Status Of Rheumatoid Arthritis Patients Research Articles

AB0440 What effect does the presence of bronchiectasis have on CCP antibody levels in patients with rheumatoid arthritis?

BackgroundIt is well established that anti cyclic citrullinated peptide (CCP) antibodies are a marker of rheumatoid arthritis (RA) and are associated with greater articular damage [1]. There is increasing evidence...

AB0180 Relationship between area level socio-economic deprivation and autoantibody status in rheumatoid arthritis patients: Multicentre cross-sectional study

BackgroundSocio-economic deprivation is known to be associated with an adverse prognosis in rheumatoid arthritis (RA); some of this may be due to differential interaction of individuals with their healthcare providers...

Relevance of the new pre-cachexia and cachexia definitions for patients with rheumatoid arthritis

The recently proposed definitions of 'pre-cachexia' and 'cachexia' might offer new possibilities for the detection of malnutrition in patients with rheumatoid arthritis (RA). The prevalence of different components of nutritional status and the compiled definitions of 'precachexia' and 'cachexia' were measured in a cohort of 103 patients with moderately active RA. Nutritional status was determined by measuring unintentional weight loss, BMI, and muscle strength. Bio-electrical Impedance Analysis (BIA) was used to determine fat free mass index (FFMI) and fat mass index. In addition, appetite, pain, fatigue, and inflammatory activity were assessed. The prevalence of 'pre-cachexia' and 'cachexia' was calculated from different combinations of these parameters. 20% of the study population had a low FFMI (<10th percentile), and 95% had a decreased muscle strength ( < lowest tertile). Weight loss and loss of appetite, both essential elements in the newly proposed (pre-)cachexia definitions, were uncommon. The prevalence of 'pre-cachexia' and 'cachexia' was both 1% (n = 1). In spite of altered body composition and impaired body function, the recently proposed definitions of both 'pre-cachexia' and 'cachexia' were unable to identify and diagnose impaired nutritional status in RA patients mainly because of low prevalences of weight loss and decreased appetite.

Peri- and postoperative status of rheumatoid arthritis patients receiving biologic disease-modifying antirheumatic drugs

Peri- and postoperative status of rheumatoid arthritis patients receiving biologic disease-modifying antirheumatic drugs

Study of vitamin D status of rheumatoid arthritis patients Rationale and design of a cross-sectional study by the osteoporosis and metabolic bone diseases study group of the Italian Society of Rheumatology (SIR)

The fundamental role of Vitamin D has been long known in regulating calcium homeostasis and bone metabolism. An increased contribution of Vitamin D was recently described in association with a lower incidence of Rheumatoid Arthritis (RA). This must not be surprising, as the immunomodulating effects of Vitamin D are clear, which have been attributed protective effects in autoimmune disorders such as some chronic inflammatory bowel diseases, multiple sclerosis and type I diabetes. An interaction was suggested between Vitamin D metabolism and inflammation indexes through mediation of TNF-alpha which is also especially involved in osteoclastic resorption and therefore in bone loss processes. Some preliminary data would indicate an association between seasonal changes of Vitamin D serum levels, latitude and disease activity (DAS28) in RA patients. Consequently, the Osteoporosis and Metabolic Bone Diseases Study Group of SIR believes that there are grounded reasons for assessing the Vitamin D status of RA patients in order to investigate whether this is to be related to physiopathological and clinical aspects of disease other than those of bone involvement. Primary end point of the study will be to assess the levels of 25 OH Vitamin D in RA patients. Secondary endpoints will include correlation with dis-ease activity, densitometry values and bone turnover. The cross-sectional study will enroll patients of both sex genders, age ranging between 30 and 75 years according to the 1988 ACR criteria, onset of symptoms at least 2 years prior to study enrollment. Patients will be excluded suffering from osteo-metabolic diseases, liver and kidney insufficiency and those administered Vitamin D boli in the previous 12 months. Disease activity will be evaluated with the HAQ. Hemato-chemical tests and femoral and lumbar bone densitometry will be performed, unless recently undergone by patients. Blood levels of 25 OH C Vitamin D and PHT and of the two bone remodelling markers (bone alkaline phosphatase and serum CTX) will be measured, as well. Patient enrollment will start on February 2007 and will last 4 months. By the end of 2007 the study will be concluded and results will be published.

