Food & Disease: How Diet May Affect Rheumatic & Musculoskeletal Diseases

Although weight loss through diet and exercise is clearly an important topic for rheumatologists to discuss with their patients, it was also noted that weight loss through bariatric surgery may hold promise to help reduce disease activity. In a 12-month prospective cohort study, 32 patients with RA underwent bariatric surgery and 33 patients received only pharmacotherapy for RA. Using outcome measures that included ACR20, ACR50, ACR70, DAS28-ESR, DAS28-CRP and Clinical Disease Activity Index (CDAI), weight loss after bariatric surgery was associated with statistically significant, lower disease activity than that found in obese patients who did not undergo surgery.¹⁰

Bottom Line

Diet is at the forefront for many patients, and more research is needed to better understand how to tailor dietary advice to individual patients and for specific diseases.

One thing is clear: Diet should be taken into account when counseling patients. Even if the plate is full of topics to discuss during an office visit, this important subject should not be neglected.

Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.

References

1. Shoenfeld Y, Zandman-Goddard G, Stojanovich L, et al. The mosaic of autoimmunity: Hormonal and environmental factors involved in autoimmune diseases—2008. Isr Med Assoc J. 2008 Jan;10(1):8–12.
2. Hu Y, Costenbader KH, Gao X, et al. Sugar-sweetened soda consumption and risk of developing rheumatoid arthritis in women. Am J Clin Nutr. 2014 Sep;100(3):959–967.
3. Fung TT, Rexrode KM, Mantzoros CS, et al. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation. 2009 Mar 3;119(8):1093–1100. Erratum in: Circulation. 2009 Mar 31;119(12):e379.
4. Lopez-Garcia E, Rodriguez-Artalejo F, Li TY, et al. The Mediterranean-style dietary pattern and mortality among men and women with cardiovascular disease. Am J Clin Nutr. 2014 Jan;99(1):172–180.
5. Petersson S, Philippou E, Rodomar C, et al. The Mediterranean diet, fish oil supplements and Rheumatoid arthritis outcomes: Evidence from clinical trials. Autoimmun Rev. 2018 Nov;17(11):1105–1114.
6. Fernandes S, Etcheto A, van der Heijde D, et al. Vitamin D status in spondyloarthritis: Results of the ASAS-COMOSPA international study. Clin Exp Rheumatol. 2018 Mar-Apr;36(2):210–214.
7. Gao CC, Liu SY, Wu ZZ, et al. Severe vitamin D deficiency increases the risk for moderate to severe disease activity in Chinese patients with SLE. Lupus. 2016 Oct;25(11):1224–1229.
8. Petri M, Bello KJ, Fang H, Magder LS. Vitamin D in systemic lupus erythematosus: Modest association with disease activity and the urine protein-to-creatinine ratio. Arthritis Rheum. 2013 Jul;65(7):1865–1871.
9. Nikiphorou E, Norton S, Young A, et al. The association of obesity with disease activity, functional ability and quality of life in early rheumatoid arthritis: Data from the Early Rheumatoid Arthritis Study/Early Rheumatoid Arthritis Network U.K. prospective cohorts. Rheumatology (Oxford). 2018 Jul 1;57(7):1194–1202.
10. Xu F, Yu C, Li DG, Yan Q, Zhang SX, Yang XD, Zhang Z. The outcomes of bariatric surgery on rheumatoid arthritis disease activity: A prospective cohort study. Sci Rep. 2020 Feb 21;10(1):3167.