patients. Research which examines RA patient's beliefs and attitudes about the impact of diet on their RA symptoms and disease is currently lacking.

Knowledge, Attitude, and Practice of Orthopedic Manual Physical Therapists Toward Lifestyle Screening and Education: A Descriptive Study

INTRODUCTION

Lifestyle-focused rehabilitation plans need to become part of the standard system of care for the treatment of chronic diseases. To achieve this goal, the KAP of rehabilitation professionals toward lifestyle medicine needs to be understood. This study investigated the niche of orthopedic manual physical therapy and is purposed as a foundational model for continued research.

METHOD

A survey instrument was designed to investigate the KAP of orthopedic manual physical therapists toward lifestyle screening and education.

RESULTS

There were 155 participants of which 58.1-72.3% reported frequently talking to their patients about lifestyle topics, while 78.1-80.6% felt highly confident and competent while doing so. Additionally, 92.9-94.8% thought that lifestyle screening and education was important and that physical therapists should be doing it. Participants discussed exercise most frequently with their patients (96.1%) and alcohol the least (12.9%). Participants with advanced degrees (ie, PhD or DSc) had significantly higher Practice (MΔ= -3.755, P = .001) and Knowledge (MΔ= -4.14904, P = .020) ratings than those with entry-level physical therapy degrees.

CONCLUSION

There was strong acceptance of lifestyle screening and education in orthopedic manual physical therapy with an emphasis on exercise. This study provides a foundational basis for continued research.

Role of Sirtuins in the Pathogenesis of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune and inflammatory disease leading to joint destruction. The causes of RA are not fully known. Most likely, the development of the disease depends on the coexistence of many factors, such as hereditary factors, immune system defects, gender, infectious agents, nicotine, and stress. Various epigenetic changes have been identified and correlated with the aggressive phenotype of RA, including the involvement of sirtuins, which are enzymes found in all living organisms. Their high content in the human body can slow down the aging processes, reduce cell death, counteract the appearance of inflammation, and regulate metabolic processes. Sirtuins can participate in several steps of RA pathogenesis. This narrative review presents, collects, and discusses the role of all sirtuins (1-7) in the pathogenesis of rheumatoid arthritis.

Atomic Simulation of the Binding of JAK1 and JAK2 with the Selective Inhibitor Ruxolitinib

Rheumatoid arthritis belongs to the group of chronic systemic autoimmune diseases characterized by the development of destructive synovitis and extra-articular manifestations. Cytokines regulate a wide range of inflammatory processes involved in the pathogenesis of rheumatoid arthritis and contribute to the induction of autoimmunity and chronic inflammation. Janus-associated kinase (JAK) and signal transducer and activator of transcription (STAT) proteins mediate cell signaling from cytokine receptors, and are involved in the pathogenesis of autoimmune and inflammatory diseases. Targeted small-molecule drugs that inhibit the functional activity of JAK proteins are used in clinical practice for the treatment of rheumatoid arthritis. In our study, we modeled the interactions of the small-molecule drug ruxolitinib with JAK1 and JAK2 isoforms and determined the binding selectivity using molecular docking. Molecular modeling data show that ruxolitinib selectively binds the JAK1 and JAK2 isoforms with a binding affinity of −8.3 and −8.0 kcal/mol, respectively. The stabilization of ligands in the cavity of kinases occurs primarily through hydrophobic interactions. The amino acid residues of the protein globules of kinases that are responsible for the correct positioning of the drug ruxolitinib and its retention have been determined.

Effects of diet on the outcomes of rheumatic and musculoskeletal diseases (RMDs): systematic review and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs

BACKGROUND

A EULAR taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). In this paper, the literature on the effect of diet on the progression of RMDs is reviewed.

METHODS

Systematic reviews and meta-analyses were performed of studies related to diet and disease outcomes in seven RMDs: osteoarthritis (OA), rheumatoid arthritis (RA), systemic lupus erythematosus, axial spondyloarthritis, psoriatic arthritis, systemic sclerosis and gout. In the first phase, existing relevant systematic reviews and meta-analyses, published from 2013 to 2018, were identified. In the second phase, the review was expanded to include published original studies on diet in RMDs, with no restriction on publication date. Systematic reviews or original studies were included if they assessed a dietary exposure in one of the above RMDs, and reported results regarding progression of disease (eg, pain, function, joint damage).

RESULTS

In total, 24 systematic reviews and 150 original articles were included. Many dietary exposures have been studied (n=83), although the majority of studies addressed people with OA and RA. Most dietary exposures were assessed by relatively few studies. Exposures that have been assessed by multiple, well conducted studies (eg, OA: vitamin D, chondroitin, glucosamine; RA: omega-3) were classified as moderate evidence of small effects on disease progression.

CONCLUSION

The current literature suggests that there is moderate evidence for a small benefit for certain dietary components. High-level evidence of clinically meaningful effect sizes from individual dietary exposures on outcomes in RMDs is missing.

A Randomized, Crossover Trial of a Nutritional Intervention for Rheumatoid Arthritis

To investigate the effects of a dietary intervention on arthritis pain and disease severity, 44 adults previously diagnosed with rheumatoid arthritis were randomly assigned to a Diet phase (vegan diet for 4 weeks, elimination of additional foods for 3 weeks, and then reintroduction of the eliminated foods individually over 9 weeks) or a Supplement (placebo) phase for 16 weeks. After a 4-week washout, they then switched to the opposite phase. The Disease Activity Score-28 (DAS28) decreased from 4.5 to 2.5 (P < .001) in the Diet phase and from 3.2 to 2.9 (P = .41) in the Supplement phase (between-group P = .01). The mean number of swollen joints decreased from 7.0 to 3.3 in the Diet phase (P = .03) and increased from 4.7 to 5 in the Supplement phase (P = .63; between-group P = .047).