Anti-neutrophil cytoplasmic autoantibodies against bactericidal/permeability-increasing protein in patients with rheumatoid arthritis and their correlation with bronchial involvement

Anti-neutrophil cytoplasmic autoantibodies against bactericidal/permeability-increasing protein (BPI-ANCA) are known to be present in patients with cystic fibrosis, diffuse panbronchiolitis, and inflammatory bowel disease, especially in relation to chronic Gram-negative bacterial infection. To investigate the possible role of BPI-ANCA in rheumatoid arthritis (RA), we measured the serum titer of BPI-ANCA and examined clinical manifestations, including pulmonary complications, in patients with RA. Seventy-four RA patients were recruited to our study. The titer of BPI-ANCA was measured by enzyme-linked immunosorbent assay (ELISA). Pulmonary complications were evaluated using high-resolution computed tomography (HRCT), which revealed 26 patients with bronchial diseases (BD group), 25 with interstitial pneumonia (IP group), and 23 without any particular lung lesion (normal group). The correlations between the titer of BPI-ANCA and patients’ clinical and laboratory findings were then analyzed. The numbers of tender joints, swollen joints, and the Disease Activity Score including 28 joint count were significantly higher in the BD group. The titer of BPI-ANCA was positively correlated with age, erythrocyte sedimentation rate (ESR), and bronchial involvement in all subjects. Stepwise multiple regression analysis of factors affecting the titer of BPI-ANCA selected ESR and bronchial involvement as independent variables. Our results show that BPI-ANCA was positively correlated with chronic inflammatory status in RA patients, and we is believe it is positively linked with bronchial diseases.

The diagnostic utility of the anti-CCP antibody test is no better than rheumatoid factor in South Africans with early rheumatoid arthritis

To establish the diagnostic utility of the anti-cyclic-citrullinated peptide antibody (aCCP) test in Black South Africans with early rheumatoid arthritis (RA). A cross-sectional study comparing the rheumatoid factor (RF) and aCCP status in RA patients and a control group consisting of healthy subjects, and patients with systemic lupus erythematosus (SLE) and scleroderma. The sensitivity, specificity, positive (PPV) and negative predictive values of the aCCP test alone were 82.5%, 84.9%, 87.6% and 79% versus 81.7%, 90.7%, 92.5% and 78% for RF alone. The best specificity (95.3) and PPV (95.8%) was observed when both aCCP and RF tests were positive. Patients with erosive disease had a significantly higher mean RF titre compared with those with non-erosive disease (p = 0.007). There was a trend towards an association of smoking (OR = 4.1, 95% CI = 0.9-18.6) and functional disability (p = 0.07) with RF-positive status. No similar clinical associations were observed with aCCP. Almost a third of SLE patients were aCCP positive. Despite the best specificity and PPV observed when both the aCCP and RF tests were positive, our findings suggest that testing for aCCP is only cost-effective in the RF-negative patient in whom there is a strong clinical suspicion of RA.

Anti-neutrophil cytoplasmic autoantibodies against bactericidal/permeability-increasing protein in patients with rheumatoid arthritis and their correlation with bronchial involvement

Anti-neutrophil cytoplasmic autoantibodies against bactericidal/permeability-increasing protein (BPI-ANCA) are known to be present in patients with cystic fibrosis, diffuse panbronchiolitis, and inflammatory bowel disease, especially in relation to chronic Gram-negative bacterial infection. To investigate the possible role of BPI-ANCA in rheumatoid arthritis (RA), we measured the serum titer of BPI-ANCA and examined clinical manifestations, including pulmonary complications, in patients with RA. Seventy-four RA patients were recruited to our study. The titer of BPI-ANCA was measured by enzyme-linked immunosorbent assay (ELISA). Pulmonary complications were evaluated using high-resolution computed tomography (HRCT), which revealed 26 patients with bronchial diseases (BD group), 25 with interstitial pneumonia (IP group), and 23 without any particular lung lesion (normal group). The correlations between the titer of BPI-ANCA and patients' clinical and laboratory findings were then analyzed. The numbers of tender joints, swollen joints, and the Disease Activity Score including 28 joint count were significantly higher in the BD group. The titer of BPI-ANCA was positively correlated with age, erythrocyte sedimentation rate (ESR), and bronchial involvement in all subjects. Stepwise multiple regression analysis of factors affecting the titer of BPI-ANCA selected ESR and bronchial involvement as independent variables. Our results show that BPI-ANCA was positively correlated with chronic inflammatory status in RA patients, and we is believe it is positively linked with bronchial diseases.

