Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Current Rheumatology Reports
Published in: Current Rheumatology Reports 5/2016

01-05-2016 | Complementary and Alternative Medicine (SL Kolasinski, Section Editor)

Is There a Role for Diet in the Therapy of Rheumatoid Arthritis?

Authors: Sara K. Tedeschi, Karen H. Costenbader

Published in: Current Rheumatology Reports | Issue 5/2016

Login to get access

Abstract

Patients with rheumatoid arthritis (RA) often inquire about dietary interventions to improve RA symptoms. Although the majority of studies of diet and RA were published prior to the start of the twenty-first century, this review discusses the evidence for a relationship between diet, in particular omega-3 fatty acid supplements, vitamin D supplements, alcohol, and the Mediterranean diet and RA disease activity. We review possible mechanisms by which these dietary intakes may affect RA disease activity. Given the complexity of studying the relationship between diet and RA disease activity, we highlight areas deserving further study before specific recommendations can be made to RA patients.
Literature
1.
Bykerk VP, Shadick N, Frits M, et al. Flares in rheumatoid arthritis: frequency and management. A report from the BRASS registry. J Rheumatol. 2014;41(2):227–34.CrossRefPubMed
2.
3.
4.
5.
Smedslund G, Byfuglien MG, Olsen SU, et al. Effectiveness and safety of dietary interventions for rheumatoid arthritis: a systematic review of randomized controlled trials. J Am Diet Assoc. 2010;110(5):727–35.CrossRefPubMed
6.
Hagen KB, Byfuglien MG, Falzon L, et al. Dietary interventions for rheumatoid arthritis. Cochrane Database Syst Rev. 2009;1:CD006400.PubMed
7.
Stamp LK, James MJ, Cleland LG. Diet and rheumatoid arthritis: a review of the literature. Semin Arthritis Rheum. 2005;35(2):77–94.CrossRefPubMed
8.
Dwyer JH, Allayee H, Dwyer KM, et al. Arachidonate 5-lipoxygenase promoter genotype, dietary arachidonic acid, and atherosclerosis. N Engl J Med. 2004;350(1):29–37.CrossRefPubMed
9.
Norris PC, Dennis EA. Omega-3 fatty acids cause dramatic changes in TLR4 and purinergic eicosanoid signaling. Proc Natl Acad Sci U S A. 2012;109(22):8517–22.CrossRefPubMedPubMedCentral
10.
Whelan J. Antagonistic effects of dietary arachidonic acid and n-3 polyunsaturated fatty acids. J Nutr. 1996;126(4 Suppl):1086S–91S.PubMed
11.
Raper NR, Cronin FJ, Exler J. Omega-3 fatty acid content of the US food supply. J Am Coll Nutr. 1992;11(3):304–8.CrossRefPubMed
12.
Volker D, Fitzgerald P, Major G, et al. Efficacy of fish oil concentrate in the treatment of rheumatoid arthritis. J Rheumatol. 2000;27(10):2343–6.PubMed
13.
Tani S, Takahashi A, Nagao K, et al. Association of fish consumption-derived ratio of serum n-3 to n-6 polyunsaturated fatty acids and cardiovascular risk with the prevalence of coronary artery disease. Int Heart J. 2015;56(3):260–8.CrossRefPubMed
14.
Sakayori N, Kikkawa T, Tokuda H, et al. Maternal dietary imbalance between omega-6 and omega-3 polyunsaturated fatty acids impairs neocortical development via epoxy metabolites. Stem Cells. 2015.
15.
Lee TH, Hoover RL, Williams JD, et al. Effect of dietary enrichment with eicosapentaenoic and docosahexaenoic acids on in vitro neutrophil and monocyte leukotriene generation and neutrophil function. N Engl J Med. 1985;312(19):1217–24.CrossRefPubMed
16.•
Camell C, Goldberg E, Dixit VD. Regulation of Nlrp3 inflammasome by dietary metabolites. Semin Immunol. 2015. This review article provides an overview of activation of the NLRP3 inflammasome via dietary metabolites including fatty acids, glucose, and ketone bodies
17.
Harrison P, Pointon JJ, Chapman K, et al. Interleukin-1 promoter region polymorphism role in rheumatoid arthritis: a meta-analysis of IL-1B-511A/G variant reveals association with rheumatoid arthritis. Rheumatology (Oxford). 2008;47(12):1768–70.CrossRef