In a subanalysis excluding individuals who increased medications during the study, DAS28 decreased 1.9 points in the Diet phase (P = .003) and .4 points in the Supplement phase (P = .27; between-group P = .04). In a further subanalysis limited to participants making no medication changes, DAS28 decreased 1.5 points in the Diet phase (P = .009) and .3 points in the Supplement phase (P = .40, between-group P = .11). We conclude that the dietary intervention was associated with symptomatic improvements. TRIAL REGISTRATION: Clinicaltrials.gov NCT01544101, NCT01700881, NCT03417648, and NCT03580681

The Critical Role of Nutrition Care to Improve Pain Management: A Global Call to Action for Physical Therapist Practice

Physical therapists have unique education in the comprehensive biopsychosocial assessment and treatment of chronic pain and its mechanisms. Recently, physical therapists have raised awareness regarding the impact of nutrition on promoting health and managing noncommunicable diseases. Robust evidence supports the implementation of nutrition in physical therapist education and practice. Of particular interest for the physical therapist are investigations that use dietary interventions for the treatment of chronic pain. Yet physical therapists have received little guidance regarding their role in nutrition care for pain management and may pass on opportunities to counsel their patients on the connection between nutrition and pain. Therefore, a clinical paradigm shift and unified voice within the profession is called on to encourage physical therapists to develop tailored multimodal lifestyle interventions that include nutrition care for the management of chronic pain. This Perspective describes evidence supporting the implementation of nutrition care in physical therapist practice, supports the role of nutritional pain management for physical therapists, and encourages the use of nutrition care for primary, secondary, tertiary, prevention, health promotion, and wellness related to chronic pain. To achieve these aims, this Perspective offers suggestions for how physical therapists can (1) enhance clinical decision making; (2) expand professional, jurisdictional, and personal scope of practice; (3) evolve entry-level education; and (4) stimulate new investigations in nutrition care and pain science research. In doing so, physical therapists can assert their role throughout the pain management continuum, champion innovative research initiatives, and enhance public health by reducing the impact of chronic pain.

IMPACT

The nutrition care process for pain management is defined as the basic duty to provide adequate and appropriate nutrition education and counseling to people living with pain. Including the nutrition care process as part of a multimodal approach to pain management provides an opportunity for physical therapists to assert their role throughout the pain management continuum. This includes championing innovative research initiatives and enhancing public health by reducing the impact of chronic pain for over 50 million Americans.

Placing a Well-Designed Vegan Diet for Slovenes

Interest in vegan diets has increased globally as well as in Slovenia. The quantity of new scientific data requires a thorough synthesis of new findings and considerations about the current reserved position of the vegan diet in Slovenia. There is frequently confusion about the benefits of vegetarian diets that are often uncritically passed on to vegan diets and vice versa. This narrative review aims to serve as a framework for a well-designed vegan diet. We present advice on how to maximize the benefits and minimize the risks associated with the vegan diet and lifestyle. We highlight the proper terminology, present the health effects of a vegan diet and emphasize the nutrients of concern. In addition, we provide guidance for implementing a well-designed vegan diet in daily life. We conducted a PubMed search, up to November 2021, for studies on key nutrients (proteins, vitamin B12, vitamin D, omega-3 long chain polyunsaturated fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), calcium, iron, zinc, iodine and selenium) in vegan diets. Given the limited amount of scientific evidence, we focus primarily on the general adult population. A well-designed vegan diet that includes a wide variety of plant foods and supplementation of vitamin B12, vitamin D in the winter months and potentially EPA/DHA is safe and nutritionally adequate. It has the potential to maintain and/or to improve health. For physically active adult populations, athletes or individuals with fast-paced lifestyles, there is room for further appropriate supplementation of a conventional vegan diet according to individuals' health status, needs and goals without compromising their health. A healthy vegan lifestyle, as included in government guidelines for a healthy lifestyle, includes regular physical activity, avoidance of smoking, restriction of alcohol and appropriate sleep hygiene.

Lifestyle Adjustments in Long-COVID Management: Potential Benefits of Plant-Based Diets

PURPOSE OF REVIEW

The SARS-CoV-2-pandemic has caused mortality and morbidity at an unprecedented global scale. Many patients infected with SARS-CoV-2 continue to experience symptoms after the acute phase of infection and report fatigue, sleep difficulties, anxiety, and depression as well as arthralgia and muscle weakness. Summarized under the umbrella term "long-COVID," these symptoms may last weeks to months and impose a substantial burden on affected individuals. Dietary approaches to tackle these complications have received comparably little attention. Although plant-based diets in particular were shown to exert benefits on underlying conditions linked to poor COVID-19 outcomes, their role with regard to COVID-19 sequelae is yet largely unknown. Thus, this review sought to investigate whether a plant-based diet could reduce the burden of long-COVID.

RECENT FINDINGS

The number of clinical trials investigating the role of plant-based nutrition in COVID-19 prevention and management is currently limited. Yet, there is evidence from pre-pandemic observational and clinical studies that a plant-based diet may be of general benefit with regard to several clinical conditions that can also be found in individuals with COVID-19. These include anxiety, depression, sleep disorders, and musculoskeletal pain. Adoption of a plant-based diet leads to a reduced intake in pro-inflammatory mediators and could be one accessible strategy to tackle long-COVID associated prolonged systemic inflammation. Plant-based diets may be of general benefit with regard to some of the most commonly found COVID-19 sequelae. Additional trials investigating which plant-based eating patterns confer the greatest benefit in the battle against long-COVID are urgently warranted.

Effect of Anti-Inflammatory Diets on Pain in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Various nutritional therapies have been proposed in rheumatoid arthritis, particularly diets rich in ω-3 fatty acids, which may lead to eicosanoid reduction. Our aim was to investigate the effect of potentially anti-inflammatory diets (Mediterranean, vegetarian, vegan, ketogenic) on pain. The primary outcome was pain on a 10 cm visual analogue scale. Secondary outcomes were C-reactive protein levels, erythrocyte sedimentation rate, health assessment questionnaire, disease activity score 28, tender/swollen joint counts, weight, and body mass index. We searched MEDLINE (OVID), Embase (Elsevier), and CINAHL for studies published from database inception to 12 November 2021. Two authors independently assessed studies for inclusion, extracted study data, and assessed the risk of bias. We performed a meta-analysis with all eligible randomized controlled trials using RevMan 5. We used mean differences or standardized mean differences and the inverse variance method of pooling using a random-effects model. The search retrieved 564 unique publications, of which we included 12 in the systematic review and 7 in the meta-analysis. All studies had a high risk of bias and the evidence was very low. The main conclusion is that anti-inflammatory diets resulted in significantly lower pain than ordinary diets (-9.22 mm; 95% CI -14.15 to -4.29; p = 0.0002; 7 RCTs, 326 participants).

