What is the role of food sensitivity testing in Rheumatoid Arthritis (RA) diagnosis and management?

From the Guidelines

The role of food sensitivity testing in Rheumatoid Arthritis (RA) diagnosis and management is best approached through an elimination diet followed by careful reintroduction of foods, rather than relying on specific testing methods, as recommended by the 2022 American College of Rheumatology guideline 1.

Key Considerations

• The American College of Rheumatology guideline emphasizes the importance of an interprofessional healthcare team, including registered dieticians, to assist individuals with RA in modifying their diet as part of their RA management plan 1.
• The guideline supports a "food first" approach, which emphasizes using high-quality foods to obtain necessary nutrients, rather than relying on dietary supplements 1.
• While some individuals with RA report benefits from identifying and avoiding food triggers, diet modification is not a substitute for conventional RA treatments, and the relationship between diet and RA is complex and can vary greatly between individuals 1.

Recommended Approach

• Start by eliminating common trigger foods such as dairy, gluten, red meat, and nightshade vegetables (tomatoes, peppers, eggplants, potatoes) for 4-6 weeks.
• Maintain a varied, nutritious diet including fruits, vegetables, lean proteins, and whole grains that aren't on the elimination list.
• Keep a detailed food and symptom diary to track any changes in symptoms.
• After the elimination period, slowly reintroduce one food group at a time, every 3-5 days, while continuing to monitor symptoms.
• If an increase in joint pain, stiffness, or other RA symptoms is noticed after reintroducing a food, it may be a trigger for the individual.

Importance of Professional Guidance

• This process should be done under the guidance of a healthcare provider or registered dietitian to ensure proper nutrition and minimize the risk of nutritional deficiencies.
• The healthcare provider or registered dietitian can help individuals with RA make informed decisions about their diet and ensure that any changes are made in a way that supports overall health and well-being 1.

From the Research

Role of Food Sensitivity Testing in RA Diagnosis and Management

• Food sensitivity testing is not a primary method for diagnosing Rheumatoid Arthritis (RA), but some studies suggest that certain foods may affect RA symptoms 2.
• A survey of patients with RA found that 24% reported that foods affect their RA symptoms, with 15% reporting improvement and 19% reporting worsening 2.
• Specific foods such as blueberries and spinach were reported to improve RA symptoms, while soda with sugar and desserts were reported to worsen symptoms 2.

Dietary Components and RA Management

• Polyphenols, found in certain foods, may have therapeutic efficacy in RA through their antioxidant, anti-inflammatory, and immunosuppressant activities 3.
• However, most data on polyphenols and RA are derived from animal models, and high-quality clinical studies are needed to establish their anti-rheumatic efficacy 3.

Treatment Patterns in RA

• Treatment patterns in RA patients often involve the use of biologic and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) 4, 5.
• The EULAR recommendations for RA management suggest using a treat-to-target approach, with methotrexate and glucocorticoids as initial therapy, and adding biologic DMARDs or targeted synthetic DMARDs as needed 5.

Cancer Risk and RA Treatment

• There is concern about the safety of immunosuppressants used in RA management and their potential impact on cancer risk and recurrence 6.
• Most meta-analyses have not observed an association between tumor necrosis factor inhibitors and risk of incident cancer, but further research is needed to guide the use of DMARDs in patients with RA and a prior malignancy 6.