A more active treatment has profound effects on the health status of rheumatoid arthritis (RA) patients: results from a population-based RA register in Malmö, Sweden, 1997–2005

Objective: Population-based studies on the trends and effects of modern antirheumatic treatment are scarce. The aim of this study was to examine trends in treatment, health-related quality of life (HRQL), and disease outcome in a population-based register of patients with rheumatoid arthritis (RA) in Malmö, Sweden.Methods: A continuously updated population-based RA register was established in the city of Malmö, southern Sweden, in 1997. Self-completed postal questionnaires issued in 1997, 2002, and 2005 were used to collect information on demographics, medication, and health status. Cross-sectional comparisons were made between data from 1997, 2002, and 2005.Results: Between 1997 and 2005, the proportion of patients treated with any disease-modifying anti-rheumatic drug (DMARD) including biologics increased substantially (from 52% to 87%), as well as the proportion treated with methotrexate (from 23% to 52%) and biologics (almost exclusively tumour necrosis factor inhibitors) (from 0% to 20%). Twelve per cent of RA patients received biologics 5 years from disease onset in 2005. In parallel with changes in treatment, mean Health Assessment Questionnaire (HAQ) scores (1.19 vs. 0.89) and all Short Form 36 (SF-36) subscales improved from 1997 to 2005 (non-overlapping confidence intervals).Conclusion: Between 1997 and 2005, there was a substantial increase in the use of DMARDs, which was accompanied by improved mean HAQ and SF-36 scores in cross-sectional comparisons. These results support the concept that more intensive treatment with DMARDs and biologics can have profound effects on the overall health status in RA patients at the population level.

The overestimation of disease activity in patients with rheumatoid arthritis and concomitant fibromyalgia

Introduction: Several instruments are commonly used to evaluate disease activity in patients with rheumatoid arthritis (RA), including the Disease Activity Score in 28 joints (DAS28), the Health Assessment Questionnaire (HAQ), and the Medical Outcomes Study Short Form 36 (SF-36) health survey. These instruments directly or indirectly measure pain and function in RA patients. Fibromyalgia (FM) is a chronic pain disorder that appears to amplify pain originating from peripheral tissues. It has been reported to co-occur in 14% to 17% of patients with RA [1,2]. In addition to joint infl ammation, FM may represent an additional factor that impacts pain, physical, social, and emotional status of RA patients. For example, the presence of FM has been associated with signifi cantly increased HAQ scores in patients with RA [3]. DAS28 scores of FM patients are similar to those of patients with RA [4], and the presence of FM in patients with RA seems to result in lower SF-36 scores compared with patients with RA only [1]. Because the DAS is a widely used instrument to measure disease activity in patients with RA, it appears relevant to assess the effects of concomitant FM on DAS28 scores of RA patients.

Cartilage oligomeric matrix protein/thrombospondin-5 (COMP/TSP-5) levels do not correlate to functional class in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) can be an incapacitating disorder. The cartilage oligomeric matrix protein/thrombospondin-5 (COMP/TSP-5), a member of extracellular proteins involved in tissue genesis and remodeling, has been considered a potential prognostic marker of RA [1]. Data on the association of functional status of RA with COMP/TSP-5 levels are virtually nonexistent. In the current study, we set up to determine the serum levels of COMP/TSP-5 in RA patients of different functional classes and in healthy controls. The study was cross-sectional. Fifty-eight patients with RA [2] followed in the Outpatient Rheumatology Clinic of Sao Lucas Hospital of PUCRS comprised the target population. The Hochberg classification [3] was used to estimate the functional status of RA patients. The control group included 100 consecutive blood donors. Levels of COMP/TSP-5 were evaluated by immunoenzimatic assay (AnaMar Medical TM, Lund, Sweden). Levels above 12 U/L were considered positive [4]. Comparison of groups was obtained by analysis of variation. A 5% significance level was considered for P values. The medium age was 48±6 years for the control group and of 54±14 years for RA patients (P>0.05). The female gender predominated in patients with RA (P<0.05). After adjustment for sex and age, the average levels of COMP/ TSP-5 were 7.0 U/L (95% CI 6.1–7.9) for the control group and 12.6 U/L (95% CI 11.1–14.1) for RA patients (P<0.01). Among RA patients, 25 showed functional class I (43.1%), 14 functional class II (24.13%), 10 functional class III (17.2%), and 9 functional class IV (15.5%). With the exception of individuals in class III, patients from other functional status presented higher frequency of positive test for COMP/TSP-5 as compared to controls (P<0.001). In each of the functional classes, the average levels of COMP/ TSP-5 were significantly higher than those of the control group (P<0.05). The 28 RA patients with elevated COMP/ TSP-5 were distributed uniformly in all four functional classes (P=0.65). COMP/TSP-5 serum levels may be a predicting factor for joint damage in RA [5]. High COMP/TSP-5 levels were described in patients with early RA [6]. A positive correlation of COMP/TSP-5 levels with cartilage damage (as measured by the Larsen radiographic score) was described in 62 RA patients [7]. RA patients with severe joint damage had higher COMP/TSP-5 and C-reactive protein levels than patients with milder disease [8]. Nevertheless, other authors reported low levels of COMP/ TSP-5 in patients with decreased functional status, probably due to cartilage degradation [9]. A recent report showed that neither baseline serum COMP/TSP-5 levels nor its individual change after 3 months from start of intensive F. D. Andrade :A. L. Bender : I. G. da Silveira :H. Stein : C. A. von Muhlen :H. L. Staub Rheumatology Department, Sao Lucas Hospital, Faculty of Medicine of Pontiphical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil

Different properties of ACPA and IgM-RF derived from a large dataset: further evidence of two distinct autoantibody systems

IntroductionThe aim of this study was to examine seroconversion and the relationship with age and inflammation of autoantibodies in a large group of patients attending an outpatient rheumatology clinic.MethodsLevels of antibodies to citrullinated proteins/peptides (ACPAs) and IgM rheumatoid factor (IgM-RF) were determined in 22,427 samples collected from 18,658 patients. The diagnosis was derived from a diagnosis registration system. The degree of seroconversion in repeated samples and the correlation of levels with age and inflammatory markers were determined for ACPA and IgM-RF in rheumatoid arthritis (RA) and non-RA patients.ResultsSeventy-one percent of RA patients (n = 1,524) were ACPA-positive and 53% were IgM-RF-positive; in non-RA patients (n = 2,245), the corresponding values were 2% and 4%, respectively. In patients with at least two samples (n = 3,769), ACPA status was more stable than IgM-RF status in RA patients. ACPA- or IgM-RF-negative non-RA patients seldom became positive. ACPA positivity was unrelated to age in both RA and non-RA patients. IgM-RF positivity was unrelated to age in RA patients; however, it increased with age in non-RA patients. The correlation between autoantibody levels and inflammatory markers was low in general and was somewhat higher for IgM-RF than for ACPA.ConclusionsACPA status is more stable in time and with increasing age than IgM-RF status, further establishing its role as a disease-specific marker. ACPA and IgM-RF levels are only moderately correlated with markers of inflammation.

Cross‐cultural adaptation and validation of the Malay health assessment questionnaire for use in rheumatoid arthritis

AbstractObjective: To validate the Malay version of the Health Assessment Questionnaire (Malay‐HAQ) for use in Malay‐speaking rheumatoid arthritis (RA) patients in the Malaysian setting. The HAQ – Disability Index has been validated in several languages, but not in Malay.Methods: The original HAQ was modified and translated into Malay by two translators, one of whom was aware of the objectives of the Questionnaire and the other as a lay translator. Two sets of Malay‐HAQ were distributed to RA patients during their routine follow‐up visits; one set to be completed immediately and another set to be completed 2 weeks later. A total of 61 patients completed the two sets of Malay‐HAQ. The data collected was analysed using SPSS V. 11.0. Reliability of the data was evaluated using the test‐retest method and internal consistency was assessed by Cronbach's alpha.Result: The study showed that the Malay‐HAQ is feasible and reliable. The Spearman's correlation coefficient ranged from 0.65 to 0.82, while the internal consistency was 0.88–0.92.Conclusion: The Malay‐HAQ is a sensitive, reliable and valid instrument for the measurement of functional status in RA patients in a Malay setting.