Efficacy of therapeutic fasting and plant-based diet in patients with rheumatoid arthritis (NutriFast): study protocol for a randomised controlled clinical trial

BACKGROUND

Previous studies have shown beneficial effects of therapeutic fasting and plant-based dietary interventions on disease activity in patients with rheumatoid arthritis (RA) for a duration of up to 1 year. To date, the effects of such interventions on the gut microbiome and on modern diagnostic markers in patients with RA have not been studied. This trial aims to investigate the clinical effects of therapeutic fasting and a plant-based diet in patients with RA, additionally considering current immunological diagnostic tools and microbiome analyses.

METHODS/DESIGN

This trial is an open-label, single-centre, randomised, controlled, parallel-group clinical trial. We will randomly assign 84 patients with RA under a stable standard therapy to either (1) therapeutic fasting followed by a plant-based dietary intervention or (2) to a conventional nutritional counselling focusing on an anti-inflammatory dietary pattern according to the recommendations of the Deutsche Gesellschaft für Ernährung (German society for nutrition). Primary outcome parameter is the group difference from baseline to 12 weeks on the Health Assessment Questionnaire (HAQ). Other secondary outcomes include established clinical criteria for disease activity and treatment response in RA (Disease Activity Score 28, Simple Disease Activity Index, ACR-Response Criteria), changes in self-reported health and physical functional ability, mood, stress, quality of life, dietary behaviour via 3-day food records and a modified Food Frequency Questionnaire, body composition, changes in the gut microbiome, metabolomics and cytometric parameters. Outcomes will be assessed at baseline and day 7, after 6 weeks, 12 weeks and after 6 months.

ETHICS AND DISSEMINATION

Ethical approval to process and analyse data, and to publish the results was obtained through the institutional review board of Charité-Universitätsmedizin Berlin. Results of this trial will be disseminated through peer-reviewed publications and scientific presentations.

TRIAL REGISTRATION NUMBER

NCT03856190.

Managing Psoriatic Arthritis With a Whole Food Plant-Based Diet: A Case Study

A 40-year-old female teacher presented to the rheumatology clinic in 2003 with nonspecific back, knees, and right ankle pain. She was subsequently diagnosed with psoriatic arthritis and was taking methotrexate to control her disease. Over the years, her symptoms were mostly under control. However, in 2018, after adopting a whole food plant-based diet free of added salt, oil, and sugar, she was able to stop taking methotrexate. She was discharged from the rheumatology clinic and has remained symptom-free since. The available literature on managing psoriatic arthritis with diet shows that less than 2% of patients with psoriatic arthritis are able to discontinue medication as a result of disease remission. This case report adds to support and encourages further research in the field of managing inflammatory polyarthropathies with diet and lifestyle.

Rheumatoid arthritis and dietary interventions: systematic review of clinical trials

CONTEXT

The impact of various dietary interventions on rheumatoid arthritis (RA), characterized by immune-inflammatory response, has been subject to increased attention.

OBJECTIVE

A systematic review was conducted to update the current knowledge on the effects of nutritional, dietary supplement, and fasting interventions on RA outcomes.

DATA SOURCES

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with prespecification of all methods, Medline and Embase were systematically searched for relevant articles.

DATA EXTRACTION

Data were extracted by 2 independent reviewers.

RESULTS

A total of 70 human studies were identified. Administration of omega-3 polyunsaturated fatty acids at high doses resulted in a reduction in RA disease activity and a lower failure rate of pharmacotherapy. Vitamin D supplementation and dietary sodium restriction were beneficial on some RA outcomes. Fasting resulted in significant but transient subjective improvements. While the Mediterranean diet demonstrated improvements in some RA disease activity measures, outcomes from vegetarian, elimination, peptide, or elemental diets suggested that responses are very individualized.

CONCLUSION

Some dietary approaches may improve RA symptoms and thus it is recommended that nutrition should be routinely addressed.

Therapeutic Implications of Diet in Inflammatory Bowel Disease and Related Immune-Mediated Inflammatory Diseases

Despite being a focal issue to patients, the effect of diet on adult inflammatory bowel disease (IBD) remains underexplored with limited guidance. While promising clinical trials are currently underway, there is a need for further evidence-based recommendations. As such, we summarize the current evidence on various diets used in the treatment of IBD and also explore the potential applications of dietary data from related immune-mediated inflammatory diseases (IMIDs), such as rheumatoid arthritis and psoriasis, to provide additional information to inform IBD providers. To date, there have been multiple diets investigated as adjunctive therapy in IBD, but many associated studies are small, non-randomized, and not controlled. Mediterranean, vegetarian/vegan, and reduced-calorie/fasting diets have been studied and have shown some positive results in other IMIDs, which may suggest potential applicability to those with IBD, but larger, well-designed clinical trials are needed for further guidance. Gluten-free and low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP)diets do not appear to have an impact on IBD disease activity, but low FODMAP may potentially be helpful for those with concurrent functional gastrointestinal symptoms. Specific carbohydrate diets have been mainly assessed in children but show some potential in small adult studies.

Resistant starch intake alleviates collagen-induced arthritis in mice by modulating gut microbiota and promoting concomitant propionate production

Gut dysbiosis precedes clinic symptoms in rheumatoid arthritis (RA) and has been implicated in the initiation and persistence of RA. The early treatment of RA is critical to better clinical outcome especially for joint destruction. Although dietary interventions have been reported to be beneficial for RA patients, it is unclear to whether diet-induced gut microbiome changes can be a preventive strategy to RA development. Here, we investigated the effect of a high fiber diet (HFD) rich with resistant starch (RS) on collagen-induced arthritis (CIA) and gut microbial composition in mice. RS-HFD significantly reduced arthritis severity and bone erosion in CIA mice. The therapeutic effects of RS-HFD were correlated with splenic regulatory T cell (Treg) expansion and serum interleukin-10 (IL-10) increase. The increased abundance of Lactobacillus and Lachnoclostridium genera concomitant with CIA were eliminated in CIA mice fed the RS-HFD diet. Notably, RS-HFD also led to a predominance of Bacteroidetes, and increased abundances of Lachnospiraceae_NK4A136_group and Bacteroidales_S24-7_group genera in CIA mice. Accompanied with the gut microbiome changes, serum levels of the short-chain fatty acid (SCFA) acetate, propionate and isobutyrate detected by GC-TOFMS were also increased in CIA mice fed RS-HFD. While, addition of β-acids from hops extract to the drinking water of mice fed RS-HFD significantly decreased serum propionate and completely eliminated RS-HFD-induced disease improvement, Treg cell increase and IL-10 production in CIA mice. Moreover, exogenous propionate added to drinking water replicated the protective role of RS-HFD in CIA including reduced bone damage. The direct effect of propionate on T cells in vitro was further explored as at least one mechanistic explanation for the dietary effects of microbial metabolites on immune regulation in experimental RA. Taken together, RS-HFD significantly reduced CIA and bone damage and altered gut microbial composition with concomitant increase in circulating propionate, indicating that RS-rich diet might be a promising therapy especially in the early stage of RA.

