Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA)-a randomized, controlled crossover trial indicating effects on disease activity

Anna K E Vadell, Linnea Bärebring, Erik Hulander, Inger Gjertsson, Helen M Lindqvist, Anna Winkvist, Anna K E Vadell, Linnea Bärebring, Erik Hulander, Inger Gjertsson, Helen M Lindqvist, Anna Winkvist

Abstract

Background: Many patients with rheumatoid arthritis (RA) report symptom relief from certain foods. Earlier research indicates positive effects of food and food components on clinical outcomes in RA, but insufficient evidence exists to provide specific dietary advice. Food components may interact but studies evaluating combined effects are lacking.

Objectives: We aimed to investigate if an anti-inflammatory diet reduces disease activity in patients with RA.

Methods: In this single-blinded crossover trial, 50 patients with RA were randomly assigned to an intervention diet containing a portfolio of suggested anti-inflammatory foods, or a control diet similar to the general dietary intake in Sweden, for 10 wk. After a 4-mo washout period the participants switched diet. Food equivalent to ∼50% of energy requirements was delivered weekly to their homes. For the remaining meals, they were encouraged to consume the same type of foods as the ones provided during each diet. Primary outcome was change in Disease Activity Score in 28 joints-Erythrocyte Sedimentation Rate (DAS28-ESR). Secondary outcomes were changes in the components of DAS28-ESR (tender and swollen joints, ESR, and visual analog scale for general health) and DAS28-C-reactive protein.

Results: In the main analysis, a linear mixed ANCOVA model including the 47 participants completing ≥1 diet period, there was no significant difference in DAS28-ESR between the intervention and control periods (P = 0.116). However, in unadjusted analyses, DAS28-ESR significantly decreased during the intervention period and was significantly lower after the intervention than after the control period in the participants who completed both periods (n = 44; median: 3.05; IQR: 2.41, 3.79 compared with median: 3.27; IQR: 2.69, 4.28; P = 0.04, Wilcoxon's Signed Rank test). No significant differences in the components were observed.

Conclusions: This trial indicates positive effects of a proposed anti-inflammatory diet on disease activity in patients with RA. Additional studies are required to determine if this diet can cause clinically relevant improvements.This trial was registered at clinicaltrials.gov as NCT02941055.

Keywords: DAS28; Sweden; anti-inflammatory; diet; dietary fiber; inflammation; omega-3 fatty acids; probiotics; rheumatoid arthritis.

Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.

Figures

FIGURE 1
FIGURE 1
Flowchart of the ADIRA (Anti-inflammatory Diet in Rheumatoid Arthritis) trial. DAS28, Disease Activity Score-28.
FIGURE 2
FIGURE 2
Disease Activity Score-28 European League Against Rheumatism (EULAR) response to an anti-inflammatory diet (intervention, n = 45) and a diet nutritionally similar to a typical Swedish diet (control, n = 46) in the crossover ADIRA (Anti-inflammatory Diet in Rheumatoid Arthritis) trial. Chi-square test was used to compare the diets’ effects on treatment response and there was no significant difference (P = 0.201). No response = grey, moderate response = striped, good response = black.
FIGURE 3
FIGURE 3
The impact of DAS28-ESR pre–intervention period on treatment response according to European League Against Rheumatism (EULAR) response criteria grouped into 2 categories in the crossover ADIRA (Anti-inflammatory Diet in Rheumatoid Arthritis) trial (n = 45). Difference in median DAS28-ESR between responders and nonresponders was tested using the Mann–Whitney U test and responders had a higher DAS28-ESR preintervention than nonresponders (P = 0.001). DAS28, Disease Activity Score-28; ESR, erythrocyte sedimentation rate.