Free radical and antioxidant status in rheumatoid arthritis

Introduction Rheumatoid arthritis (RA) has long been categorized as a connective tissue disease and an autoimmune disease, but was not generally recognized, until recently, as a disease of oxidative stress. The present study attempted to gain an insight into the overall status of oxidative stress parameters in RA patients. Objective To assess the free radical and antioxidant status in RA patients. Methods Patients with RA satisfying the revised 1987 ACR classification criteria were included into group I ( n = 60). Group II ( n = 60) consisted of age and sex matched normal healthy controls. The free radical and antioxidant status of both groups were determined by a set of 5 parameters viz. serum nitrite, serum nitrate, plasma malondialdehyde, serum protein carbonyl and plasma superoxide dismutase. Results A total of 60 RA patients (M : 21; F : 39) with a mean ± SD age of 47.28 ± 11.72 years were included in the present study. The aforementioned parameters of free radical and antioxidant status were assayed and the results compared with those from 60 age and sex matched controls. All parameters were found to be significantly elevated in RA patients compared to the controls. Conclusion The findings suggest that oxidative stress generated in an inflamed joint can contribute to autoimmune phenomenon and connective tissue destruction in RA. New therapeutic protocols based on correcting oxidative stress levels may prove effective in restricting disease progression and limiting deformities.

Correlation between serum methotrexate concentrations and disease remission status in rheumatoid arthritis patients on triple disease-modifying antirheumatic drug therapy

Correlation between serum methotrexate concentrations and disease remission status in rheumatoid arthritis patients on triple disease-modifying antirheumatic drug therapy

Do visual analogue scale (VAS) derived standard gamble (SG) utilities agree with Health Utilities Index utilities? A comparison of patient and community preferences for health status in rheumatoid arthritis patients

BackgroundAssessment of Health Related Quality of Life (HRQL) has become increasingly important and various direct and indirect methods and instruments have been devised to measure it. In direct methods such as Visual Analog Scale (VAS) and Standard Gamble (SG), respondent both assesses and values health states therefore the final score reflects patient's preferences. In indirect methods such as multi-attribute health status classification systems, the patient provides the assessment of a health state and then a multi-attribute utility function is used for evaluation of the health state. Because these functions have been estimated using valuations of general population, the final score reflects community's preferences. The objective of this study is to assess the agreement between community preferences derived from the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) systems, and patient preferences.MethodsVisual analog scale (VAS) and HUI scores were obtained from a sample of 320 rheumatoid arthritis patients. VAS scores were adjusted for end-aversion bias and transformed to standard gamble (SG) utility scores using 8 different power conversion formulas reported in other studies. Individual level agreement between SG utilities and HUI2 and HUI3 utilities was assessed using the intraclass correlation coefficient (ICC). Group level agreement was assessed by comparing group means using the paired t-test.ResultsAfter examining all 8 different SG estimates, the ICC (95% confidence interval) between SG and HUI2 utilities ranged from 0.45 (0.36 to 0.54) to 0.55 (0.47 to 0.62). The ICC between SG and HUI3 utilities ranged from 0.45 (0.35 to 0.53) to 0.57 (0.49 to 0.64). The mean differences between SG and HUI2 utilities ranged from 0.10 (0.08 to 0.12) to 0.22 (0.20 to 0.24). The mean differences between SG and HUI3 utilities ranged from 0.18 (0.16 to 0.2) to 0.28 (0.26 to 0.3).ConclusionAt the individual level, patient and community preferences show moderate to strong agreement, but at the group level they have clinically important and statistically significant differences. Using different sources of preference might alter clinical and policy decisions that are based on methods that incorporate HRQL assessment. VAS-derived utility scores are not good substitutes for HUI scores.

Detection of alveolar epithelial injury by Tc-99m DTPA radioaerosol inhalation lung scan in rheumatoid arthritis patients

Rheumatoid arthritis (RA) is a systemic autoimmune disorder primarily involving the joints. Lung alterations in RA may be primary or secondary to pharmacological treatments and may involve the alveoli, interstitium, airways and/or pleura. Technetium-99m diethylenetriaminepentaacetic acid (Tc-99m DTPA) aerosol inhalation scintigraphy is a sensitive and noninvasive test commonly employed to assess pulmonary epithelial membrane permeability. The purpose of the this study was a) to investigate the changes of pulmonary alveolar epithelial permeability in patients with RA, b) to determine the relationship between the clearance rate of Tc-99m DTPA and pulmonary function test (PFT) results, and c) to determine the relationship between the clearance rete of Tc-99m DTPA and clinical parameters of disease. Twenty-five patients with RA but without lung alterations were included in the study. The patients were 22 females, and 3 males; mean age 53.6 +/- 8.7 years. Technetium-99m DTPA aerosol inhalation scintigraphy was performed on the study and healthy control groups. Clearance half times (T1/2) were calculated by placing a mono-exponential fit on the curves. Penetration index (PI) was calculated on the first-minute image. There were no significant differences in the mean T1/2 or mean PI values between the RA patients and control subjects. No correlation was found between the mean T1/2 values of Tc-99m DTPA clearance and activity of RA, clinical values, or the spirometric measurements except FEV1/FVC and functional status in RA patients (p = 0.02, p = 0.01, respectively). However, a weak correlation was found between duration of disease and T1/2 values of Tc-99m DTPA clearance (p = 0.006). PI values tended to correlate with FEF25-75, although, this was not statistically significant (p = 0.057). This study shows that no changes occur in alveolar-capillary permeability in RA patients without lung alterations.