Dietary Interventions Are Beneficial for Patients with Chronic Pain: A Systematic Review with Meta-Analysis

Background

The standard Western diet is high in processed hyperpalatable foods that displace nutrient-dense whole foods, leading to inflammation and oxidative stress. There is limited research on how these adverse metabolic drivers may be associated with maladaptive neuroplasticity seen in chronic pain and whether this could be attenuated by a targeted nutritional approach. The aim of this study was to review the evidence for whole-food dietary interventions in chronic pain management.

Method

A structured search of eight databases was performed up to December 2019. Two independent reviewers screened studies and evaluated risk of bias by using the National Institutes of Health assessment tool for controlled or pre–post studies and the Joanna Briggs checklist for case reports. A meta-analysis was performed in Review Manager.

Results

Forty-three studies reporting on 48 chronic pain groups receiving a whole-food dietary intervention were identified. These included elimination protocols (n = 11), vegetarian/vegan diets (n = 11), single-food changes (n = 11), calorie/macronutrient restriction (n = 8), an omega-3 focus (n = 5), and Mediterranean diets (n = 2). A visual analog scale was the most commonly reported pain outcome measure, with 17 groups reporting a clinically objective improvement (a two-point or 33% reduction on the visual analog scale). Twenty-seven studies reported significant improvement on secondary metabolic measures. Twenty-five groups were included in a meta-analysis that showed a significant finding for the effect of diet on pain reduction when grouped by diet type or chronic pain type.

Conclusion

There is an overall positive effect of whole-food diets on pain, with no single diet standing out in effectiveness. This suggests that commonalities among approaches (e.g., diet quality, nutrient density, weight loss) may all be involved in modulating pain physiology. Further research linking how diet can modulate physiology related to pain (such as inflammation, oxidative stress, and nervous system excitability) is required.

Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations?

Rheumatoid arthritis (RA) is a systemic, autoimmune disease characterized by joint involvement, with progressive cartilage and bone destruction. Genetic and environmental factors determine RA susceptibility. In recent years, an increasing number of studies suggested that diet has a central role in disease risk and progression. Several nutrients, such as polyunsaturated fatty acids, present anti-inflammatory and antioxidant properties, featuring a protective role for RA development, while others such as red meat and salt have a harmful effect. Gut microbiota alteration and body composition modifications are indirect mechanisms of how diet influences RA onset and progression. Possible protective effects of some dietary patterns and supplements, such as the Mediterranean Diet (MD), vitamin D and probiotics, could be a possible future adjunctive therapy to standard RA treatment. Therefore, a healthy lifestyle and nutrition have to be encouraged in patients with RA.

Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review

Dietary patterns may play an important role in musculoskeletal well-being. However, the link between dietary patterns, the components of patients' diet, and chronic musculoskeletal pain remains unclear. Therefore, the purpose of this review was to systematically review the literature on the link between dietary patterns, the components of patients' diet and chronic musculoskeletal pain. This review was conducted following the "Preferred Reporting Items for Systematic reviews and Meta-Analyses" (PRISMA) guidelines and was registered in PROSPERO with the registration number CRD42018110782. PubMed, Web of Science, and Embase online databases were searched. After screening titles and abstracts of 20,316 articles and full texts of 347 articles, 12 eligible articles were included in this review, consisting of nine experimental and three observational studies. Seven out of nine experimental studies reported a pain-relieving effect of dietary changes. Additionally, protein, fat, and sugar intake were found to be associated with pain intensity and pain threshold. In conclusion, plant-based diets might have pain relieving effects on chronic musculoskeletal pain. Patients with chronic rheumatoid arthritis pain can show inadequate intake of calcium, folate, zinc, magnesium, and vitamin B6, whilst patients with fibromyalgia can show a lower intake of carbohydrates, proteins, lipids, vitamin A-E-K, folate, selenium, and zinc. Chronic pain severity also shows a positive relation with fat and sugar intake in osteoarthritis, and pain threshold shows a positive association with protein intake in fibromyalgia.

Nutrition Interventions in Rheumatoid Arthritis: The Potential Use of Plant-Based Diets. A Review

Rheumatoid arthritis (RA), a chronic inflammatory autoimmune disease, affects roughly 1% of the world's population. RA pathogenesis remains unclear, but genetic factors account for 50–60% of the risk while the remainder might be linked to modifiable factors, such as infectious diseases, tobacco smoking, gut bacteria, and nutrition. Dietary triggers may play an inciting role in the autoimmune process, and a compromised intestinal barrier may allow food components or microorganisms to enter the blood stream, triggering inflammation. In addition, excessive body weight may affect pharmacotherapy response and the likelihood of disease remission, as well as the risk of disease mortality. Evidence suggests that changes in diet might play an important role in RA management and remission. Several studies have shown improvements in RA symptoms with diets excluding animal products. Studies have also shown that dietary fiber found in these plant-based foods can improve gut bacteria composition and increase bacterial diversity in RA patients, thus reducing their inflammation and joint pain. Although some of the trigger foods in RA patients are individualized, a vegan diet helps improve symptoms by eliminating many of these foods. This review examines the potential role of a plant-based diet in mediating RA symptoms. Further research is needed to test the effectiveness of plant-based diets on joint pain, inflammation, and quality of life in patients with RA.

