Abstract
BackgroundTo explore possible anti-inflammatory effects of the specific carbohydrate diet in children with juvenile idiopathic arthritis. This diet has shown anti-inflammatory effect in children with inflammatory bowel disease.MethodsTwenty-two patients with juvenile idiopathic arthritis (age 6.3–17.3 years), with ≤2 inflamed joints and an erythrocyte sedimentation rate < 30 mm/h, were included in this explorative study. Fifteen children completing four weeks on the diet were evaluated. A dietician introduced parents and children to the diet, and two follow-ups were performed during the intervention. Conventional laboratory tests and multiplex analyses of 92 inflammatory proteins were used. Short-chain fatty acids in faecal samples were examined.ResultsThe diet significantly decreased morning stiffness (p = 0.003) and pain (p = 0.048). Physical function, assessed through the child health assessment questionnaire, improved (p = 0.022). Arthritis improved in five of the seven children with arthritis; in those seven, multiplex analyses showed a significant decrease in nine inflammatory proteins, including TNF-alpha (p = 0.028), after four weeks. Faecal butyrate, analysed in all 15 participants, increased significantly (p = 0.020).ConclusionThe specific carbohydrate diet may have significant positive effects on arthritis in children with juvenile idiopathic arthritis, but further studies are needed.Clinical trials identifierNCT04205500, 2019/12/17, retrospectively registered. URL:https://register.clinicaltrials.gov
Highlights
Juvenile idiopathic arthritis (JIA) is an umbrella term, which describes a heterogeneous group of rheumatologic diseases that affect children; it is one of the most common chronic paediatric conditions [1]
Increased gut permeability has been shown in several other inflammatory diseases and in one Berntson Pediatric Rheumatology (2021) 19:88 study on JIA, suggesting that a dysfunctional gut barrier could increase the possibility for bacteria and other substances to interplay with the immune system, leading to a breakage of T cell tolerance [9]
Further inclusion criteria were that patients had to be on stable treatment – i.e., there had been no change in medical treatment with disease-modifying anti-rheumatic drugs (DMARDs) or biological DMARDs during the preceding twelve weeks – with a mild to moderate disease activity, no more than two active joints at inclusion, and an erythrocyte sedimentation rate (ESR) of no more than 30 mm/h
Summary
Juvenile idiopathic arthritis (JIA) is an umbrella term, which describes a heterogeneous group of rheumatologic diseases that affect children; it is one of the most common chronic paediatric conditions [1]. Increased gut permeability has been shown in several other inflammatory diseases and in one Berntson Pediatric Rheumatology (2021) 19:88 study on JIA, suggesting that a dysfunctional gut barrier could increase the possibility for bacteria and other substances to interplay with the immune system, leading to a breakage of T cell tolerance [9]. These factors may alter the likelihood of JIA by influencing the development of the immune system, the integrity of the intestinal mucosal barrier, and the differentiation of immune stimulatory and regulatory cells [10, 11]. This diet has shown anti-inflammatory effect in children with inflammatory bowel disease
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