18.
Gabay C, Lamacchia C, Palmer G. IL-1 pathways in inflammation and human diseases. Nat Rev Rheumatol. 2010;6(4):232–41.CrossRefPubMed
19.
Choulaki C, Papadaki G, Repa A, et al. Enhanced activity of NLRP3 inflammasome in peripheral blood cells of patients with active rheumatoid arthritis. Arthritis Res Ther. 2015;17:257.CrossRefPubMedPubMedCentral
20.
L’Homme L, Esser N, Riva L, et al. Unsaturated fatty acids prevent activation of NLRP3 inflammasome in human monocytes/macrophages. J Lipid Res. 2013;54(11):2998–3008.CrossRefPubMedPubMedCentral
21.
Youm YH, Nguyen KY, Grant RW, et al. The ketone metabolite beta-hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease. Nat Med. 2015.
22.
Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, et al. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet. 1991;338(8772):899–902.CrossRefPubMed
23.
Skoldstam L, Larsson L, Lindstrom FD. Effect of fasting and lactovegetarian diet on rheumatoid arthritis. Scand J Rheumatol. 1979;8(4):249–55.CrossRefPubMed
24.
Muller H, de Toledo FW, Resch KL. Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scand J Rheumatol. 2001;30(1):1–10.CrossRefPubMed
25.
Ravussin E, Redman LM, Rochon J, et al. A 2-year randomized controlled trial of human caloric restriction: feasibility and effects on predictors of health span and longevity. J Gerontol A Biol Sci Med Sci. 2015;70(9):1097–104.CrossRefPubMed
26.
Vandanmagsar B, Youm YH, Ravussin A, et al. The NLRP3 inflammasome instigates obesity-induced inflammation and insulin resistance. Nat Med. 2011;17(2):179–88.CrossRefPubMedPubMedCentral
27.
Thorburn AN, Macia L, Mackay CR. Diet, metabolites, and “western-lifestyle” inflammatory diseases. Immunity. 2014;40(6):833–42.CrossRefPubMed
28.
Trompette A, Gollwitzer ES, Yadava K, et al. Gut microbiota metabolism of dietary fiber influences allergic airway disease and hematopoiesis. Nat Med. 2014;20(2):159–66.CrossRefPubMed
29.
30.•
Arpaia N, Campbell C, Fan X, et al. Metabolites produced by commensal bacteria promote peripheral regulatory T-cell generation. Nature. 2013;504(7480):451–5. This study demonstrated that in a murine model, commensal gut flora metabolized starch into short-chain fatty acids, which promoted regulatory T cell (Treg) differentiation.CrossRefPubMedPubMedCentral
31.
Maslowski KM, Vieira AT, Ng A, et al. Regulation of inflammatory responses by gut microbiota and chemoattractant receptor GPR43. Nature. 2009;461(7268):1282–6.CrossRefPubMedPubMedCentral
32.
Sweeney SE, Firestein GS. Rheumatoid arthritis: regulation of synovial inflammation. Int J Biochem Cell Biol. 2004;36(3):372–8.CrossRefPubMed
33.
Hughes DA, Pinder AC, Piper Z, et al. Fish oil supplementation inhibits the expression of major histocompatibility complex class II molecules and adhesion molecules on human monocytes. Am J Clin Nutr. 1996;63(2):267–72.PubMed
34.
Dell’Agli M, Fagnani R, Mitro N, et al. Minor components of olive oil modulate proatherogenic adhesion molecules involved in endothelial activation. J Agric Food Chem. 2006;54(9):3259–64.CrossRefPubMed
35.
Carluccio MA, Siculella L, Ancora MA, et al. Olive oil and red wine antioxidant polyphenols inhibit endothelial activation: antiatherogenic properties of Mediterranean diet phytochemicals. Arterioscler Thromb Vasc Biol. 2003;23(4):622–9.CrossRefPubMed
36.
Khalfoun B, Thibault F, Watier H, et al. Docosahexaenoic and eicosapentaenoic acids inhibit in vitro human endothelial cell production of interleukin-6. Adv Exp Med Biol. 1997;400B:589–97.PubMed
37.
Trebble T, Arden NK, Stroud MA, et al. Inhibition of tumour necrosis factor-alpha and interleukin 6 production by mononuclear cells following dietary fish-oil supplementation in healthy men and response to antioxidant co-supplementation. Br J Nutr. 2003;90(2):405–12.CrossRefPubMed