Evaluation of an Eight-Week Whole-Food Plant-Based Lifestyle Modification Program

Poor diet quality is the leading cause of death both in the United States and worldwide, and the prevalence of obesity is at an all-time high and is projected to significantly worsen. Results from an eight-week group program utilizing an ad-libitum whole-food plant-based dietary pattern, were reviewed. There were 79 participants, all self-referred from the community, including 24 (30.4%) who were already vegetarian or vegan at baseline. Seventy-eight participants (98.7%) completed the eight-week program. Among completers, those with higher BMI at baseline lost a larger percentage of their body weight (total body weight loss of 3.0 ± SD 2.1%, 5.8 ± 2.8%, and 6.4 ± 2.5% for participants who had baseline BMI in normal, overweight, and obese range, respectively). The average weight loss for all the completers was 5.5 ± 3.0 kg (p < 0.0001). Final blood pressure and plasma lipids were reduced compared to baseline (SBP decreased 7.1 ± 15.5 mmHg (p = 0.0002), DBP decreased 7.3 ± 10.9 mmHg (p < 0.0001), total cholesterol decreased 25.2 ± 24.7 mg/dL (p < 0.0001), LDL decreased 15.3 ± 21.1 mg/dL (p < 0.0001)). Twenty-one (26.9%) participants were able to decrease or stop at least one chronic medication compared to two (2.6%) participants who required an increased dose of a chronic medication. Participants who were already vegetarian or vegan at baseline experienced statistically significant weight loss and reductions in total and LDL cholesterol. There was a non-significant trend toward less weight loss in these participants compared to participants who were non-vegetarian at baseline. Reductions in total and LDL cholesterol were not significantly different when comparing vegetarian or vegan and non-vegetarian participants. A whole-food plant-based dietary intervention may provide significant short-term benefits for both non-vegetarian, vegetarian, and vegan individuals.

Is There a Lack of Support for Whole-Food, Plant-Based Diets in the Medical Community?

Since the early 2000s, plant-based nutrition has increased in popularity in the general population. Kaiser Permanente significantly contributes to this development by promoting plant-based diets and by continuously incorporating plant-based nutrition on the front lines with their dietary recommendations. Despite a continuously growing body of evidence and the meticulous work of renowned experts in this field worldwide, the latest findings in this area have not found their way into US national dietetic guidelines.We must ask ourselves why this is the case, given the numerous advantages and health benefits of a whole-food, plant-based diet. What role do physicians play in this context? Is there potentially a lack of support for whole-food, plant-based diets and comprehensive lifestyle change programs in the medical community?

Beneficial effects and potential risks of tomato consumption for human health: An overview

Tomato and its derived products have a very interesting nutritional value in addition to prominent antioxidant, anti-inflammatory, and anticancer activities. Tomatoes are generally quite safe to eat. However, overall consumption varies from individual to individual. Indeed, either beneficial or harmful effects of plants or their derived products are closely related to quality, including the presence of biologically active compounds. On the other hand, the synthesis and accumulation of these bioactive molecules depends on many other factors, such as environmental conditions. In this sense, this review briefly highlights the relationship between the chemistry of tomato and its derived products and their beneficial or harmful effects on human health, such as gastroesophageal reflux disease or heartburn, allergies, kidney and cardiovascular disorders, prostate cancer, irritable bowel syndrome, lycopenodermia, body aches, arthritis, and urinary problems.

Plant-Based Diets for Cardiovascular Safety and Performance in Endurance Sports

Studies suggest that endurance athletes are at higher-than-average risk for atherosclerosis and myocardial damage. The ability of plant-based regimens to reduce risk and affect performance was reviewed. The effect of plant-based diets on cardiovascular risk factors, particularly plasma lipid concentrations, body weight, and blood pressure, and, as part of a healthful lifestyle, reversing existing atherosclerotic lesions, may provide a substantial measure of cardiovascular protection. In addition, plant-based diets may offer performance advantages. They have consistently been shown to reduce body fat, leading to a leaner body composition. Because plants are typically high in carbohydrate, they foster effective glycogen storage. By reducing blood viscosity and improving arterial flexibility and endothelial function, they may be expected to improve vascular flow and tissue oxygenation. Because many vegetables, fruits, and other plant-based foods are rich in antioxidants, they help reduce oxidative stress. Diets emphasizing plant foods have also been shown to reduce indicators of inflammation. These features of plant-based diets may present safety and performance advantages for endurance athletes. The purpose of this review was to explore the role of nutrition in providing cardioprotection, with a focus on plant-based diets previously shown to provide cardiac benefits.

A systematic review and meta-analysis of nutrition interventions for chronic noncancer pain

BACKGROUND

This systematic review aimed to evaluate the impact of nutrition interventions on participant reported pain severity and intensity in populations with chronic pain.

METHODS

Eight databases were systematically searched for studies that included adult populations with a chronic pain condition, a nutrition intervention and a measure of pain. Where possible, data were pooled using meta-analysis. Seventy-one studies were included, with 23 being eligible for meta-analysis.

RESULTS

Studies were categorised into four groups: (i) altered overall diet with 12 of 16 studies finding a significant reduction in participant reported pain; (ii) altered specific nutrients with two of five studies reporting a significant reduction in participant reported pain; (iii) supplement-based interventions with 11 of 46 studies showing a significant reduction in pain; and (iv) fasting therapy with one of four studies reporting a significant reduction in pain. The meta-analysis found that, overall, nutrition interventions had a significant effect on pain reduction with studies testing an altered overall diet or just one nutrient having the greatest effect.

CONCLUSIONS

This review highlights the importance and effectiveness of nutrition interventions for people who experience chronic pain.

Chronic musculoskeletal pain and function improve with a plant-based diet

BACKGROUND

Chronic musculoskeletal pain, often debilitating, affects all genders, ethnicities, and age groups. Research suggests consumption of a plant-based diet may improve the status of persons with chronic pain. A diet rich in fruits, vegetables and whole grains has been shown to reduce chronic pain and disability associated with musculoskeletal conditions.

OBJECTIVE

The purpose of this study was to examine the value of a plant-based diet in the management of chronic musculoskeletal pain and functional limitations.

METHOD

Fourteen subjects participated in the eight-week study. Baseline evaluation included anthropometric measurements and completion of two self-reported outcome measures: Numeric Pain Rating Scale (NPRS) and the Short Form Health Survey (SF-36). A registered dietitian nutritionist provided a sample menu cycle and education on a plant-based diet. Subjects utilized a phone app to log food intake and receive support from the dietitian. Post data collection included a repeat of the baseline measures and the Patient Global Impression of Change Scale. The sample was small. Twenty subjects began, 14 completed. No comparison group was used. Results should be considered with caution.