References

    1. Choy E. Understanding the dynamics: pathways involved in the pathogenesis of rheumatoid arthritis. Rheumatology. 2012;51(5):v3–11.
    1. Matcham F, Scott IC, Rayner L, Hotopf M, Kingsley GH, Norton S, Scott DL, Steer S. The impact of rheumatoid arthritis on quality-of-life assessed using the SF-36: a systematic review and meta-analysis. Semin Arthritis Rheum. 2014;44(2):123–30.
    1. Khan NA, Yazici Y, Calvo-Alen J, Dadoniene J, Gossec L, Hansen TM, Huisman M, Kallikorm R, Muller R, Liveborn M et al. .. Reevaluation of the role of duration of morning stiffness in the assessment of rheumatoid arthritis activity. J Rheumatol. 2009;36(11):2435–42.
    1. Minichiello E, Semerano L, Boissier M-C. Time trends in the incidence, prevalence, and severity of rheumatoid arthritis: a systematic literature review. Joint Bone Spine. 2016;83(6):625–30.
    1. Buckwalter J, Lappin D. The disproportionate impact of chronic arthralgia and arthritis among women. Clin Orthop Relat Res. 2000;(372):159–68.
    1. Smolen JS, Landewé R, Bijlsma J, Burmester G, Chatzidionysiou K, Douados M, Nam J, Ramiro S, Voshaar M, Vollenhoven RV et al. .. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017;76(6):960–77.
    1. Yu C, Jin S, Wang Y, Jiang N, Wu C, Wang Q, Tian X, Li M, Zeng X. Remission rate and predictors of remission in patients with rheumatoid arthritis under treat-to-target strategy in real-world studies: a systematic review and meta-analysis. Clin Rheumatol. 2019;38(3):727–38.
    1. Altawil R, Saevarsdottir S, Wedrén S, Alfredsson L, Klareskog L, Lampa J. Remaining pain in early rheumatoid arthritis patients treated with methotrexate. Arthritis Care Res (Hoboken). 2016;68(8):1061–8.
    1. Druce KL, Bhattacharya Y, Jones GT, Macfarlane GJ, Basu N. Most patients who reach disease remission following anti-TNF therapy continue to report fatigue: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Rheumatology. 2016;55(10):1786–90.
    1. Berenbaum F, Chauvin P, Hudry C, Mathoret-Philibert F, Poussiere M, De Chalus T, Dreuillet C, Russo-Marie F, Joubert JM, Saraux A. Fears and beliefs in rheumatoid arthritis and spondyloarthritis: a qualitative study. PLoS One. 2014;9(12):e114350.
    1. Haugen M, Kjeldsen-Kragh J, Nordvåg B, Førre Ø. Diet and disease symptoms in rheumatic diseases — results of a questionnaire based survey. Clin Rheumatol. 1991;10(4):401–7.
    1. Tedeschi SK, Frits M, Cui J, Zhang ZZ, Mahmoud T, Iannaccone C, Lin TC, Yoshida K, Weinblatt ME, Shadick NA et al. .. Diet and rheumatoid arthritis symptoms: survey results from a rheumatoid arthritis registry. Arthritis Care Res (Hoboken). 2017;69(12):1920–5.
    1. Forsyth C, Kouvari M, D'Cunha NM, Georgousopoulou EN, Panagiotakos DB, Mellor DD, Kellett J, Naumovski N. The effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment: a systematic review of human prospective studies. Rheumatol Int. 2018;38(5):737–47.
    1. Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, Laerum E, Eek M, Mowinkel P, Hovi K, Forre O. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet. 1991;338(8772):899–902.
    1. Hafström I, Ringertz B, Spångberg A, von Zweigbergk L, Brannemark S, Nylander I, Rönnelid J, Laasonen L, Klareskog L. 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. 2001;40(10):1175–9.
    1. Gioxari A, Kaliora AC, Marantidou F, Panagiotakos DP. Intake of omega-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: a systematic review and meta-analysis. Nutrition. 2018;45:114–24..e4.
