Rheumatoid Arthritis

Dose-Response Associations Between Diet and Risk of Rheumatoid Arthritis: A Meta-Analysis of Prospective Cohort Studies.

Dong Y, Greenwood DC, Webster J, Uzokwe C, Tao J, Hardie LJ · Nutrients · 2024 · n=747

To provide a systematic and quantitative summary of dietary factors and rheumatoid arthritis (RA) risk. A systematic review and meta-analysis included prospective cohort studies from 2000 to 2024 reporting relative risks (RRs) with 95% confidence intervals (CIs) for RA incidence relating to 32 different dietary exposures. Linear and non-linear dose-response analyses were conducted. Thirty studies were included, involving 2,986,747 participants with 9,677 RA cases. Linear dose-response analysis suggested that each 2-unit per week increase in total alcohol intake was linked to 4% risk reduction (RR (95%-CI), heterogeneity (I2), NutriGrade score: 0.96 (0.94, 0.98), 58%, moderate certainty), and beer consumption was associated with a 10% reduction per 2 units/week increase (0.90 (0.84, 0.97), 0%, very low certainty). Each 2-unit/week increase in total alcohol intake was associated with a 3% decrease in seropositive RA risk (0.97 (0.96, 0.99), 28%, moderate certainty). Increased intakes of

Effects of omega-3 supplementation on lipid metabolism, inflammation, and disease activity in rheumatoid arthritis: a meta-analysis of randomized controlled trials.

Wang W, Xu Y, Zhou J, Zang Y · Clinical rheumatology · 2024

Omega-3 possesses anti-inflammatory and lipid metabolism modifying effects in rheumatoid arthritis (RA), but inconsistency exists among previous studies. This meta-analysis intended to explore the effects of omega-3 supplementation on fatty acid distribution, blood lipid profiles, inflammation, and disease activity in RA patients. This meta-analysis followed the Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) protocol. PubMed, Web of Science, and Embase databases were searched until August 31, 2023. Eighteen randomized controlled trials with 1018 RA patients were included. Regarding fatty acid distribution, omega-3 supplementation increased eicosapentaenoic acid (EPA) [standardized mean difference (SMD): 0.74; 95% confidence interval (CI): 0.46, 1.01; P < 0.001] and docosahexanoic acid (DHA) (SMD: 0.62; 95% CI: 0.35, 0.89; P < 0.001), but reduced omega-6:omega-3 ratio (SMD: -1.06; 95% CI: -1.39, -0.73; P < 

Vitamin, antioxidant and micronutrient supplementation and the risk of developing incident autoimmune diseases: a systematic review and meta-analysis.

Low CE, Loke S, Chew NSM, Lee ARYB, Tay SH · Frontiers in immunology · 2024

Autoimmune diseases pose significant health challenges worldwide and affect millions. In recent years, there has been growing interest in exploring preventive strategies through nutritional interventions using vitamins, antioxidants, and micronutrients to reduce the risk of developing autoimmune diseases. However, excessive supplementation has also been associated with toxicity. We aim to assess how the intake of vitamins, antioxidants and micronutrients affect the risk of developing autoimmune diseases. This PRISMA-adherent systematic review involved a systematic search of PubMed, Embase and Cochrane for controlled studies that evaluated the risk of incident autoimmune diseases after supplementation. Random effects meta-analyses were used for primary analysis. 18 studies were included. Overall meta-analyses observed that vitamin D did not influence the risk of autoimmune diseases (RR=0.99, 95%CI: 0.81-1.20). However, among the different vitamin D dosages, subgroup analysis demonstr

Coenzyme Q10 supplementation in rheumatic diseases: A systematic review.

Freire de Carvalho J, Skare T · Clinical nutrition ESPEN · 2024 · n=483

Coenzyme Q10 (CoQ10) is a potent antioxidant and anti-inflammatory substance used to treat some rheumatic diseases. Our objective was to review the use of CoQ10 in rheumatic diseases. PubMed/Medline, Embase, Scopus, and Web of Science databases were searched for articles on CoQ10 and rheumatic diseases between 1966 and April 2023. Twenty articles were found, including 483 patients. The investigated conditions were Fibromyalgia (FM) with 15 studies, Rheumatoid Arthritis (RA) with 3 studies, and Antiphospholipid Syndrome (APS) with 2 studies. After CoQ10 supplementation, RA patients observed improvements in disease activity index, inflammatory biomarkers (erythrocyte sedimentation rate), cytokine levels, and a decrease in malondialdehyde. In APS, CoQ10 improved endothelial function and decreased prothrombotic and proinflammatory mediators. Regarding FM, in most of the studies, the patients observed improvements in pain, fatigue, sleep, tender points count, mood disorders, and scores on t

Dietary Interventions with or without Omega-3 Supplementation for the Management of Rheumatoid Arthritis: A Systematic Review.

