Strict Gluten-Restricted Diet Reduces Disease Activity of Rheumatoid Arthritis with Low Anti-Cyclic Citrullinated Peptide Antibodies

Objective: To investigate the efficacy of gluten-restricted diet for the disease activity of Rheumatoid Arthritis (RA) and clinical factors corresponding to the response. Methods: Sixty three patients with active RA were included in this study. At baseline, we gave the patients the information about gluten-free and-contained foods, and asked them to refrain from the daily gluten consumption during the experimental period. Results: The 16-week gluten-restricted diet significantly improved DAS28-CRP and CDAI scores. The percentages of patients achieving DAS28-CRP- and CDAI-defined remission or LDA were significantly increased at Week 16. When the self-reported levels about adherence to the gluten-restricted diet were divided into two categories, a significant improvement in DAS28- CRP, CDAI, and EULAR treatment response after 16 weeks was detected only in the patient group with the strict adherence to gluten-restriction. Significantly lower levels of Anti-Cyclic Citrullinated Peptide Antibodies (ACPA) were detected in responders to the gluten-restriction than in non-responders. Conclusion: This study demonstrates that strict adherence to gluten-restricted diet results in decreased disease activity of RA patients with low ACPA.