The Relationship of Diet on the Disease Status in Patients Suffering from Rheumatoid Arthritis

Document Type : Original Article(s)


1 Associate Professor, Department of Nutritional Sciences, School of Nutrition Sciences & Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran

2 MSc, Department of Nutritional Sciences, School of Nutrition Sciences & Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran

3 Assistant Professor, Department of Nutritional Sciences, School of Nutrition Sciences & Food Technology AND Research Center of Oils and Fats, Research Institute for Health Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran


Background: Diet with regulating inflammation and oxidative stress plays an important role in the pathogenesis and development of rheumatoid arthritis (RA). The aim of this study was to investigate the relationship between diet and disease activity score in RA patients in Kermanshah city.
Methods: This cross-sectional study was conducted on 184 patients with a definitive diagnosis of RA according to the criteria of the 2010 American College of Rheumatology/ European League against Rheumatism in Kermanshah city. Dietary intake was assessed using a validated 168-item food frequency questionnaire and disease activity score-28 (DAS-28) based on the number of swollen and sensitive joints, ESR level and self-assessed general health. Logistic regression test with adjusting confounders was used to investigate the relationship between diet and DAS-28.
Findings: DAS-28 was directly related to total fat intake (β = 0.54) saturated fatty acid intake (β = 0.21), and omega 6 fatty acid intake (β = 0.26), while it was inversely related to protein intake (β = -0.62). Additionally, intake of red meats (β = 0.31) and animal fats (β = 0.24) was directly associated to DAS-28 and intake of white meats (β = -0.31), low-fat dairies (β = -0.53), vegetable oils (β = -0.21), fruits (β = -0.19), vegetables (β = -0.25), and spices (β = -0.29) were inversely associated.
Conclusion: Adherence to a high-protein and low-fat diets from white meats, low-fat dairies, fruits, vegetables, vegetable oils, and spices can be included in the diet therapy of patients with RA.


Main Subjects

  1. Xu Y, Wu Q. Prevalence trend and disparities in rheumatoid arthritis among us adults, 2005-2018. J Clin Med 2021; 10(15): 3289.
  2. Gioia C, Lucchino B, Tarsitano MG, Iannuccelli C, Di Franco M. Dietary habits and nutrition in rheumatoid arthritis: can diet influence disease development and clinical manifestations? Nutrients 2020; 12(5): 1456.
  3. Skoczyńska M, Świerkot J. The role of diet in rheumatoid arthritis. Reumatologia 2018; 56(4): 259-67.
  4. Gheita T, Kamel S, Helmy N, El-Laithy N, Monir A. Omega-3 fatty acids in juvenile idiopathic arthritis: effect on cytokines (IL-1 and TNF-α), disease activity and response criteria. Clin Rheumatol 2012; 31(2): 363-6.
  5. Gioxari A, Kaliora AC, Marantidou F, Panagiotakos DP. Intake of ω-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: A systematic review and meta-analysis. Nutrition (Burbank, Los Angeles County, Calif) 2018; 45: 114-24.e4.
  6. Jin J, Li J, Gan Y, Liu J, Zhao X, Chen J, et al. Tea consumption is associated with decreased disease activity of rheumatoid arthritis in a real-world, large-scale study. Ann Nutr Metab 2020; 76(1): 54-61.
  7. Fleischmann RM, van der Heijde D, Gardiner PV, Szumski A, Marshall L, Bananis E. DAS28-CRP and DAS28-ESR cut-offs for high disease activity in rheumatoid arthritis are not interchangeable. RMD Open 2017; 3(1): e000382.
  8. Green SB. How many subjects does it take to do a regression analysis. Multivariate Behav Res 1991; 26(3): 499-510.
  9. Matsumoto Y, Sugioka Y, Tada M, Okano T,
    Mamoto K, Inui K, et al. Monounsaturated fatty acids might be key factors in the Mediterranean diet that suppress rheumatoid arthritis disease activity: The TOMORROW study. Clin Nutr 2018; 37(2): 675-80.
  10. Tedeschi SK, Bathon JM, Giles JT, Lin TC, Yoshida K, Solomon DH. Relationship between fish consumption and disease activity in rheumatoid arthritis. Arthritis Care Res (Hoboken) 2018; 70(3): 327-32.
  11. DiNicolantonio JJ, O’Keefe JH. Importance of maintaining a low omega–6/omega–3 ratio for reducing inflammation. Open Heart 2018; 5(2): e000946.
  12. Poprac P, Jomova K, Simunkova M, Kollar V, Rhodes CJ, Valko M. Targeting free radicals in oxidative stress-related human diseases. Trends in pharmacological sciences 2017; 38(7): 592-607.
  13. Grönwall C, Amara K, Hardt U, Krishnamurthy A, Steen J, Engström M, et al. Autoreactivity to malondialdehyde-modifications in rheumatoid arthritis is linked to disease activity and synovial pathogenesis. J Autoimmun 2017; 84: 29-45.
  14. Hayashi H, Satoi K, Sato-Mito N, Kaburagi T, Yoshino H, Higaki M, et al. Nutritional status in relation to adipokines and oxidative stress is associated with disease activity in patients with rheumatoid arthritis. Nutrition 2012; 28(11-12): 1109-14.
  15. Zhou H, Urso CJ, Jadeja V. Saturated fatty acids in obesity-associated inflammation. J Inflamm Res 2020;13 :1-14.
  16. Radzikowska U, Rinaldi AO, Çelebi Sözener Z, Karaguzel D, Wojcik M, Cypryk K, et al. The nfluence of dietary fatty acids on immune responses.
    Nutrients 2019; 11(12): 2990.
  17. Jin J, Li J, Gan Y, Liu J, Zhao X, Chen J, et al. Red meat intake is associated with early onset of rheumatoid arthritis: A cross-sectional study. Sci Rep 2021; 11: 5681.
  18. Klaunig JE, Wang Z. Oxidative stress in carcinogenesis. Curr Opin Toxicol 2018; 7: 116-21.
  19. Gholizadah S, Mohammadi R, Soleimani D, Rezaei M, Ahanikamangar S, Mosalmanzadeh N, et al. Polycyclic aromatic hydrocarbons in grilled foods from Kermanshah province. Food Addit Contam Part B Surveill 2021; 14(4): 287-94.
  20. Clarke RE, Dordevic AL, Tan SM, Ryan L, Coughlan MT. Dietary advanced glycation end products and risk factors for chronic disease: a systematic review of randomised controlled trials. Nutrients 2016; 8(3): 125.
  21. Koeth RA, Wang Z, Levison BS, Buffa JA, Org E, Sheehy BT, et al. Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med 2013; 19(5): 576-85.