38.
Babcock TA, Novak T, Ong E, et al. Modulation of lipopolysaccharide-stimulated macrophage tumor necrosis factor-alpha production by omega-3 fatty acid is associated with differential cyclooxygenase-2 protein expression and is independent of interleukin-10. J Surg Res. 2002;107(1):135–9.PubMed
39.
Novak TE, Babcock TA, Jho DH, et al. NF-kappa B inhibition by omega-3 fatty acids modulates LPS-stimulated macrophage TNF-alpha transcription. Am J Physiol Lung Cell Mol Physiol. 2003;284(1):L84–9.CrossRefPubMed
40.
Lo CJ, Chiu KC, Fu M, et al. Fish oil decreases macrophage tumor necrosis factor gene transcription by altering the NF kappa B activity. J Surg Res. 1999;82(2):216–21.CrossRefPubMed
41.••
Serhan CN, Chiang N, Dalli J. The resolution code of acute inflammation: novel pro-resolving lipid mediators in resolution. Semin Immunol. 2015;27(3):200–15. This review article describes the role of lipid mediators (specialized pro-resolving mediators) involved in the active process of inflammation resolution.CrossRefPubMed
42.
Colas RA, Shinohara M, Dalli J, et al. Identification and signature profiles for pro-resolving and inflammatory lipid mediators in human tissue. Am J Physiol Cell Physiol. 2014;307(1):C39–54.CrossRefPubMedPubMedCentral
43.
Giera M, Ioan-Facsinay A, Toes R, et al. Lipid and lipid mediator profiling of human synovial fluid in rheumatoid arthritis patients by means of LC-MS/MS. Biochim Biophys Acta. 2012;1821(11):1415–24.CrossRefPubMedPubMedCentral
44.
Fito M, Cladellas M, de la Torre R, et al. Anti-inflammatory effect of virgin olive oil in stable coronary disease patients: a randomized, crossover, controlled trial. Eur J Clin Nutr. 2008;62(4):570–4.CrossRefPubMed
45.
Adam O, Beringer C, Kless T, et al. Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis. Rheumatol Int. 2003;23(1):27–36.PubMed
46.
Berbert AA, Kondo CR, Almendra CL, et al. Supplementation of fish oil and olive oil in patients with rheumatoid arthritis. Nutrition. 2005;21(2):131–6.CrossRefPubMed
47.••
Proudman SM, James MJ, Spargo LD, et al. Fish oil in recent onset rheumatoid arthritis: a randomised, double-blind controlled trial within algorithm-based drug use. Ann Rheum Dis. 2015;74(1):89–95. This randomized, double-blind, placebo-controlled trial evaluated the efficacy of high-dose versus low-dose fish oil supplements in preventing failure of triple DMARD therapy in early RA.CrossRefPubMed
48.
Kremer JM, Lawrence DA, Petrillo GF, et al. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Clinical and immune correlates. Arthritis Rheum. 1995;38(8):1107–14.CrossRefPubMed
49.
50.
Miles EA, Calder PC. Influence of marine n-3 polyunsaturated fatty acids on immune function and a systematic review of their effects on clinical outcomes in rheumatoid arthritis. Br J Nutr. 2012;107 Suppl 2:S171–84.CrossRefPubMed
51.
Proudman SM, Cleland LG, James MJ. Dietary omega-3 fats for treatment of inflammatory joint disease: efficacy and utility. Rheum Dis Clin North Am. 2008;34(2):469–79.CrossRefPubMed
52.
Goldberg RJ, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain. 2007;129(1-2):210–23.CrossRefPubMed
53.
Park Y, Lee A, Shim SC, et al. Effect of n-3 polyunsaturated fatty acid supplementation in patients with rheumatoid arthritis: a 16-week randomized, double-blind, placebo-controlled, parallel-design multicenter study in Korea. J Nutr Biochem. 2013;24(7):1367–72.CrossRefPubMed
54.••
Jeffery LE, Raza K, Hewison M. Vitamin D in rheumatoid arthritis—towards clinical application. Nat Rev Rheumatol. 2015. This review article discusses mechanisms through which vitamin D could potentially affect RA pathogenesis and severity.
55.