    1. Aqaeinezhad Rudbane SM, Rahmdel S, Abdollahzadeh SM, Zare M, Bazrafshan A, Mazloomi SM. The efficacy of probiotic supplementation in rheumatoid arthritis: a meta-analysis of randomized, controlled trials. Inflammopharmacol. 2018;26(1):67–76.
    1. Franco AS, Freitas TQ, Bernardo WM, Pereira RMR. Vitamin D supplementation and disease activity in patients with immune-mediated rheumatic diseases: a systematic review and meta-analysis. Medicine (Baltimore). 2017;96(23):e7024.
    1. van Vugt RM, Rijken PJ, Rietveld AG, van Vugt AC, Dijkmans BA. Antioxidant intervention in rheumatoid arthritis: results of an open pilot study. Clin Rheumatol. 2008;27(6):771–5.
    1. Khojah HM, Ahmed S, Abdel-Rahman MS, Elhakeim EH. Resveratrol as an effective adjuvant therapy in the management of rheumatoid arthritis: a clinical study. Clin Rheumatol. 2018;37(8):2035–42.
    1. Ghavipour M, Sotoudeh G, Tavakoli E, Mowla K, Hasanzadeh J, Mazloom Z. Pomegranate extract alleviates disease activity and some blood biomarkers of inflammation and oxidative stress in rheumatoid arthritis patients. Eur J Clin Nutr. 2017;71(1):92–6.
    1. Javadi F, Ahmadzadeh A, Eghtesadi S, Aryaeian N, Zabihiyeganeh M, Rahimi Foroushani A, Jazayeri S. The effect of quercetin on inflammatory factors and clinical symptoms in women with rheumatoid arthritis: a double-blind, randomized controlled trial. J Am Coll Nutr. 2017;36(1):9–15.
    1. Thimoteo NSB, Iryioda TMV, Alfieri DF, Rego BEF, Scavuzzi BM, Fatel E, Lozovoy MAB, Simao ANC, Dichi I. Cranberry juice decreases disease activity in women with rheumatoid arthritis. Nutrition. 2019;60:112–17.
    1. Chandran B, Goel A. A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis. Phytother Res. 2012;26(11):1719–25.
    1. Shishehbor F, Rezaeyan Safar M, Rajaei E, Haghighizadeh MH. Cinnamon consumption improves clinical symptoms and inflammatory markers in women with rheumatoid arthritis. J Am Coll Nutr. 2018;37(8):685–90.
    1. Winkvist A, Bärebring L, Gjertsson I, Ellegård L, Lindqvist HM. A randomized controlled cross-over trial investigating the effect of anti-inflammatory diet on disease activity and quality of life in rheumatoid arthritis: the Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA) study protocol. Nutr J. 2018;17(1):44.
    1. Amcoff E, Edberg A, Barbieri HE, Lindroos AK, Nälsén C, Pearson M, Lemming EW. Riksmaten – vuxna 2010–11. Livsmedels- och näringsintag bland vuxna i Sverige (Riksmaten – adults 2010–11. Food- and nutrient intake in the Swedish adult population). [Internet] Uppsala: Livsmedelsverket; 2012; [cited 2 July 2019]. Available from: (in Swedish).
    1. Livsmedelsverket. Portionsguide (Portion size guide). Uppsala: Livsmedelsverket; 2010; (in Swedish).
    1. Becker W. Indikatorer för bra matvanor. Resultat från intervjuundersökningar 2008 (Indicators of good food habits. Results from interview studies 2008). [Internet] Uppsala: Livsmedelsverket; 2009; [cited 2 July 2019]. Livsmedelsverkets rapportserier; No. 22/2009. Available from: (in Swedish).
    1. Bärebring L, Winkvist A, Gjertsson I, Lindqvist HM. Poor dietary quality is associated with increased inflammation in Swedish patients with rheumatoid arthritis. Nutrients. 2018;10(10):1535.
    1. van Riel PLCM. The development of the disease activity score (DAS) and the disease activity score using 28 joint counts (DAS28). Clin Exp Rheumatol. 2014;32(5 Suppl 85):S65–74.
