Nutritional interventions and supplementation for rheumatoid arthritis patients: A systematic review for clinical application, Part 1: Dieting

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 and improve QOL. Objectives: In this systematic review, data was collected on the most recent non-pharmacological interventions used in RA treatment. The efficacy and potential practical applications of various nutritional interventions used in the RA management will be discussed. The diets discussed in this article include the anti-inflammatory diet in RA diet, elemental and elimination diets, weight loss, and a Mediterranean Diet (MD). For more information on the other contents of this systematic review you may refer to part 2; Supplementation and part 3; Fruit 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 sectional 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 studiesFive articles were placed under the category of diet which includes one systematic review, two RCT and two literature reviews. Conclusion: Dietary interventions may be an effective method for reducing inflammation and symptoms associated with RA. Significant improvements in indices of RA, such as the DAS-28 and HAQ, were observed with the use of a MD, vegan, and vegetarian diets as well as exercise and weight loss. However, past research has identified highly immunogenic foods which may induce symptoms and therefore clinicians should familiarize themselves with these triggers to educate their patients.