T.N. KHALFINA¹, E.S. ZAMANOVA², G.I. NURULLINA¹

¹Kazan State Medical University, Kazan

²Republican Clinical Hospital of the MH of RT, Kazan

Contact:

Khalfina T.N. ― PhD (medicine), Assistant of the Department of Hospital Therapy

Address: 49 Butlerov Str., Kazan, Russian Federation, 420012, tel. +7-919-685-32-95, e-mail: tamila-khalfina@mail.ru

Today, there is an opinion that some dietary products may increase the risk of rheumatoid arthritis (RA). The article reviews various dietary strategies and their influence on the risk of RA development and the course of the disease. Allegedly, the widespread «Western» type of diet with high calorie intake, rich with simple carbohydrates, saturated fats and red meat, low level of omega-3 and omega-9 polyunsaturated fatty acids (PUFAs) and fiber may serve as one of the triggers for the development and progression of RA. Alternatively, high intake of omega-3 PUFAs is associated with decreased risk of RA, most probably as a result of their anti-inflammatory and membrane-protective properties. Evidence suggests an advantage of Mediterranean diet, rich in fiber contained in wholegrain foods, beans, fruits and vegetables and also cold-pressed olive oil (rich in omega-9 PUFAs) with near-complete absence of red meat. Despite a variety of dietary strategies with specific advantages and disadvantages, general dietary recommendations for RA patients should include absence of simple carbohydrates and sweet beverages, decrease of red meat and saturated fat intake with an increase of the proportion of seawater fish, vegetable protein, fiber and omega-9 PUFAs in daily diet.

Key words: rheumatoid arthritis, diet, dietary strategies. 

(For citation: Khalfina T.N., Zamanova E.S., Nurullina G.I. Role of diet in the risk and progress of rheumatoid arthritis. Practical medicine. 2019. . Vol. 17, № 6 (part 1), P. 26-30)

