Abstract
BackgroundMany patients with rheumatoid arthritis (RA) report symptom relief from certain foods. Earlier research indicates positive effects of food and food components on clinical outcomes in RA, but insufficient evidence exists to provide specific dietary advice. Food components may interact but studies evaluating combined effects are lacking.ObjectivesWe aimed to investigate if an anti-inflammatory diet reduces disease activity in patients with RA.MethodsIn this single-blinded crossover trial, 50 patients with RA were randomly assigned to an intervention diet containing a portfolio of suggested anti-inflammatory foods, or a control diet similar to the general dietary intake in Sweden, for 10 wk. After a 4-mo washout period the participants switched diet. Food equivalent to ∼50% of energy requirements was delivered weekly to their homes. For the remaining meals, they were encouraged to consume the same type of foods as the ones provided during each diet. Primary outcome was change in Disease Activity Score in 28 joints-Erythrocyte Sedimentation Rate (DAS28-ESR). Secondary outcomes were changes in the components of DAS28-ESR (tender and swollen joints, ESR, and visual analog scale for general health) and DAS28-C-reactive protein.ResultsIn the main analysis, a linear mixed ANCOVA model including the 47 participants completing ≥1 diet period, there was no significant difference in DAS28-ESR between the intervention and control periods (P = 0.116). However, in unadjusted analyses, DAS28-ESR significantly decreased during the intervention period and was significantly lower after the intervention than after the control period in the participants who completed both periods (n = 44; median: 3.05; IQR: 2.41, 3.79 compared with median: 3.27; IQR: 2.69, 4.28; P = 0.04, Wilcoxon's Signed Rank test). No significant differences in the components were observed.ConclusionsThis trial indicates positive effects of a proposed anti-inflammatory diet on disease activity in patients with RA. Additional studies are required to determine if this diet can cause clinically relevant improvements.This trial was registered at clinicaltrials.gov as NCT02941055.
Highlights
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by synovial inflammation often followed by cartilage and bone erosion [1]
We found no significant difference in effects on DAS28 and its components between this diet and a diet nutritionally similar to a typical Swedish diet
The anti-inflammatory diet used in this crossover trial is similar to the Mediterranean diet used in Sköldstam et al.’s [33] parallel trial and based on unadjusted analyses, the obtained results are consistent; a reduced DAS28 during the intervention period and a larger reduction than during the control period
Summary
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by synovial inflammation often followed by cartilage and bone erosion [1]. Objectives: We aimed to investigate if an anti-inflammatory diet reduces disease activity in patients with RA. Methods: In this single-blinded crossover trial, 50 patients with RA were randomly assigned to an intervention diet containing a portfolio of suggested anti-inflammatory foods, or a control diet similar to the general dietary intake in Sweden, for 10 wk. Results: In the main analysis, a linear mixed ANCOVA model including the 47 participants completing ≥1 diet period, there was no significant difference in DAS28-ESR between the intervention and control periods (P = 0.116). Conclusions: This trial indicates positive effects of a proposed antiinflammatory diet on disease activity in patients with RA. Additional studies are required to determine if this diet can cause clinically relevant improvements. This trial was registered at clinicaltrials.gov as NCT02941055.
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