Raad T, Griffin A, George ES, Larkin L, Fraser A, Kennedy N · Nutrients · 2021 · n=1063

Rheumatoid Arthritis (RA) is a chronic autoimmune condition characterized by symptoms of inflammation and pain in the joints. RA is estimated to have a worldwide prevalence of 0.5-1%, with a predominance in females. Diet may play an important role in the symptoms of RA; however, little is known about the effects of various diets. The aim of this systematic review is to explore the effect of dietary interventions, with or without omega-3 supplementation for the management of RA. The electronic databases MEDLINE, EMBASE, CINAHL, and the Cochrane Library were systematically searched for clinical trials investigating dietary interventions, with or without omega-3 supplementation to retrieve papers from inception to April 2021. Randomized and non-randomized controlled trials of dietary interventions in adults with RA were eligible for inclusion. Twenty studies with a total of 1063 participants were included. The most frequently reported outcomes were pain, duration of morning stiffness, joi

Impact of Yoga on Inflammatory Biomarkers: A Systematic Review.

Djalilova DM, Schulz PS, Berger AM, Case AJ, Kupzyk KA, Ross AC · Biological research for nursing · 2019 · n=11

Many chronic conditions, including heart disease, cancer, and rheumatoid arthritis, are associated with underlying chronic inflammatory processes. Literature reviews have analyzed a variety of integrative therapies and their relationships with chronic inflammation. This systematic review is unique in reporting solely on yoga's relationship with inflammation. Its purpose was to synthesize current literature examining the impact of yoga interventions on inflammatory biomarkers in adults with chronic inflammatory-related disorders. Searches of several electronic databases were conducted. Inclusion criteria were (a) English language, (b) sample age >18 years old, (c) yoga interventions involving postures with or without yoga breathing and/or meditation, and (d) measured inflammatory biomarkers. The final review included 15 primary studies. Of these, seven were rated as excellent and eight as average or fair. There was considerable variability in yoga types, components, frequency, sess

2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis

American College of Rheumatology · Strength: null

This guideline provides recommendations for the treatment of rheumatoid arthritis, covering pharmacological and non-pharmacological approaches. It includes guidance on initial therapy, disease monitoring, and managing refractory disease.

Rheumatoid arthritis in adults: management

NICE

This guideline covers diagnosing and managing rheumatoid arthritis in adults. It aims to improve care from diagnosis, through to choosing drug treatments, managing flares and offering support for self-management.

NICE guideline [NG227]: Rheumatoid arthritis in adults: management

NICE

This guideline covers diagnosing and managing rheumatoid arthritis in adults, with recommendations on drug treatments, non-pharmacological interventions, and patient education. It aims to improve patient outcomes and quality of life.

Effects of Savoring Meditation on Positive Emotions and Pain-Related Brain Function: A Mechanistic Randomized Controlled Trial in People With Rheumatoid Arthritis.

Finan PH, Hunt C, Keaser ML, Smith K, Lerman S, Bingham CO · The journal of pain · 2024 · n=44

Positive emotions are a promising target for intervention in chronic pain, but mixed findings across trials to date suggest that existing interventions may not be optimized to efficiently engage the target. The aim of the current pilot mechanistic randomized controlled trial was to test the effects of a positive emotion-enhancing intervention called Savoring Meditation on pain-related neural and behavioral targets in patients with rheumatoid arthritis. Participants included 44 patients with a physician-confirmed diagnosis of rheumatoid arthritis (n = 29 included in functional magnetic resonance imaging (fMRI) analyses), who were randomized to either Savoring Meditation or a Slow Breathing control. Both meditation interventions were brief (four 20-minute sessions). Self-report measures were collected pre-and post-intervention. An fMRI task was conducted at post-intervention, during which participants practiced the meditation technique on which they had been trained while expos

Vitamin D and marine omega 3 fatty acid supplementation and incident autoimmune disease: VITAL randomized controlled trial.

