Diet in Rheumatic diseases at the EULAR 2014 Meeting in Paris

[SP0022] H. Thorseng reported about " Food as therapy – supporting healthy choices". The Danish Rheumatism Assosiation gives free information either through their website, their mailbox or their hotline advice service. On the free helpline "people with RMDs and their relatives can talk to a professional adviser e.g. a nutritionist."

[SP0025]

Another talk was by M. Cutolo, EULAR president, on Vitamin D status. He pointed out: "80% of the vit D needs are obtained through exposure to sunlight: ,,," " a sunscreen with a sun protection factor (SPF) of 8 reduces the capacity of the skin to produce vit D3 by >95%!" He advises to use dietary supplements and fortified foods, but I must add that fortified foods aren't available everywhere due to legislation. Vitamin D is available as D2 (ergocalciferol) and D3 (cholecalciferol). he suggested taking 1,500 -2,000 IU per day during in winter.

[SP0025]

K. Betteridge's talk has been on "FOOD CHALLENGES - GETTING IN; GETTING IT ON; GETTING IT OFF". His conclusion: "With the right information, motivation and support, it is possible to make healthy choices in order to maintain a healthy diet when living with an RMD [people with rheumatic or musculoskeletal diseases]."

[SP0106]

J. Richardson talked on "EHEALTH LITERACY ON RHEUMATIC DISEASES: ANALYSING THE POWER OF THE INTERNET: HEALTH TALK ONLINE - PATIENTS’ EXPERIENCE OF GOUT". In his talk he pointed out: " Many people found a lot of conflicting and confusing information about diet and complementary treatments on the internet." And that is true for other diseases as well.

[OP0010-HPR]

Y. Matsumoto and colleagues lokked at "INTAKE OF MONOUNSATURATED FATTY ACIDS AS COMPONENTS OF A MEDITERRANEAN DIET SUPPRESSES RHEUMATOID ARTHRITIS DISEASE ACTIVITY – THE TOMORROW STUDY". T&he study showed that RA patients' intake is lower than of healthy volunteers. However, a high intake of MUFA was an independent predictor of remission in patients with RA. The authors concluded: "The daily intake of MUFA, a component of the Mediterranean diet, might suppress disease activity in patients with RA."

[OP0195]

B. Sundstrom and colleagues presented: "HIGH SODIUM INTAKE AMONG SMOKERS IS A RISK FACTOR FOR ACPA POSITIVITY IN RA". Conclusions: "High dietary intake of sodium among smokers was associated with an increased risk to develop ACPA positive RA and there was a significant interaction between the two environmental factors – sodium intake and smoking in conferring to this increased disease risk."

These findings should find way into preventive medicine. Once the avanlanche is started it runs down. So we have to warn more against smoking and high intake of sodium.

[THU0030]

S. Abou-Raya and collegues looked at "NUTRITIONAL STATUS IN RELATION TO INFLAMMATORY AND OXIDATIVE STRESS MARKERS: ASSOCIATION WITH DISEASE ACTIVITY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS". They found 27% of pats. were obese, while 10% were malnourished. " The dietary intake assessment showed a lower intake consumption of fresh fruit, vegetables, milk and other dairy products and an increased intake of fats and oils. Low intake of iron, calcium and zinc was found in 35%, 58% and 78% respectively." In their conclusions they stated: "Interventions aimed at promoting adequate nutritional status may have beneficial effects by decreasing inflammation and oxidative stress and thus may contribute to reduction of comorbidities and improved quality of life in these patients."

[AB0145]

S.M. Jung and colleagues presented the following study; "SODIUM CHLORIDE AGGRAVATES ARTHRITIS BY TH17

POLARIZATION". Results: "NaCl promoted the induction of Th17 cells from PBMC in RA patients. Th17 differentiation was progressively upregulated as NaCl concentration increased upto 60 mM. Correspondingly, high salt diet exacerbated the arthritis of CIA mice." Conclusions: "This study suggests that NaCl can aggravate arthritis via Th17 differentiation. High salt condition can contribute to the development and progression of RA." Another hint to advocate low sodium diets to people with rheumatic or musculoskeletal diseases.

[AB1042]

B. Sundstrom and colleagues looked at: "DIETARY PATTERNS, MACRONUTRIENTS AND ALCOHOL AS RISK FACTORS FOR RHEUMATOID ARTHRITIS". "The study included 386 individuals (271 women, 115 men) who previously had stated their dietary habits as part VIP (Vasterbotten Intervention Program= before the onset of symptoms of RA." Conclusions: "There were no significant associations of the dietary patterns studied on the risk for development of RA in this cohort. Neither were there any associations to the risk for RA with alcohol consumption and on diet examined as macronutrients." That's sobering!

[AB1191-HPR]

S. Meyfroidt and colleagues presented this meta-study: "NUTRITIONAL INTERVENTIONS IN THE MANAGEMENT OF RHEUMATOID ARTHRITIS: A REVIEW OF THE LITERATURE". "Our search strategy yielded 19 randomized, placebo-controlled clinical

trials including 3 crossover trials." There were ony two trials on diet therapies. "Evidence was found for a reduction in inflammatory activity by adjusting to a Mediterranean or a calorie restriction diet. However, these diets were difficult to comply with and maintain in the long-term." Conclusions: "Supplementation of n-3 fatty acids, a low n-6 fatty acids intake and some diet therapies appeared to have a positive effect in patients with RA. However, most nutritional interventions cannot be effectively and safely recommended for the management of RA due to the limited number of trials, the inconsistencies between trials and the limits of applicability in patients’ daily life. The current evidence suggests that some supplements and suitable diet therapies may warrant further investigation."

I think the last study is also the most interesting. Patients ask what they can do in form of dietary changes, but we still lack studies.

I'll advise to stop smoking, lower intake of omega-6 fatty acids, increase omega-3 fatty acids, use olive oil, supplement viatmin D3, lower sodium intake. Advice, which isn't based on the above studies might include reducing meat, increasing fruits and veggies, reducing purines.