RESULTS

The diet intervention resulted in decreased pain and improvement in quality of life. Diet adherence by ten of fourteen subjects was 89% based on completion of food intake records and adherence to allowed foods.

CONCLUSION

Consumption of a plant-based diet produced positive improvements in chronic pain and function. Interprofessional collaboration between physical therapists and registered dietitian nutritionists, along with other healthcare practitioners, can encourage and promote diet interventions that positively affect chronic pain.

Impact of Dietary Cholesterol on the Pathophysiology of Infectious and Autoimmune Disease

Cellular cholesterol metabolism, lipid raft formation, and lipoprotein interactions contribute to the regulation of immune-mediated inflammation and response to pathogens. Lipid pathways have been implicated in the pathogenesis of bacterial and viral infections, whereas altered lipid metabolism may contribute to immune dysfunction in autoimmune diseases, such as systemic lupus erythematosus, multiple sclerosis, and rheumatoid arthritis. Interestingly, dietary cholesterol may exert protective or detrimental effects on risk, progression, and treatment of different infectious and autoimmune diseases, although current findings suggest that these effects are variable across populations and different diseases. Research evaluating the effects of dietary cholesterol, often provided by eggs or as a component of Western-style diets, demonstrates that cholesterol-rich dietary patterns affect markers of immune inflammation and cellular cholesterol metabolism, while additionally modulating lipoprotein profiles and functional properties of HDL. Further, cholesterol-rich diets appear to differentially impact immunomodulatory lipid pathways across human populations of variable metabolic status, suggesting that these complex mechanisms may underlie the relationship between dietary cholesterol and immunity. Given the Dietary Guidelines for Americans 2015⁻2020 revision to no longer include limitations on dietary cholesterol, evaluation of dietary cholesterol recommendations beyond the context of cardiovascular disease risk is particularly timely. This review provides a comprehensive and comparative analysis of significant and controversial studies on the role of dietary cholesterol and lipid metabolism in the pathophysiology of infectious disease and autoimmune disorders, highlighting the need for further investigation in this developing area of research.

Long-Term Dietary Changes after Diagnosis of Rheumatoid Arthritis in Swedish Women: Data from a Population-Based Cohort

Objective

To investigate long-term dietary changes after rheumatoid arthritis (RA) diagnosis in Swedish women, compared to women without RA.

Methods

This study included 21,602 women from the Swedish Mammography Cohort (SMC), who completed dietary questionnaires in 1997 and 2009. Between 1997 and 2009, 191 women were diagnosed with RA. Dietary changes after RA diagnosis were analyzed based on intake of 82 food items. Statistical analysis included linear mixed models.

Results

Women with RA, compared to women without RA, had significantly lower intake (mean servings per week) of animal products such as black pudding, egg, kidney, and liver paste (2.94±2.73 versus 2.45±1.82, p=0.010) and dairy products (35.14±20.02 versus 28.42±16.10, p=0.040) in 1997 and of cereals and grains (31.01±15.54 versus 28.00±14.98, p=0.009) in 2009. However, multivariable adjusted changes in dietary intake from 1997 to 2009 did not show any significant difference in intake. Nevertheless, women without RA increased their intake of whole wheat bread, wheat/oat bran, and rice more than women with RA.

Conclusion

Women who had been diagnosed with RA had similar dietary patterns over time as the general population; these women did not remarkably change their diet over time due to their disease. Dietary recommendations for RA patients are needed.

The impact of nutrition and generally available products such as nicotine and alcohol on rheumatoid arthritis - review of the literature

Nutrition habits and diet may influence disease development and course. There are no specific recommendations related to rheumatic diseases for a diet that would facilitate treatment. However, some research results suggest that various nutrients may affect the health of patients, especially in the case of inflammatory rheumatic disease such as rheumatoid arthritis (RA). Scientists have been trying to find a relation between inflammatory rheumatic diseases and diet but have never come up with any firm conclusions that would help in determining the model of a diet for such patients. Nevertheless, there are some consistent results that refer to the influence of nutritional behaviours on symptoms of RA. The article presents a review of the research showing that certain nutrients may be beneficial for the course of disease among some RA patients.

Role of Diet in Influencing Rheumatoid Arthritis Disease Activity

BACKGROUND

Patients with Rheumatoid Arthritis (RA) frequently ask their doctors about which diets to follow, and even in the absence of advice from their physicians, many patients are undertaking various dietary interventions.

DISCUSSION

However, the role of dietary modifications in RA is not well understood. Several studies have tried to address these gaps in our understanding. Intestinal microbial modifications are being studied for the prevention and management of RA. Some benefits of vegan diet may be explained by antioxidant constituents, lactobacilli and fibre, and by potential changes in intestinal flora. Similarly, Mediterranean diet shows anti-inflammatory effects due to protective properties of omega-3 polyunsaturated fatty acids and vitamins, but also by influencing the gut microbiome. Gluten-free and elemental diets have been associated with some benefits in RA though the existing evidence is limited. Long-term intake of fish and other sources of long-chain polyunsaturated fatty acids are protective for development of RA. The benefits of fasting, anti-oxidant supplementation, flavanoids, and probiotics in RA are not clear. Vitamin D has been shown to influence autoimmunity and specifically decrease RA disease activity. The role of supplements such as fish oils and vitamin D should be explored in future trials to gain new insights in disease pathogenesis and develop RA-specific dietary recommendations.

CONCLUSION

Specifically more research is needed to explore the association of diet and the gut microbiome and how this can influence RA disease activity.

Managing Rheumatoid Arthritis with Dietary Interventions

Self-help by means of dietary interventions can help in management of various disorders including rheumatoid arthritis (RA), a debilitating autoimmune disease. Dietary interventions necessitate a widespread appeal for both patients as well as clinicians due to factors including affordability, accessibility, and presence of scientific evidences that demonstrate substantial benefits in reducing disease symptoms such as pain, joint stiffness, swelling, tenderness and associated disability with disease progression. However, there is still an uncertainty among the community about the therapeutic benefits of dietary manipulations for RA. In the present review, we provide an account of different diets and their possible molecular mechanism of actions inducing observed therapeutic benefits for remission and management of RA. We further indicate food that can be a potential aggravating factor for the disease or may help in symptomatic relief. We thereafter summarize and thereby discuss various diets and food which help in reducing levels of inflammatory cytokines in RA patients that may play an effective role in management of RA following proper patient awareness. We thus would like to promote diet management as a tool that can both supplement and complement present treatment strategies for a better patient health and recovery.