Hahn J, Cook NR, Alexander EK, Friedman S, Walter J, Bubes V · BMJ (Clinical research ed.) · 2022 · n=871

To investigate whether vitamin D and marine derived long chain omega 3 fatty acids reduce autoimmune disease risk. Vitamin D and omega 3 trial (VITAL), a nationwide, randomized, double blind, placebo controlled trial with a two-by-two factorial design. Nationwide in the United States. 25 871 participants, consisting of 12 786 men ≥50 years and 13 085 women ≥55 years at enrollment. Vitamin D (2000 IU/day) or matched placebo, and omega 3 fatty acids (1000 mg/day) or matched placebo. Participants self-reported all incident autoimmune diseases from baseline to a median of 5.3 years of follow-up; these diseases were confirmed by extensive medical record review. Cox proportional hazard models were used to test the effects of vitamin D and omega 3 fatty acids on autoimmune disease incidence. The primary endpoint was all incident autoimmune diseases confirmed by medical record review: rheumatoid arthritis, polymyalgia rheumatica, autoimmune thyroid disea

Acupuncture for rheumatoid arthritis: an analysis of the literature.

Bhatt-Sanders D · Seminars in arthritis and rheumatism · 1985

Despite the claims that acupuncture is beneficial in the treatment of stages I and II rheumatoid arthritis (RA), few satisfactory double-blind controlled studies exist. A review of the world literature showed eight studies examining the efficacy of acupuncture in RA. Five studies claim that acupuncture treatments give significant pain relief. Two studies claim that there is no significant difference between real and placebo acupuncture in RA. One study claims that acupuncture has antiinflammatory effects. Analysis of problems related to study design demonstrates that methodological flaws invalidate in varying degrees the broad spectrum of conclusions. The need for a more effective therapeutic armamentarium in the treatment of RA makes it imperative that satisfactory trials of acupuncture for RA be conducted in the future.

Intake of one-carbon metabolism nutrients and risk of rheumatoid arthritis: a prospective UK biobank cohort study.

Zhang S, Xia B, Kang Y, Wang Y, Liang Z, He Q · European journal of nutrition · 2025 · n=440

One-carbon metabolism (OCM) nutrients are essential for methylation processes and may be involved in the pathogenesis of rheumatoid arthritis (RA), but prospective evidence remains limited. This study aimed to investigate the association between dietary OCM nutrients and RA risk, and their interactions with genetic and lifestyle factors. A total of 189,440 participants from the UK Biobank were included. Dietary intake was assessed using repeated 24-hour recalls. Nutrient levels were estimated based on McCance and Widdowson's The Composition of Foods and the USDA Food and Nutrient Database for Dietary Studies. Cox proportional hazards models were used to evaluate the independent and joint associations of OCM nutrients, genetic risk, and RA risk. Nonlinear associations were examined using restricted cubic spline. During a median follow-up of 13.43 years, 1,751 RA cases were identified. Participants in the highest quartile of OCM nutrient intake had a significantly lower risk of RA comp

Effect of Different Physiotherapeutic Interventions in Patients With Rheumatoid Arthritis: A Systematic Review and Meta-Analysis.

Sundus H, Khan ZA, Rashid H, Agarwal A, Khan SA · Musculoskeletal care · 2025 · n=1362

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder causing joint damage, pain, and functional limitations. While pharmacotherapy remains central to management, physiotherapeutic interventions are increasingly recognised for their supportive role in symptom alleviation and quality of life enhancement. This systematic review and meta-analysis aimed to evaluate the effectiveness of various physiotherapeutic interventions in reducing pain and improving function and quality of life in patients with RA. Following PRISMA guidelines, a comprehensive search of PubMed, Scopus, and Web of Science (2010-2025) identified randomized controlled trials (RCTs) assessing physiotherapy modalities in RA. Methodological quality was appraised using the Cochrane RoB 2.0 tool. Pain outcomes were synthesised via meta-analysis using a random-effects model. Seventeen RCTs involving 1362 participants were included. Interventions encompassed aerobic/resistance exercise, hydrotherapy, manual

Environment and arthritis.

Ruzzon F, Adami G · Clinical and experimental rheumatology · 2024

The present narrative review explores the multifactorial aetiology of rheumatoid arthritis (RA) and other immunemediated inflammatory disorders (IMIDs), emphasising the significant role of various environmental factors in disease development and exacerbation. Key modifiable environmental factors such as cigarette smoking and air pollution are identified as major contributors to RA. We will also focus on the influence of weather, seasonality, and particularly vitamin D levels, on RA activity, suggesting potential for seasonal management and supplementation to mitigate disease severity. The emerging role of diet and the gut microbiome in RA pathogenesis and progression is discussed as well, with dietary interventions and specific nutrients like omega-3 fatty acids offering protective benefits against inflammation. Despite the mounting evidence around these factors, further research is needed, to better understand the clinical impacts on RA, including well-designed randomised clinical tri

Omega-3 polyunsaturated fatty acids and inflammatory processes: nutrition or pharmacology?

