This systematic review assesses the effectiveness and safety of dietary interventions
for rheumatoid arthritis. Randomized controlled trials comparing any dietary manipulation
with an ordinary diet were included. Eight randomized controlled trials with a total
of 366 patients were included. One trial found that fasting, followed by 13 months
on a vegetarian eating plan, might reduce pain (mean difference on a zero to 10 scale
-1.89, 95% confidence interval [CI] -3.62 to -0.16). Another single trial found that
a 12-week Cretan Mediterranean eating plan might reduce pain (mean difference on a
0 to 100 scale -14.00, 95% CI -23.6 to -4.37). Due to inadequate data reporting, the
effects of vegan eating plans and elimination diets are uncertain. When comparing
any dietary manipulation with an ordinary diet we found a higher total drop-out of
8% (risk difference 0.08, 95% CI -0.01 to 0.17), higher treatment-related drop-out
of 5% (risk difference 0.05, 95% CI -0.03 to 0.14) and a significantly higher weight
loss (weighted mean difference -3.24, 95% CI -4.81 to -1.67 kg) in the diet groups
compared to the control groups. The effects of dietary manipulation, including vegetarian,
Mediterranean, and elemental eating plans, and elimination diets on rheumatoid arthritis
are still uncertain due to the included studies being small, single trials with moderate
to high risk of bias. We conclude that higher dropout rates and weight loss in the
groups with dietary manipulation indicate that potential adverse effects should not
be ignored.
Copyright 2010 American Dietetic Association. Published by Elsevier Inc. All rights
reserved.