Nutrition and quality of life referring to physical abilities - a comparative analysis of a questionnaire study of patients with rheumatoid arthritis and osteoarthritis

OBJECTIVES

A comparative analysis of opinions on diet and nutrition of patients suffering from rheumatoid arthritis (RA) and osteoarthritis (OA), and quality of life limited to physical abilities in both study groups.

MATERIAL AND METHODS

In the period from August to December 2012 an anonymous questionnaire survey was carried out among the patients of the Institute of Rheumatology. The respondents were asked to define their dietary preferences, dietary supplementation, and the level of physical limitations by completing the Health Assessment Questionnaire (HAQ). The study was carried out with the consent of the Bioethics Committee.

RESULTS

A total of 397 questionnaires were obtained. The majority of respondents were women (77%). 62% of RA patients (165 respondents) had been treated for over 10 years as opposed to OA patients (80 respondents), where the largest group (33%) were patients during their first year. There is a significant difference in the disability level of patients in both compared groups. The average HAQ of RA patients was 1.09 and OA patients - 0.46. A change of dietary habits was declared by 32% of RA patients and by 17% of OA patients (p = 0.049) mostly without consulting a specialist - it concerned mainly limiting the consumption of sweets (30% vs. 21%), a meatless diet: 19% vs. 14%, and a non-dairy diet: 9% vs. 14%.

CONCLUSIONS

Regardless of their diagnosis, the respondents believe that the way of eating affects their health. There are visible differences between diet and dietary supplementation, depending on the diagnosis of the disease. Differences were also observed in physical limitations of both patient groups - a higher level of disability was noted among RA patients. It is necessary to continue the topic at the level of clinical trials and medical experiments within the scope of the impact of diet as a supportive element in the treatment of rheumatic diseases.

Altered gut microbiota in RA: implications for treatment

Rheumatoid arthritis (RA) is an autoimmune disease with progressive joint disorder. The complex interplay of genetic and environmental influences is important for the development of the disease. A growing body of evidence has shed light on the association of dysbiosis of gut microbiota with RA. Certain gut microbial strains have been shown to inhibit or attenuate immune responses in RA experimental models, suggesting that specific species among intestinal commensal bacteria may play either a pathogenic or a protective role in the development of RA. Oral intake of probiotics/prebiotics can therefore represent a therapeutic approach for RA treatment. However, the relevant scientific work has only just begun, and the available data in this field remain limited. Fortunately, utilization of new sequencing technologies allows expanded research on the association of intestinal bacterial flora and human diseases to be attempted. In this review, we summarize the role of gut microbiota in RA progression and address how specific bacterial strains regulate the immune response in disease process. Probiotics/prebiotics in the treatment of RA is also discussed.

Dietary Behaviors in Psoriasis: Patient-Reported Outcomes from a U.S. National Survey

INTRODUCTION

Psoriasis patients demonstrate high interest in the role of diet on their skin condition. However, data are lacking to describe dietary interventions among psoriasis patients and associated outcomes. This study aims to identify common dietary habits, interventions and perceptions among patients with psoriasis, and to examine patient-reported skin outcomes in response to these interventions.

METHODS

We administered a 61-question survey to the National Psoriasis Foundation membership asking psoriasis patients about dietary habits, modifications, skin responses, and perceptions.

RESULTS

A total of 1206 psoriasis patients responded to the survey. Compared to age- and sex-matched controls, psoriasis patients consumed significantly less sugar, whole grain fiber, dairy, and calcium (p < 0.001), while consuming more fruits, vegetables, and legumes (p < 0.01). Eighty-six percent of respondents reported use of a dietary modification. The percentage of patients reporting skin improvement was greatest after reducing alcohol (53.8%), gluten (53.4%), nightshades (52.1%), and after adding fish oil/omega-3 (44.6%), vegetables (42.5%), and oral vitamin D (41%). Specific diets with the most patients reporting a favorable skin response were Pagano (72.2%), vegan (70%), and Paleolithic (68.9%). Additionally, 41.8% of psoriasis respondents reported that a motivation for attempting dietary changes was to improve overall health.

CONCLUSION

This national survey is among the first to report the dietary behaviors of patients with psoriasis. The data provided from this large cohort may benefit patients and clinicians as they discuss the role of diet in managing both psoriasis and associated cardiometabolic comorbidities.

Microbiota and arthritis: correlations or cause?

PURPOSE OF REVIEW

The microorganisms that colonise our bodies, the commensal 'microbiota', respond to changes in our behaviour and environment, and can also profoundly affect our health. We can now investigate these organisms with unprecedented depth and precision, revealing that they may contribute to the pathogenesis of diseases including arthritis. Here we discuss the changes occurring in the microbiota in people with arthritis, and how manipulation of the microbiota may provide an additional pathway for therapy.

RECENT FINDINGS

We highlight two important aspects of the recent literature. First we describe changes in the microbiota identified in people with arthritis; these correlations give insights into the microbial changes that may contribute to symptoms of arthritis. We then discuss attempts to ameliorate arthritis by manipulating the microbiota. This is a rapidly developing area of research. There are tantalising hints that interventions targeting the microbiota may become therapeutically viable for some types of inflammatory arthritis.

SUMMARY

Our commensal microbial communities respond to changes in our health, and are altered in people with arthritis. Understanding the complex relationships between the microbiota and the body may enable us to deliberately manipulate these organisms and provide additional therapeutic options for people with arthritis.

Are strict vegetarians protected against prostate cancer?

BACKGROUND

According to the American Cancer Society, prostate cancer accounts for ∼27% of all incident cancer cases among men and is the second most common (noncutaneous) cancer among men. The relation between diet and prostate cancer is still unclear. Because people do not consume individual foods but rather foods in combination, the assessment of dietary patterns may offer valuable information when determining associations between diet and prostate cancer risk.

