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Does illness also depend on food?
Many people have the impression that rheumatism is often associated with "incurable", and long-term chronic disease management is required most of the time to minimize disease activity, thereby achieving a higher quality of life and prognosis for patients, which is indispensable to the complex impact
of diet on rheumatism.
How to develop an intervention plan for diet in rheumatism? This year's American College of Rheumatology (ACR) is a special topic to demonstrate the importance of
diet for colleagues around the world.
Figure 1: Complex association
between diet and rheumatism The role of different substances in dietary interventions for rheumatism
Most of the body's immune cells are located in the digestive tract, and nutrients (vitamins, salts, fatty acids, etc.
) may change the permeability of the intestine and have a direct impact on the intestinal immune cells, and the activated immune cells in the intestine migrate to joints and other tissues, which may eventually lead to the occurrence of rheumatism [1-2].
Figure 2.
Common nutrient classification 1
fatty acids
Unsaturated fatty acids are precursors of prostaglandins and leukotrienes, and the Ω-3/6 ratio is associated with
pro-inflammatory/anti-inflammatory cytokine balance.
Studies have shown that intake of Ω-3 fatty acids (or fish oil) is inversely associated with the incidence of rheumatoid arthritis (RA) (especially when intake> at 2 g per day), and Ω-3 fatty acid intake is also associated with the expression of anti-cyclic citrullinated peptide antibodies [3-4].
Saturated fatty acids, on the other hand, increase bacterial endotoxins (lipopolysaccharides), while red meat intake is associated with the prevalence of RA [5].
Vitamin
E has limited effect on RA disease activity, and there is also a lack of evidence on disease activity in spondyloarthritis or psoriatic arthritis; Vitamin K has a limited effect on disease activity (DAS-28); Folic acid supplementation should prevent methotrexate-related side effects; Vitamin D supplementation in rheumatology patients with vitamin D deficiency prevents musculoskeletal complications [6].
3
salt
intake can increase pro-inflammatory macrophage development, while increasing the activity of helper T cells (Th17), Promotes cytokine (IL-17) production and reduces the function of
regulatory T cells (Tregs).
Daily sodium intake has been shown to correlate with the confirmed diagnosis of RA in a dose-dependent manner [7].
4
.
Sugar and soft drinks
Sugars activate transforming growth factors ( TGF-β), promotes Th17 cell differentiation, reduces the density of intestinal probiotic colonies, and intensifies autoimmunity
.
At the same time, sugary and high-glycemic index foods can cause obesity, and soft drinks such as sugary soda are associated with an increased risk of seropositive RA and worsening of perceived symptoms [8].
alcohol
Resveratrol in red wine has an anti-inflammatory effect and can be reduced NF-kB, COX-2 are activated and exert antioxidant effects
by reducing the production of reactive oxygen species (ROS).
At the same time, low or moderate alcohol consumption was dose-dependent on a reduced risk of RA compared with no alcohol [9].
Miscellaneous
Caffeine can be increased Risk of RA, which may be dose-dependent and may promote rheumatoid factor production
.
The antioxidant flavonoids in cocoa beans can reduce the production of autoantibodies and promote the expression balance of anti-inflammatory cytokines in RA patients, while flavonoids in green tea can reduce cartilage destruction, reduce the expression of inflammatory factors, and increase the apoptosis
of synovial fibroblasts.
In addition, capsaicin in red pepper can increase the expression and regulation of anti-inflammatory cells Painful symptoms in patients with RA; Red ginseng powder can reduce the expression of pro-inflammatory cytokines in RA patients; Curcumin has the effect of promoting antioxidant production and increasing the expression of anti-inflammatory genes; Probiotics reduce the antibody immune response
.
The role of dietary intervention programmes in rheumatism
In recent decades, chronic disease management has paid increasing attention to the role of dietary interventions, taking the Mediterranean diet as an example, which is related to The risk of RA is associated with a reduction, but there are differences
between other factors (e.
g.
, sex, smoking, seropositivity, country).
In addition, the disease activity of psoriatic arthritis (DAPSA) is inversely correlated with adherence to the Mediterranean diet [10].
However, in addition to the Mediterranean diet, there are a number of dietary intervention programmes (mainly targeted interventions for RA), studies of these intervention regimens were limited to small sample sizes, low-certainty evidence, and methodological considerations were not sufficient and will not be repeated
here.