The Nottingham Health Profile in rheumatoid arthritis: correlation with other health status measurements and clinical variables.

The overall effect of rheumatoid arthritis (RA) on general health status has drawn attention in recent years. The aim of this study was to determine the clinical relevance of the Nottingham Health Profile (NHP) in RA patients and the relationship between conventional clinical measures, the Health Assessment Questionnaire (HAQ), and the Beck Depression Inventory (BDI) METHOD: One hundred RA patients (mean age 48.9+/-12.1 years, mean disease duration 101.3+/-85.5 months) were included in the study. Quality of life, health status, and psychological mood of the patients were assessed using NHP, HAQ, and BDI. The Ritchie Articular Index (RAI), visual analog scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor, and modified Larsen Scale were used to assess clinical, laboratory, and radiological changes. All subgroups of the NHP significantly correlated to VAS, RAI, BDI, and HAQ scores (P<0.001). Except in the social isolation subgroup, there were significant correlations with ESR (P<0.05, P<0.001, and P<0.0001, respectively). There were no correlations between CRP levels and health status measures (P>0.05). The NHP reflects the clinical and psychological status of RA patients and can be used as a sensitive health status measure for clinical evaluation.

Inadequate Antioxidant Nutrient Intake and Altered Plasma Antioxidant Status of Rheumatoid Arthritis Patients

Objective: Elevated free radical generation in inflamed joints and impaired antioxidant system have been implicated in rheumatoid arthritis (RA). The present study was performed to evaluate dietary nutrient intake and plasma oxidant/antioxidant status in RA patients.Methods: RA patients (n = 97) and their age, gender-matched controls (n = 97) participated in this cross-sectional case-control study. Nutrient intake was estimated using a semi-quantitative food frequency questionnaire. Twenty subjects from each group provided blood samples, and plasma concentrations of α-tocopherol and malondiadehyde (MDA) were measured. Also, plasma activities of superoxide dismutase (SOD) and glutathione peroxidase (GPx) were measured.Results: The mean calorie intake of RA patients was lower than that of the healthy controls. Energy-adjusted intake of fat, vitamin A and β-carotene were significantly lower in patients than those of the control subjects. RA patients had a decreased mean plasma α-tocopherol level. The activity of plasma SOD and GPx in patients was significantly lower than that in control subjects.Conclusion: These results suggest proper antioxidant nutrient intake management may reduce free radical generation and improve antioxidant status in RA patients.

Nutritional management of rheumatoid arthritis: a review of the evidence.

Rheumatoid arthritis (RA) is a debilitating disease and is associated with increased risk of cardiovascular disease and osteoporosis. Poor nutrient status in RA patients has been reported and some drug therapies, such as nonsteroidal anti-inflammatory drugs (NSAIDs), prescribed to alleviate RA symptoms, may increase the requirement for some nutrients and reduce their absorption. This paper reviews the scientific evidence for the role of diet and nutrient supplementation in the management of RA, by alleviating symptoms, decreasing progression of the disease or by reducing the reliance on, or combating the side-effects of, NSAIDs. Supplementation with long-chain n-3 polyunsaturated fatty acids (PUFA) consistently demonstrates an improvement in symptoms and a reduction in NSAID usage. Evidence relating to other fatty acids, antioxidants, zinc, iron, folate, other B vitamins, calcium, vitamin D and fluoride are also considered. The present evidence suggests that RA patients should consume a balanced diet rich in long-chain n-3 PUFA and antioxidants. More randomized long-term studies are needed to provide evidence for the benefits of specific nutritional supplementation and to determine optimum intake, particularly for n-3 PUFA and antioxidants.