General or personal diet: the individualized model for diet challenges in patients with rheumatoid arthritis.
ABSTRACT This study was performed to evaluate the effect of individualized diet challenges consisting of allergen foods on disease activity in rheumatoid arthritis (RA) patients. Twenty patients with positive skin prick test (SPT) response for food extracts and 20 with negative SPT response were included. All patients were instructed to restrict the most common allergen foods during 12 days and then assigned into two groups according to SPT results. Food challenges were performed with all of the allergen foods in prick test positive group (PTPG) and with corn and rice in prick test negative group (PTNG) during 12 days. Allergen foods were then eliminated from PTPG patients' diet, while corn and rice were removed in PTNG. Clinical evaluations were performed after fasting (baseline), at the end of the challenge phase and reelimination phase. Stiffness, pain, physician's and patient's global assessment of disease activity, health assessment questionnaire (HAQ), Ritchie's index, serum amyloid A protein, erythrocyte sedimentation rate and C-reactive protein were determined. All of the disease variables, except HAQ, were increased with food challenges in PTPG. In PTNG, no significant change was observed in any of the variables except pain (P<0.05) and patient's global assessment (P<0.05). Our results showed that the individualized dietary manipulations may effect the disease activity for selected RA patients.
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ABSTRACT: The question of what potential benefits and harms are associated with certain dietary regimes used in rheumatoid arthritis is an important one for many patients and health care providers. To assess the effectiveness and safety of dietary interventions in the treatment of rheumatoid arthritis. We searched the Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library, issue 1 2008), MEDLINE, EMBASE, AMED, CINAHL and reference lists of relevant articles (up to January 2008), and contacted authors of included articles. Randomised controlled trials (RCTs) or controlled clinical trials (CCTs) where the effectiveness of dietary manipulation was evaluated. Dietary supplement studies (including fish oil supplements) were not included. Two authors independently selected trials for inclusion, assessed the internal validity of included trials and extracted data. Investigators were contacted to obtain missing information. Fourteen RCTs and one CCT, with a total of 837 patients, were included. Due to heterogeneity of interventions and outcomes, baseline imbalance and inadequate data reporting, no overall effects were calculated. A single trial with a moderate risk of bias found that fasting, followed by 13 months on a vegetarian diet, may reduce pain (mean difference (MD) on a 0 to 10 scale -1.89, 95% confidence interval (CI) -3.62 to -0.16), but not physical function or morning stiffness immediately after intervention. Another single trial with a moderate risk of bias found that a 12-week Cretan Mediterranean diet may reduce pain (MD on a 0 to 100 scale -14.00, 95% CI -23.6 to -4.37), but not physical function or morning stiffness immediately after intervention. Two trials compared a 4-week elemental diet with an ordinary diet and reported no significant differences in pain, function or stiffness. Due to inadequate data reporting, the effects of vegan and elimination diets are uncertain. When comparing any dietary manipulation with an ordinary diet we found a significantly higher total drop-out of 10% (risk difference (RD) 0.10, 95% CI 0.02 to 0.18), higher treatment-related drop-out of 5% (RD 0.05, 95% CI -0.03 to 0.14) and a significantly higher weight loss (weighted mean difference -3.23, 95% CI -4.79 to -1.67 kg) in the diet groups compared to the control groups. The effects of dietary manipulation, including vegetarian, Mediterranean, elemental and elimination diets, on rheumatoid arthritis are still uncertain due to the included studies being small, single trials with moderate to high risk of bias. Higher drop-out rates and weight loss in the groups with dietary manipulation indicate that potential adverse effects should not be ignored.Cochrane database of systematic reviews (Online) 02/2009; DOI:10.1002/14651858.CD006400.pub2 · 5.94 Impact Factor
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ABSTRACT: Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized by chronic inflammation and joint destruction. In this study, we investigated whether dietary supplementation with alpha lipoic acid (ALA) suppresses collagen-induced arthritis (CIA) in mice. Mice were randomly divided into three groups: (1) a control CIA group was fed a normal diet, (2) a CIA group was fed a 0.1% ALA diet (average ALA intake of 160 mg/kg/day), and (3) a CIA group was fed a 0.5% ALA diet (average ALA intake of 800 mg/kg/day). The ALA-fed mice showed a decreased incidence and severity of arthritis compared to the normal diet group. Radiographic findings revealed a dramatic decrease in bone destruction, and histological findings showed extensively suppressed pathological changes in the ALA-fed mice. The ALA-fed mice exhibited inhibited generation of tartrate resistant acid phosphatase (TRAP)-positive osteoclasts in vivo. Additionally, ALA-fed mice reduced production of various proinflammatory cytokines and the soluble receptor activator of NF-κB ligand (sRANKL) in the joint tissues and the sera. In conclusion, dietary supplementation with ALA attenuated inflammatory responses and bone destruction in CIA mice.Rheumatology International 05/2010; 31(12):1583-90. DOI:10.1007/s00296-010-1505-3 · 1.63 Impact Factor