    1. van Gestel AM, Haagsma CJ, van Riel PL. Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis Rheum. 1998;41(10):1845–50.
    1. Sköldstam 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.
    1. Guerreiro CS, Calado A, Sousa J, Fonseca JE. Diet, microbiota, and gut permeability—the unknown triad in rheumatoid arthritis. Front Med. 2018;5:349.
    1. Alipour B, Homayouni-Rad A, Vaghef-Mehrabany E, Sharif SK, Vaghef-Mehrabany L, Asghari-Jafarabadi M, Nakhjavani MR, Mohtadi-Nia J. 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.
    1. Mandel DR, Eichas K, Holmes J. Bacillus coagulans: a viable adjunct therapy for relieving symptoms of rheumatoid arthritis according to a randomized, controlled trial. BMC Complement Altern Med. 2010;10:1.
    1. de Los Angeles Pineda M, Thompson SF, Summers K, de Leon F, Pope J, Reid G. A randomized, double-blinded, placebo-controlled pilot study of probiotics in active rheumatoid arthritis. Med Sci Monit. 2011;17(6):CR347–54.
    1. Zamani B, Golkar HR, Farshbaf S, Emadi-Baygi M, Tajabadi-Ebrahimi M, Jafari P, Akhavan R, Taghizadeh M, Memarzadeh MR, Asemi Z. Clinical and metabolic response to probiotic supplementation in patients with rheumatoid arthritis: a randomized, double-blind, placebo-controlled trial. Int J Rheum Dis. 2016;19(9):869–79.
    1. Jiang J, Li K, Wang F, Yang B, Fu Y, Zheng J, Li D. Effect of marine-derived n-3 polyunsaturated fatty acids on major eicosanoids: a systematic review and meta-analysis from 18 randomized controlled trials. PLoS One. 2016;11(1):e0147351.
    1. Cleland LG, Caughey GE, James MJ, Proudman SM. Reduction of cardiovascular risk factors with longterm fish oil treatment in early rheumatoid arthritis. J Rheumatol. 2006;33(10):1973–9.
    1. Leeb BF, Sautner J, Andel I, Rintelen B. Intravenous application of omega-3 fatty acids in patients with active rheumatoid arthritis. The ORA-1 trial. An open pilot study. Lipids. 2006;41(1):29–34.
    1. Das Gupta AB, Hossain AK, Islam MH, Dey SR, Khan AL. Role of omega-3 fatty acid supplementation with indomethacin in suppression of disease activity in rheumatoid arthritis. Bangladesh Med Res Counc Bull. 2009;35(2):63–8.
    1. Veselinovic M, Vasiljevic D, Vucic V, Arsic A, Petrovic S, Tomic-Lucic A, Savic M, Zivanovic S, Stojic V, Jakovljevic V. Clinical benefits of n-3 PUFA and γ-linolenic acid in patients with rheumatoid arthritis. Nutrients. 2017;9(4):325.
    1. Tedeschi SK, Bathon JM, Giles JT, Lin TC, Yoshida K, Solomon DH. Relationship between fish consumption and disease activity in rheumatoid arthritis. Arthritis Care Res (Hoboken). 2018;70(3):327–32.
    1. Lindqvist HM, Gjertsson I, Eneljung T, Winkvist A. Influence of blue mussel (Mytilus edulis) intake on disease activity in female patients with rheumatoid arthritis: the MIRA randomized cross-over dietary intervention. Nutrients. 2018;10(4):481.
    1. Eriksson JK, Neovius M, Ernestam S, Lindblad S, Simard JF, Askling J. Incidence of rheumatoid arthritis in Sweden: a nationwide population‐based assessment of incidence, its determinants, and treatment penetration. Arthritis Care Res (Hoboken). 2013;65(6):870–8.
    1. Smedslund G, Hagen KB. Does rain really cause pain? A systematic review of the associations between weather factors and severity of pain in people with rheumatoid arthritis. Eur J Pain. 2011;15(1):5–10.

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