At the level of higher-level evidence, researchers of axial spondyloarthritis focused more on the intervention role of Ω-3 unsaturated fatty acids; Osteoarthritis researchers love Ω-3 unsaturated fatty acids, avocado and its extract, and vitamin D; Scleroderma, systemic lupus erythematosus, and gout lack high-level evidence-based evidence [11].
Guidelines on dietary interventions [12-13]
cite the European Union Against Rheumatism (EULAR) guidelines as an example: they recommend supplementation Ω-3 (such as fish oil or nuts); A Mediterranean diet is also recommended for patients with rheumatism for better management of complications; Indicate that the use of spices (curcumin, capsaicin), etc.
may benefit patients; It is recommended to consume coffee and alcohol in moderation; Excessive consumption of salt and sugar is discouraged [12].
summary
In practice, nutritional supplementation is often preferred over alternative pharmacotherapy, and patients with other complications (eg, diabetes, cardiovascular disease, osteoporosis, hyperuricemia, obesity) should further develop an individualized diet
.
Overall, a balanced diet and avoiding partial foods such as a gluten/dairy-free diet can have a positive effect
on inflammation and autoimmunity.
Diet is significant in the development of many rheumatisms, so it is also a positive step
to listen to dietitians across disciplines in practice.
References:
[1] Tajik N, Frech M, Schulz O, et al.
Targeting zonulin and intestinal epithelial barrier function to prevent onset of arthritis[J].
Nature communications, 2020, 11(1): 1-14.
[2] Tourkochristou E, Triantos C, Mouzaki A.
The influence of nutritional factors on immunological outcomes[J].
Frontiers in Immunology, 2021, 12: 665968.
[3] Di Giuseppe D, Discacciati A, Orsini N, et al.
Cigarette smoking and risk of rheumatoid arthritis: a dose-response meta-analysis[J].
Arthritis research & therapy, 2014, 16(2): 1-7.
[4] Sparks J A, O’Reilly É J, Barbhaiya M, et al.
Association of fish intake and smoking with risk of rheumatoid arthritis and age of onset: a prospective cohort study[J].
BMC musculoskeletal disorders, 2019, 20(1): 1-13.
[5] Grant W B.
The role of meat in the expression of rheumatoid arthritis[J].
British Journal of Nutrition, 2000, 84(5): 589-595.
[6] Nguyen Y, Sigaux J, Letarouilly J G, et al.
Efficacy of oral vitamin supplementation in inflammatory rheumatic disorders: a systematic review and meta-analysis of randomized controlled trials[J].
Nutrients, 2020, 13(1): 107.
[7] Debotton N, Dahan A.
Applications of polymers as pharmaceutical excipients in solid oral dosage forms[J].
Medicinal research reviews, 2017, 37(1): 52-97.
[8] Sparks J A, Lin T C, Camargo Jr C A, et al.
Rheumatoid arthritis and risk of chronic obstructive pulmonary disease or asthma among women: A marginal structural model analysis in the Nurses’ Health Study[C]//Seminars in arthritis and rheumatism.
WB Saunders, 2018, 47(5): 639-648.
[9] Hedström A K, Hössjer O, Klareskog L, et al.
Interplay between alcohol, smoking and HLA genes in RA aetiology[J].
RMD open, 2019, 5(1): e000893.
[10] Oliviero F, Spinella P, Fiocco U, et al.
How the Mediterranean diet and some of its components modulate inflammatory pathways in arthritis[J].
Swiss medical weekly, 2015 (45).
[11] Gwinnutt J M, Wieczorek M, Rodríguez-Carrio J, et al.
Effects of diet on the outcomes of rheumatic and musculoskeletal diseases (RMDs): systematic review and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs[J].
RMD open, 2022, 8(2): e002167.
[12] Gwinnutt J M, Wieczorek M, Balanescu A, et al.
2021 EULAR recommendations regarding lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases[J].
Annals of the rheumatic diseases, 2022.
[13] Daien C, Czernichow S, Letarouilly J G, et al.
Dietary recommendations of the French Society for Rheumatology for patients with chronic inflammatory rheumatic diseases[J].
Joint Bone Spine, 2022, 89(2): 105319.
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