OBJECTIVE

This study aimed to examine the association between dietary patterns (nonvegetarian, lacto-ovo-vegetarian, pesco-vegetarian, vegan, and semi-vegetarian) and prostate cancer incidence among 26,346 male participants of the Adventist Health Study-2.

DESIGN

In this prospective cohort study, cancer cases were identified by matching to cancer registries. Cox proportional hazards regression analysis was performed to estimate HRs by using age as the time variable.

RESULTS

In total, 1079 incident prostate cancer cases were identified. Around 8% of the study population reported adherence to the vegan diet. Vegan diets showed a statistically significant protective association with prostate cancer risk (HR: 0.65; 95% CI: 0.49, 0.85). After stratifying by race, the statistically significant association with a vegan diet remained only for the whites (HR: 0.63; 95% CI: 0.46, 0.86), but the multivariate HR for black vegans showed a similar but nonsignificant point estimate (HR: 0.69; 95% CI: 0.41, 1.18).

CONCLUSION

Vegan diets may confer a lower risk of prostate cancer. This lower estimated risk is seen in both white and black vegan subjects, although in the latter, the CI is wider and includes the null.

Whole-foods, plant-based diet alleviates the symptoms of osteoarthritis

Objective. To evaluate the effectiveness of a whole-foods, plant-based diet (WFPB) to reduce symptoms of osteoarthritis. Methods. Six-week, prospective randomized open-label study of patients aged 19–70 with osteoarthritis. Participants were randomized to a WFPB (intervention) or continuing current diet (control). Outcomes were assessed by mixed models analysis of participant self-assessed weekly SF-36v2 domain t scores, weekly Patient Global Impression of Change (PGIC) scales, and mean weekly Visual Analog Scale (VAS) pain assessment. Mixed models analysis also evaluated pre-post change from baseline level for standard clinical measures: weight, BMI, body temperature, pulse, and blood pressure. Results. Forty participants were randomized. Thirty-seven of them, 18 control and 19 intervention, completed the study. The intervention group reported a significantly greater improvement than the control group in SF-36v2 energy/vitality, physical functioning, role physical, and the physical component summary scale. The differences between the intervention and control PGIC scales were statistically significant over time. Intervention group improvement in VAS weekly mean was also significantly greater than that of the control group from week 2 onward. Conclusion. Study results suggest that a whole-foods, plant-based diet significantly improves self-assessed measures of functional status among osteoarthritis patients.

A systematic review of behavioural techniques used in nutrition and weight loss interventions among adults with mobility-impairing neurological and musculoskeletal conditions

Obesity is a common comorbidity in adults with mobility-impairing neurological and musculoskeletal conditions, such as stroke and arthritis. The interaction between mobility impairments and environmental factors often compromises motivation and ability to engage in healthy behaviours. Such difficulties to engage in healthy behaviours can result in energy imbalance, weight gain and a cycle of functional declines; i.e. obesity can exacerbate mobility impairments and symptoms and increase the likelihood of other comorbid conditions, all of which make it more difficult to engage in healthy behaviours. To help disrupt this cycle, there is a need to identify strategies to optimize energy balance. Thus, this review summarizes clinical trials of nutrition and weight loss interventions in adults with mobility-impairing conditions. Although adults with osteoarthritis were represented in large rigorous clinical trials, adults with neurological conditions were typically represented in studies characterized by a small number of participants, a short-term follow-up and high attrition rates. Studies varied greatly in outcome measures, description and implementation of the interventions, and the strategies used to promote behaviour change. Nutrition and weight loss research in adults with mobility-impairing conditions is still in its formative stages, and there is a substantial need to conduct randomized controlled trials.

Evidence-Based Complementary and Alternative Medicine in Inpatient Care

The aim of this report is to provide the reader an overview of the complex therapy currently used within the German health system. Complex therapies in inpatient care in Germany establish the basis for an integrative and interdisciplinary provision of services. They define minimal criteria for the organization of a hospital, enable the integration of different therapeutic approaches, and therefore, lead to an intensive and holistic treatment by a specially trained team. The German model can be viewed as a pilot program for the introduction of integrative patient-centered care in other hospitals around the world.

Health Implications of a Vegetarian Diet

There is now a significant amount of research that demonstrates the health benefits of vegetarian and plant-based diets, which have been associated with a reduced risk of obesity, diabetes, heart disease, and some types of cancer as well as increased longevity. Vegetarian diets are typically lower in fat, particularly saturated fat, and higher in dietary fiber. They are also likely to include more whole grains, legumes, nuts, and soy protein, and together with the absence of red meat, this type of eating plan may provide many benefits for the prevention and treatment of obesity and chronic health problems, including diabetes and cardiovascular disease. Although a well-planned vegetarian or vegan diet can meet all the nutritional needs of an individual, it may be necessary to pay particular attention to some nutrients to ensure an adequate intake, particularly if the person is on a vegan diet. This article will review the evidence for the health benefits of a vegetarian diet and also discuss strategies for meeting the nutritional needs of those following a vegetarian or plant-based eating pattern.

A randomized, double-blinded, placebo-controlled pilot study of probiotics in active rheumatoid arthritis

Background

To examine the effect of probiotics as adjunctive therapy for the treatment of rheumatoid arthritis (RA). A sample size of 30 subjects was calculated to determine a moderate effect.

Material/Methods

A three month double-blind, placebo-controlled study was performed using probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 capsules administered orally. Inclusion criteria required at least 4 swollen and 4 tender joints and stable medications with no steroids for at least 1 month prior to and during the study. Twenty-nine patients with RA were randomized to treatment. ACR20 responses, serum cytokine levels and safety parameters were assessed.

Results

Fifteen patients were randomized to the probiotic group, and 14 to placebo. Three subjects in the probiotic (20%) and one in the placebo group (7%) achieved an ACR20 response (p= 0.33). There was no statistically significant difference between individual components of the ACR20 criteria. Changes in cytokines favored placebo over probiotic. There was a significant improvement in the Health Assessment Questionnaire (HAQ) score in the probiotic group from visit 1 to visit 3 (p=0.02) but no between-group differences.

Conclusions

Due to inclusion criteria, patients selected for the study had stable RA with chronic synovitis, and thus it may have been difficult for an adjunctive therapy to demonstrate improvement within 3 months. Although probiotics did not clinically improve RA as measured by the ACR20, it is interesting that there was functional improvement seen within the probiotic group compared to placebo.