Heaney RP, Armas LA, French C. All-source basal vitamin D inputs are greater than previously thought and cutaneous inputs are smaller. J Nutr. 2013;143(5):571–5.CrossRefPubMed
56.
Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004;80(6 Suppl):1678S–88S.PubMed
57.
58.
Jakobsen J, Maribo H, Bysted A, et al. 25-Hydroxyvitamin D3 affects vitamin D status similar to vitamin D3 in pigs—but the meat produced has a lower content of vitamin D. Br J Nutr. 2007;98(5):908–13.CrossRefPubMed
59.
Costenbader KH, Feskanich D, Holmes M, et al. Vitamin D intake and risks of systemic lupus erythematosus and rheumatoid arthritis in women. Ann Rheum Dis. 2008;67(4):530–5.CrossRefPubMedPubMedCentral
60.
Merlino LA, Curtis J, Mikuls TR, et al. Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women’s Health Study. Arthritis Rheum. 2004;50(1):72–7.CrossRefPubMed
61.
Andjelkovic Z, Vojinovic J, Pejnovic N, et al. Disease modifying and immunomodulatory effects of high dose 1 alpha (OH) D3 in rheumatoid arthritis patients. Clin Exp Rheumatol. 1999;17(4):453–6.PubMed
62.••
Salesi M, Farajzadegan Z. Efficacy of vitamin D in patients with active rheumatoid arthritis receiving methotrexate therapy. Rheumatol Int. 2012;32(7):2129–33. This is the only randomized, placebo-controlled trial of vitamin D supplementation in RA published as of January 2016, to our knowledge.CrossRefPubMed
63.
64.
Imhof A, Froehlich M, Brenner H, et al. Effect of alcohol consumption on systemic markers of inflammation. Lancet. 2001;357(9258):763–7.CrossRefPubMed
65.
Sierksma A, Patel H, Ouchi N, et al. Effect of moderate alcohol consumption on adiponectin, tumor necrosis factor-alpha, and insulin sensitivity. Diabetes Care. 2004;27(1):184–9.CrossRefPubMed
66.
Brien SE, Ronksley PE, Turner BJ, et al. Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies. BMJ. 2011;342:d636.CrossRefPubMedPubMedCentral
67.
Maxwell JR, Gowers IR, Moore DJ, et al. Alcohol consumption is inversely associated with risk and severity of rheumatoid arthritis. Rheumatology (Oxford). 2010;49(11):2140–6.CrossRef
68.
Lu B, Rho YH, Cui J, et al. Associations of smoking and alcohol consumption with disease activity and functional status in rheumatoid arthritis. J Rheumatol. 2014;41(1):24–30.CrossRefPubMedPubMedCentral
69.
70.
Bergman S, Symeonidou S, Andersson ML, et al. Alcohol consumption is associated with lower self-reported disease activity and better health-related quality of life in female rheumatoid arthritis patients in Sweden: data from BARFOT, a multicenter study on early RA. BMC Musculoskelet Disord. 2013;14:218.CrossRefPubMedPubMedCentral
71.
Casas R, Sacanella E, Estruch R. The immune protective effect of the Mediterranean diet against chronic low-grade inflammatory diseases. Endocr Metab Immune Disord Drug Targets. 2014;14(4):245–54.CrossRefPubMedPubMedCentral
72.
Fung TT, McCullough ML, Newby PK, et al. Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr. 2005;82(1):163–73.PubMed
73.
Sanchez-Tainta A, Estruch R, Bullo M, et al. Adherence to a Mediterranean-type diet and reduced prevalence of clustered cardiovascular risk factors in a cohort of 3,204 high-risk patients. Eur J Cardiovasc Prev Rehabil. 2008;15(5):589–93.CrossRefPubMed
74.
Athyros VG, Kakafika AI, Papageorgiou AA, et al. Effect of a plant stanol ester-containing spread, placebo spread, or Mediterranean diet on estimated cardiovascular risk and lipid, inflammatory and haemostatic factors. Nutr Metab Cardiovasc Dis. 2011;21(3):213–21.CrossRefPubMed
75.
Mena MP, Sacanella E, Vazquez-Agell M, et al. Inhibition of circulating immune cell activation: a molecular antiinflammatory effect of the Mediterranean diet. Am J Clin Nutr. 2009;89(1):248–56.CrossRefPubMed
76.
