Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations?

Abstract

Rheumatoid arthritis (RA) is a systemic, autoimmune disease characterized by joint involvement, with progressive cartilage and bone destruction. Genetic and environmental factors determine RA susceptibility. In recent years, an increasing number of studies suggested that diet has a central role in disease risk and progression. Several nutrients, such as polyunsaturated fatty acids, present anti-inflammatory and antioxidant properties, featuring a protective role for RA development, while others such as red meat and salt have a harmful effect. Gut microbiota alteration and body composition modifications are indirect mechanisms of how diet influences RA onset and progression. Possible protective effects of some dietary patterns and supplements, such as the Mediterranean Diet (MD), vitamin D and probiotics, could be a possible future adjunctive therapy to standard RA treatment. Therefore, a healthy lifestyle and nutrition have to be encouraged in patients with RA.

Impact of Mediterranean Diet on Disease Activity and Gut Microbiota Composition of Rheumatoid Arthritis Patients

“…It has also been suggested that the gut microbiota can be significantly modulated by different environmental factors such as diet, smoke, and therapy [ 1 , 10 ]. On the other hand, it has been reported, with contrasting results, that diet regimen can influence arthritis onset and outcome [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Unlike the western diet, the Mediterranean diet is composed of a variety of foods and has been reported as the best-balanced and complete diet that provides antioxidant, anti-inflammatory, and prebiotic effects [ 12 , 13 ].…”

“…Foods rich in fibers, such as those present in the Mediterranean diet, indeed, are degraded by Firmicutes and Bacteroidetes into short-chain fatty acids (SCFA), such as butyrate, [ 17 , 18 ], which can result in a protective effect on the intestinal barrier by reducing its permeability [ 19 ]. A number of studies have also suggested associations between dietary habits, and RA development and outcome; however, the results are still scarce and contrasting [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. In this study, we found a protective role of the Mediterranean diet on the disease activity of RA patients supported by a healthy impact on microbiota composition.…”

Diet as a Modulator of Intestinal Microbiota in Rheumatoid Arthritis

“…LA and ALA are essential components of phospholipid membranes, and both are precursors of inflammatory mediators, such as prostaglandins (PGs) and leukotrienes (LTs) when metabolised to eicosanoids. The n-6 PUFAs and LA have a pro-inflammatory profile, whilst n-3 PUFAs and ALA have a role in the resolution of the inflammatory response [ 18 , 98 ]. The same enzymes metabolise both LA and ALA, with greater affinity for the anti-inflammatory ALA [ 103 ].…”

“…It has been proposed that the Mediterranean diet (MD), together with genetic and other lifestyle factors, could explain the lower incidence of RA in Southern Europe compared to Northern Europe and North America [ 17 , 18 ]. This, however, is still controversial, since studies have failed to prove that adherence to the MD is associated with a decreased risk of developing RA [ 19 , 20 ].…”

Phenolic Compounds Impact on Rheumatoid Arthritis, Inflammatory Bowel Disease and Microbiota Modulation

“…A systematic review has suggested that there is evidence of a protective effect from increased fruit and vegetable intake in the development of RA [ 122 , 123 ]. Dietary antioxidants effectively suppress inflammatory cytokine release by in vitro studies [ 124 , 125 , 126 , 127 , 128 ].…”