Calder PC · British journal of clinical pharmacology · 2013

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are n-3 fatty acids found in oily fish and fish oil supplements. These fatty acids are able to inhibit partly a number of aspects of inflammation including leucocyte chemotaxis, adhesion molecule expression and leucocyte-endothelial adhesive interactions, production of eicosanoids like prostaglandins and leukotrienes from the n-6 fatty acid arachidonic acid, production of inflammatory cytokines and T cell reactivity. In parallel, EPA gives rise to eicosanoids that often have lower biological potency than those produced from arachidonioc acid and EPA and DHA give rise to anti-inflammatory and inflammation resolving resolvins and protectins. Mechanisms underlying the anti-inflammatory actions of n-3 fatty acids include altered cell membrane phospholipid fatty acid composition, disruption of lipid rafts, inhibition of activation of the pro-inflammatory transcription factor nuclear factor kappa B so reducing expression of inflammat

Rheumatoid arthritis

NHS

Information about the symptoms, causes, diagnosis, and treatment of rheumatoid arthritis is provided. It also offers advice on living with the condition.

Clinical Study Evaluating the Efficacy of Nitazoxanide and Escitalopram as Adjuvant Therapies in Patients With Rheumatoid Arthritis

n=90 · NCT05480878 · COMPLETED · COMPLETED

This study aims at evaluating the therapeutic effects of both Nitazoxanide and Escitalopram as adjuvant therapies in patients with Rheumatoid Arthritis and to evaluate their impact on STAT3/ JAK2, TLR /IL -1β signaling pathways.

A 12-Week, Double-Blind, Randomized, Parallel Group, Placebo Controlled Study of Two Doses of VX-702 in Subjects With Moderate to Severe Rheumatoid Arthritis

n=300 · NCT00205478 · COMPLETED · COMPLETED

The purpose of this study is to assess the clinical activity and safety of two doses of VX-702 compared to placebo in subjects with moderate to severe Rheumatoid Arthritis.

Evaluation of TNFα Blockers Monotherapy in Early Rheumatoid Arthritis in France

n=813 · NCT02927535 · COMPLETED · COMPLETED

Aim: To describe 1) The use of TNF blockers monotherapy in early arthritis in daily clinical practice in France 2) To evaluate symptomatic, structural efficacy, and retention rate over 5 years of TNF blockers monotherapy 3) To evaluate predictive factors for TNF blocker response monotherapy Type of study: Observational cohort study using cross-section and longitudinal data. Description of the project methodology * Patients: All patients in the ESPOIR cohort (multicentre French cohort study of early RA).A sub-analysis will be conducted among patients satisfying the ACR-EULAR 2010 criteria. * Data collected: Patient characteristics, Clinical data regarding RA and related pathologies, Characteristics of treatments received The analysis will be conducted using data collected at baseline, 6, 12, 18, 24, 36, 48, 60 months. * Analyses: 1. Frequency of use of TNF blockers monotherapy: we will calculate the % of patients initiating TNF blockers monotherapy (Kaplan-Meier method), and we will describe the type of TNF blocker, the route of administration, the dosage, and the place of the TNF blockers monotherapy in the treatment strategy during the first 5 years. 2. Identification of potential predictive factors for initiation of TNF blockers monotherapy: a survival curve (Kaplan-Meier) will be performed. The baseline characteristics of the patients with regard to the initiation of TNF blocker monotherapy during the first 5 years of the disease will be compared by univariate analysis and Log-rank test will be performed in all variables. A stepwise multivariate analysis (Cox analysis) will be performed. 3. Therapeutical effect: we will calculate the retention rate over time, and will compare the changes in different variables in the group of patients who have received TNF blockers monotherapy matched (using a propensity score) to 1,2 or 3 patients who have received TNF blockers in combination with synthetic DMARDs. We will assess and compare DAS28 and HAQ at short term (after at least 8 weeks of treatment) and long term (last available visit) in groups. The structural efficacy was evaluated by the radiographic progression at last available visit. We will identically estimate the drug effect depending on the TNF blocker used, by calculating the retention rate and comparing DAS28 at short term and long term. 4. Identification of predictive factors for TNF blocker monotherapy response: To evaluate the impact of baseline demographics and disease conditions on the DAS28 and HAQ response during the first 5 years will be compared by univariate and multivariate analysis. Expected results: Increase knowledge on the use of TNF blocker monotherapy, its efficacy and retention rate, and on predictive factors for TNF blocker monotherapy response in early RA patients.

Cochrane Reviews on Rheumatoid Arthritis

Cochrane

The Cochrane Library provides systematic reviews and meta-analyses of healthcare interventions, offering high-quality evidence on various treatments and management strategies for rheumatoid arthritis.