Nutritional interventions and supplementation for rheumatoid arthritis patients: A systematic review for clinical application, Part 2: Supplementation

Abstract

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease that is associated with local and systemic inflammation, resulting in chronic pain and physical function limitations that may negatively impact quality of life (QOL). Despite advances in pharmacological therapies, currently available treatment options may be associated with adverse events and come at a high price tag. As a result, research efforts have grown to focus on nutritional interventions to support pharmacological therapies, reduce inflammation (targeting biomarkers of disease activity) and improve QOL. Objectives: In this systematic review, data was collected on the most recent non-pharmacological interventions used for RA management. The efficacy and potential practical applications of various nutritional interventions used in the RA management will be discussed. This review has been divided into three parts. In the second of our 3-part series we will discuss interventions involving supplementation and their clinical impact on patients with RA. The compounds discussed in this article include coenzyme q10 (CoQ10), fatty acids (n-3 PUFA and GLA), synbiotics/ probiotics, and quercetin. For more information on the other contents of this systematic review you may refer back to Part 1: Dieting and Part 3: Fruits and herbs. Methods: A search of the literature was conducted to identify nutritional interventions in the progression and management of RA. Eligible study designs included meta-analyses, systematic reviews, randomized control trials (RCT), and prospective/retrospective studies. Exclusion criteria included non, in vivo human studies, n<40, crosssectional studies, case-studies, and lack of access to available text. Results: Initially, 334 articles were identified. After removing studies for lack of relevance, exclusion criteria and duplicates, 22 articles remained. The eligible articles were divided into five groups based on design: Meta analyses, systematic reviews, RCTs, literature reviews, and prospective studies. The eligible articles were grouped together based on intervention type: Diets, supplementation and the implementation of fruits and herbs. Ten articles were placed under the category of supplementation which includes three Meta analyses, one systematic review, four RCT and two literature reviews Conclusion: Nutritional interventions may be an effective method for reducing inflammation and symptoms associated with RA. In particular, the use of Omega-3 (n-3) polyunsaturated fatty acids (PUFA) demonstrated significant improvements in RA indices, in line with prior findings, and is considered safe and effective adjuvant. therapies to utilize in clinical practice. Specific recommendations in this article for reduction of pain and medication management include dosage, ratio and duration. Coenzyme q10 and quercetin also demonstrated improvements in DAS-28 as well as TJC and displayed excellent safety profiles but further research needs to be completed before recommendations as alternative therapy can be made. Despite this, these nutritional interventions are considered safe enough to incorporate into daily regimens with minimal risk. The use of synbiotics in clinical practice requires further research before recommendations can be made.