FRI0168 POSITIVE EFFECTS OF AN ANTI-INFLAMMATORY DIET IN RHEUMATOID ARTHRITIS
Authors: Anna Vadell, Erik Hulander, Linnea Barebring, Inger Gjertsson, Helen Lindqvist, Anna Winkvist
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Many patients with rheumatoid arthritis (RA) experience symptom relief of certain foods and earlier research has shown positive effects of food and food components on clinical outcomes of RA. Food components may potentiate each other in their effects on RA, but even so, studies combining foods and food components with probable effects on RA are scarce. Furthermore, comorbidities are common in RA and the risk of cardiovascular disease is elevated in this group. Assumed mechanisms include classical risk factors such as systemic inflammation, dyslipidemia as well as an unfavorable body composition. <h3>Objectives:</h3> We investigated if a diet combining foods with anti-inflammatory effects, i.e. an anti-inflammatory portfolio diet, could reduce RA disease activity, markers of inflammation, body composition and blood lipid levels compared to a control diet. <h3>Methods:</h3> In this controlled cross-over trial, 50 patients with RA were randomized to start with either intervention or control diet for ten weeks followed by a wash-out period of four months. The intervention diet was an anti-inflammatory portfolio diet containing foods rich in omega-3 fatty acids, fibers and probiotics. The control diet was a typical Swedish diet. Food equivalent to 50% of daily energy needs was delivered home weekly. For the remaining intake, participants were instructed to consume similar foods as the study diet regimen. Primary outcome measure was change in DAS28, using ESR. Secondary outcomes included changes in blood lipid levels, ESR and CRP as well as body composition. <h3>Results:</h3> No significant difference in DAS28 between the groups was seen using Mixed Models analyze (p=0.116). However, DAS28 was significantly lower after the intervention diet compared to after control diet (p=0.04) and a significant reduction over time was seen in the intervention group (p=0.012) using Wilcoxon signed rank test. HDL-cholesterol was increased and TG were lowered after intervention compared to control, analyzed using Mixed Models (p=0.046 and p=0.006 respectively). In addition, there was a non-significant trend towards lowered LDL-cholesterol (p=0.077). Comparing after intervention to after control, there were non-significant lower weight, BMI and fat mass after the intervention (p=0.077, p=0.075 and p=0.058 respectively). None of the other outcomes changed significantly between groups. <h3>Conclusion:</h3> This study showed positive effects on disease activity and blood lipid levels of a diet combining foods with anti-inflammatory properties, but the results must be confirmed in larger studies. <h3>References:</h3> [1] Agca R, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Annals of the rheumatic diseases. 2017;76(1):17-28. [2] Piepoli MF, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention &amp; Rehabilitation (EACPR). European heart journal. 2016;37(29):2315-81. [3] Sköldstam L, et al. An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Ann Rheum Dis. 2003;62(3):208-14. [4] SLV. [Available from: https://www.livsmedelsverket.se/matvanor-halsa--miljo/kostrad-och- matvanor/matvanor---undersokningar/riksmaten-2010-11---vuxna. [5] Tedeschi SK, et al. Diet and Rheumatoid Arthritis Symptoms: Survey Results From a Rheumatoid Arthritis Registry. Arthritis Care Res (Hoboken). 2017;69(12):1920-5. <h3>Disclosure of Interests:</h3> Anna Vadell: None declared, Erik Hulander: None declared, Linnea Barebring: None declared, Inger Gjertsson: None declared, Helen Lindqvist Employee of: Yes, for Janssen-Cilag AB in 2001-2003, Before I was a phD-student and within a different field (dementia). My research field is within diet and Rheumatology., Anna Winkvist: None declared