Bendinelli B, Masala G, Saieva C, et al. Fruit, vegetables, and olive oil and risk of coronary heart disease in Italian women: the EPICOR Study. Am J Clin Nutr. 2011;93(2):275–83.CrossRefPubMed
77.
Skoldstam L, Hagfors L, Johansson G. An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Ann Rheum Dis. 2003;62(3):208–14.CrossRefPubMedPubMedCentral
78.
McKellar G, Morrison E, McEntegart A, et al. A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow. Ann Rheum Dis. 2007;66(9):1239–43.CrossRefPubMedPubMedCentral
79.
Willett WC. Nutritional epidemiology. 3 ed: Oxford University Press, 2012.
80.
Fung TT, Schulze M, Manson JE, et al. Dietary patterns, meat intake, and the risk of type 2 diabetes in women. Arch Intern Med. 2004;164(20):2235–40.CrossRefPubMed
81.
Lu B, Hu Y, Sparks JA, et al. Prospective study of dietary patterns and risk of rheumatoid arthritis in women. San Francisco, CA: American College of Rheumatology Annual Scientific Meeting; 2015.
82.
83.
84.
Hafstrom I, Ringertz B, Spangberg A, et al. A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens. Rheumatology (Oxford). 2001;40(10):1175–9.CrossRef
85.
Hatakka K, Martio J, Korpela M, et al. Effects of probiotic therapy on the activity and activation of mild rheumatoid arthritis—a pilot study. Scand J Rheumatol. 2003;32(4):211–5.CrossRefPubMed
86.
Vaghef-Mehrabany E, Homayouni-Rad A, Alipour B, et al. Effects of probiotic supplementation on oxidative stress indices in women with rheumatoid arthritis: a randomized double-blind clinical trial. J Am Coll Nutr. 2015;1–9.
87.
Alipour B, Homayouni-Rad A, Vaghef-Mehrabany E, et al. Effects of Lactobacillus casei supplementation on disease activity and inflammatory cytokines in rheumatoid arthritis patients: a randomized double-blind clinical trial. Int J Rheum Dis. 2014;17(5):519–27.PubMed
88.
Nakamura H, Masuko K, Yudoh K, et al. Effects of glucosamine administration on patients with rheumatoid arthritis. Rheumatol Int. 2007;27(3):213–8.CrossRefPubMed
89.
Jalili M, Kolahi S, Aref-Hosseini SR, et al. Beneficial role of antioxidants on clinical outcomes and erythrocyte antioxidant parameters in rheumatoid arthritis patients. Int J Prev Med. 2014;5(7):835–40.PubMedPubMedCentral
90.
van Vugt RM, Rijken PJ, Rietveld AG, et al. Antioxidant intervention in rheumatoid arthritis: results of an open pilot study. Clin Rheumatol. 2008;27(6):771–5.CrossRefPubMedPubMedCentral
91.
Tanner SB, Callahan LF, Panush RS, et al. Dietary and allergic associations with rheumatoid arthritis. Arthritis Rheum. 1990;3(4):189–95.CrossRef
Metadata
Title
Is There a Role for Diet in the Therapy of Rheumatoid Arthritis?
Authors
Sara K. Tedeschi
Karen H. Costenbader
Publication date
01-05-2016
Publisher
Springer US
Published in
Current Rheumatology Reports / Issue 5/2016
Print ISSN: 1523-3774
Electronic ISSN: 1534-6307
DOI
https://doi.org/10.1007/s11926-016-0575-y

Other articles of this Issue 5/2016

Current Rheumatology Reports 5/2016 Go to the issue

Rheumatoid Arthritis (LW Moreland, Section Editor)

Rheumatoid Arthritis Pharmacotherapies: Do They Have Anti-Atherosclerotic Activity?

Antiphospholipid Syndrome (S Zuily, Section Editor)

Prevention of Recurrent Thrombosis in Antiphospholipid Syndrome: Different from the General Population?

Chronic Pain (R Staud, Section Editor)

Cognitive Dysfunction in Chronic Fatigue Syndrome: a Review of Recent Evidence

Pediatric Rheumatology (S Ozen, Section Editor)

Pediatric Mixed Connective Tissue Disease

Crystal Arthritis (MH Pillinger and SK Samuels, Section Editors)

The Role of ANK in Calcium Pyrophosphate Deposition Disease

Infections and Arthritis (K Winthrop, Section Editor)

Fungal Infections and New Biologic Therapies

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24 to hear Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits