Personalized diet and exercise recommendations in early rheumatoid arthritis: A feasibility trial

Garner, Stephanie; Fenton, Tanis R.; Martin, Liam; Creaser, Caitlin; Johns, Carolyn; Barnabe, Cheryl

doi:10.1002/msc.1214

Cited by 16 publications

(48 citation statements)

References 20 publications

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“…In 386 patients from the Västerbotten Intervention Program (VIP) cohort, diet was not associated with a risk of RA. [ 55 ] In a recent feasibility trial, individualized counselling did not significantly improve the dietary habits in patients with inflammatory RA (n=31) of <1 year duration [ 77 ].…”

Section: Discussionmentioning

confidence: 99%

Role of Diet in Influencing Rheumatoid Arthritis Disease Activity

Badsha

2018

TORJ

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Background:Patients with Rheumatoid Arthritis (RA) frequently ask their doctors about which diets to follow, and even in the absence of advice from their physicians, many patients are undertaking various dietary interventions.Discussion:However, the role of dietary modifications in RA is not well understood. Several studies have tried to address these gaps in our understanding. Intestinal microbial modifications are being studied for the prevention and management of RA. Some benefits of vegan diet may be explained by antioxidant constituents, lactobacilli and fibre, and by potential changes in intestinal flora. Similarly, Mediterranean diet shows anti-inflammatory effects due to protective properties of omega-3 polyunsaturated fatty acids and vitamins, but also by influencing the gut microbiome. Gluten-free and elemental diets have been associated with some benefits in RA though the existing evidence is limited. Long-term intake of fish and other sources of long-chain polyunsaturated fatty acids are protective for development of RA. The benefits of fasting, anti-oxidant supplementation, flavanoids, and probiotics in RA are not clear. Vitamin D has been shown to influence autoimmunity and specifically decrease RA disease activity. The role of supplements such as fish oils and vitamin D should be explored in future trials to gain new insights in disease pathogenesis and develop RA-specific dietary recommendations.Conclusion:Specifically more research is needed to explore the association of diet and the gut microbiome and how this can influence RA disease activity.

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Section: Discussionmentioning

confidence: 99%

Role of Diet in Influencing Rheumatoid Arthritis Disease Activity

Badsha

2018

TORJ

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“…Impaired physical function, as well as fatigue and a negatively affected mental health, could affect grocery shopping, cooking, and appetite, and thus impact energy and nutrient intake. Several studies have reported energy and nutrient intake in patients with RA, but the results are somewhat disparate (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Some Swedish studies have described a high intake of saturated fatty acids (SFAs) and low intakes of several micronutrients, e.g., vitamin D, vitamin E, and folate, in this patient group (10)(11)(12).…”

Section: Introductionmentioning

confidence: 89%

Inadequate Dietary Nutrient Intake in Patients With Rheumatoid Arthritis in Southwestern Sweden: A Cross-Sectional Study

Wadell

Bärebring²,

Hulander³

et al. 2022

Front. Nutr.

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BackgroundPatients with rheumatoid arthritis (RA), who suffer from impaired physical function and fatigue, may have difficulties with grocery shopping and preparing meals. Also, to improve symptoms, patients often experiment with diets but seldom consult a dietitian. Although this could lead to a nutritiously deprived diet, an up-to-date, thorough description of the nutrient intake in Swedish patients with RA is absent. Here, we investigated the habitual dietary energy and nutrient intake in patients with RA living in southwestern Sweden.Materials and MethodsThree-day food records performed at two time points during the ADIRA (Anti-inflammatory Diet In Rheumatoid Arthritis) trial, were used. The intake of energy and nutrients was analyzed using The Swedish Food Composition Database.ResultsA total of 62 participants (50 females, 12 males) were included in the study, where 18 participants completed one 3-day food record and 44 participants completed two 3-day food records. Median (IQR) intake of total fat was above or in the upper range of recommendations (females: 37.1 [32.5, 41.7] energy percent (E%), and males: 40.3 [37.5, 42.9] E%). Median (IQR) intake of saturated fatty acids exceeded recommendations (females: 14.9 [12.5, 17.0] E% and males: 15.4 [12.2, 17.0] E%), while median (IQR) carbohydrate and fiber intakes were below recommendations (females: 41.7 [36.3, 45.4] E% and 17.2 [12.8, 20.9] g, respectively, and males: 38.8 [35.2, 40,3] E% and 18.5 [15.7, 21.0] g, respectively). The reported intake of other macronutrients was in line with recommendations. For several micronutrients, e.g., vitamin A and D, folate, and calcium, median intake was below recommended intake. Vitamin A intake was especially low and did not reach lower intake level (LI) for 14 and 17% of females and males, respectively. For females, about 10% did not reach LI for vitamin D, calcium, and riboflavin.ConclusionWe found that patients with RA residing in southwestern Sweden reported a high intake of saturated fatty acids and low intake of fiber and several micronutrients.Clinical Trial Registration[https://clinicaltrials.gov/ct2/show/NCT02941055?term=NCT02941055&draw=2&rank=1], identifier [NCT02941055].

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“…Despite high prevalence of foot disease and impaired lower limb function in early RA, our recruitment rate for the GREAT Strides programme was lower than anticipated, with an average of 3.5 participants per month. Poor enrolment and attrition rates have been reported in other feasibility studies involving behaviour change in this population [ 78 ]. Through evaluation of screening logs and dialogue with site personnel, we established one of the limiting factors was confirmation of meeting ACR 2010 classification criteria for RA, which is often not recorded in routine care and the inclusion criterion for the future main trial will be amended so that patients with a clinician diagnosis of RA can be included.…”

Section: Discussionmentioning

confidence: 83%

Gait rehabilitation for foot and ankle impairments in early rheumatoid arthritis: a feasibility study of a new gait rehabilitation programme (GREAT Strides)

Hendry

Bearne

Foster

et al. 2022

Pilot Feasibility Stud

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Background Foot impairments in early rheumatoid arthritis are common and lead to progressive deterioration of lower limb function. A gait rehabilitation programme underpinned by psychological techniques to improve adherence, may preserve gait and lower limb function. This study evaluated the feasibility of a novel gait rehabilitation intervention (GREAT Strides) and a future trial. Methods This was a mixed methods feasibility study with embedded qualitative components. People with early (< 2 years) rheumatoid arthritis (RA) and foot pain were eligible. Intervention acceptability was evaluated using a questionnaire. Adherence was evaluated using the Exercise Adherence Rating Scale (EARS). Safety was monitored using case report forms. Participants and therapists were interviewed to explore intervention acceptability. Deductive thematic analysis was applied using the Theoretical Framework of Acceptability. For fidelity, audio recordings of interventions sessions were assessed using the Motivational Interviewing Treatment Integrity (MITI) scale. Measurement properties of four candidate primary outcomes, rates of recruitment, attrition, and data completeness were evaluated. Results Thirty-five participants (68.6% female) with median age (inter-quartile range [IQR]) 60.1 [49.4–68.4] years and disease duration 9.1 [4.0–16.2] months), were recruited and 23 (65.7%) completed 12-week follow-up. Intervention acceptability was excellent; 21/23 were confident that it could help and would recommend it; 22/23 indicated it made sense to them. Adherence was good, with a median [IQR] EARS score of 17/24 [12.5–22.5]. One serious adverse event that was unrelated to the study was reported. Twelve participants’ and 9 therapists’ interviews confirmed intervention acceptability, identified perceptions of benefit, but also highlighted some barriers to completion. Mean MITI scores for relational (4.38) and technical (4.19) aspects of motivational interviewing demonstrated good fidelity. The Foot Function Index disability subscale performed best in terms of theoretical consistency and was deemed most practical. Conclusion GREAT Strides was viewed as acceptable by patients and therapists, and we observed high intervention fidelity, good patient adherence, and no safety concerns. A future trial to test the additional benefit of GREAT Strides to usual care will benefit from amended eligibility criteria, refinement of the intervention and strategies to ensure higher follow-up rates. The Foot Function Index disability subscale was identified as the primary outcome for the future trial. Trial registration ISRCTN14277030

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Personalized diet and exercise recommendations in early rheumatoid arthritis: A feasibility trial

Cited by 16 publications

References 20 publications

Role of Diet in Influencing Rheumatoid Arthritis Disease Activity

Role of Diet in Influencing Rheumatoid Arthritis Disease Activity

Inadequate Dietary Nutrient Intake in Patients With Rheumatoid Arthritis in Southwestern Sweden: A Cross-Sectional Study

Gait rehabilitation for foot and ankle impairments in early rheumatoid arthritis: a feasibility study of a new gait rehabilitation programme (GREAT Strides)

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