REFERENCES

1. Badsha H. Role of Diet in Influencing Rheumatoid Arthritis Disease Activity. The Open Rheumatology Journal, 2018, 12, pp. 19-28.
2. Smedslund G., Byfuglien M.G., Olsen S.U., Hagen K.B. Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials. Am. Diet Assoc, 2010, no. 110 (5), pp. 727-35.
3. Philippou E., Nikiphorou E. Are we really what we eat? Nutrition and its role in the onset of rheumatoid arthritis. Autoimmunity Reviews, 2018, 17, iss. 11, pp. 1074-1077.
4. Duerkop B.A., Vaishnava S., Hooper L.V. Immune responses to the microbiota at the intestinal mucosal surface. Immunity, 2009, 31 (3), pp. 368-76.
5. Macpherson A.J., Harris N.L. Interactions between commensal intestinal bacteria and the immune system. Rev. Immunol, 2004, no. 4 (6), pp. 478-85.
6. Yeoh N., Burton J.P., Suppiah P. et al. The Role of the Microbiome in Rheumatic Curr. Rheumatol Rep, 2013, no. 15 (3), p. 314.
7. Mohammed R.H.A., Elmakhzangy H.I.I. The Gut Microbiota and Inflammation in Rheumatoid Arthritis. Book: New Developments in the Pathogenesis of Rheumatoid Arthritis: IntechOpen, Pp. 83-99.
8. Sandhya P., Danda D., Sharma D., Scaria V. Does the buck stop with the bugs?: An overview of microbial dysbiosis in rheumatoid arthritis. J. Rheum. Dis, 2016, no. 19 (1), pp. 8-20.
9. Wu H.J., Ivanov I.I., Darce J. et al. Gut-residing segmented filamentous bacteria drive autoimmune arthritis via T helper 17 cells. Immunity, 2010, 32 (6), pp. 815-27.
10. Daïen C.I., Sellam J. Obesity and inflammatory arthritis: Impact on occurrence, disease characteristics and therapeutic response. RMD Open, 2015, 1 (1), pp. 10-12.
11. Scher J.U., Abramson S.B. The microbiome and rheumatoid arthritis. Rev. Rheumatol, 2011, no. 7 (10), pp. 569-78.
12. Pattison D.J., Symmons D.P., Lunt M. et al. Dietary risk factors for the development of inflammatory polyarthritis: evidence for a role of high level of red meat consumption. Arthritis Rheum, 2004, 50, pp. 3804-3812.
13. Benito-Garcia E., Feskanich D., Hu F.B. et al. Protein, iron, and meat consumption and risk for rheumatoid arthritis: a prospective cohort study. Arthritis Res Ther, 2007, 9, r. 16.
14. Salgado E., Bes-Restrollo M., de Irala J. et al. High Sodium Intake Is Associated With Self-Reported Rheumatoid Arthritis: A Cross Sectional and Case Control Analysis Within the SUN Cohort. Medicine (Baltimore), 2015, 94 (37), e924.
15. Jiang X., Sundstrom B., Alfredsson L. et al. High sodium chloride consumption enhances the effects of smoking but does not interact with SGK1 polymorphisms in the development of ACPA-positive status in patients with RA. Rheum Dis, 2016, no. 75, pp. 943-946.
16. Sales C., Oliviero F., Spinella P. The mediterranean diet model in inflammatory rheumatic diseases. Reumatismo, 2009, 61 (1), pp. 10-14.
17. Sköldstam L., Hagfors L., Johansson G. An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Rheum. Dis, 2003, no. 62 (3), pp. 208-14.
18. Dinu M., Pagliai G., Casini A., Sofi F. Mediterranean diet and multiple health out- comes: an umbrella review of meta-analyses of observational studies and randomised trials. J. Clin. Nutr, 2018, no. 72, pp. 30-43.
19. Warjri S.B., Ete T., Beyong T. et al. Coeliac disease with rheumatoid arthritis: An unusual association. Gastroenterol Res, 2015, 8 (1), pp. 167-168.
20. El-Chammas K., Danner E. Gluten-free diet in nonceliac disease. Clin. Pract, 2011, no. 26 (3), pp. 294-299.
21. Elkan A.C., Sjöberg B., Kolsrud B. et al. Gluten-free vegan diet induces decreased LDL and oxidized LDL levels and raised atheroprotective natural antibodies against phosphorylcholine in patients with rheumatoid arthritis: A randomized study. Arthritis Res Ther, 2008, 10 (2), r. 34.
22. Stamp L.K., James M.J., Cleland L.G. Diet and rheumatoid arthritis: A review of the literature. Semin Arthritis Rheum, 2005, 35 (2), pp. 77-94.
23. Toivanen P., Eerola E. A vegan diet changes the intestinal flora. Rheumatology (Oxford), 2002, 41 (8), pp. 950-951.
24. McDougall J., Bruce B., Spiller G. et al. Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. Altern Complement Med, 2002, no. 8 (1), pp. 71-75.
25. Khanna S., Jaiswal K.S., Gupta B. Managing Rheumatoid Arthritis with Dietary interventions. Front Nutr, 2017, 4, p. 52.
26. Van de Laar M., Van der Korst J. Food intolerance in rheumatoid arthritis. I. A double blind, controlled trial of the clinical effects of elimination of milk allergens and AZO dyes. Ann Rheum Dis, 1992, no. 51 (3), 298-302.
27. Karatay S., Erdem T., Yildirim K. et al. The effect of individualized diet challenges consisting of allergenic foods on TNF-α and IL-1β levels in patients with rheumatoid arthritis. Rheumatology, 2004, 43 (11), pp. 1429-1433.
28. Saidane O., Semerano L., Sellam J. Could omega-3 fatty acids prevent rheumatoid arthritis? Joint Bone Spine, 2019, no. 86 (1), 9-12.
29. Di Giuseppe D., Wallin A., Bottai M. et al. Long-term intake of dietary long-chain n-3 polyunsaturated fatty acids and risk of rheumatoid arthritis: A prospective cohort study of women. Ann Rheum Dis, 2014, 73 (11), pp. 1949-1953.
30. Navarini L., Afeltra A., Gallo Afflitto G., Margiotta D.P. Polyunsaturated fatty acids: Any role in rheumatoid arthritis? Lipids Health Dis, 2017, no. 16 (1), 197.
31. Schorpion A., Kolasinski S.L., Marantidou F., Panagiotakos D.P. Intake of ω-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: A systematic review and meta-analysi. Nutrition, 2018, no. 45, 114-124.
32. Podas T., Nightingale J.M., Oldham R. et al. Is rheumatoid arthritis a disease that starts in the intestine? A pilot study comparing an elemental diet with oral prednisolone. Med. J, 2007, no. 83 (976), pp. 128-31.