Is a special diet effective in treating rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE)?

Role of Diet in Treatment of Rheumatoid Arthritis and Systemic Lupus

A Mediterranean-style diet is conditionally recommended for rheumatoid arthritis management, while no specific diet has proven consistently effective for systemic lupus erythematosus. 1

Mediterranean Diet for Rheumatoid Arthritis

The American College of Rheumatology (ACR) provides specific dietary recommendations for rheumatoid arthritis:

• Mediterranean-style diet is conditionally recommended over no formally defined diet 1

  • Emphasizes vegetables, fruits, whole grains, nuts, seeds, and olive oil
  • Includes moderate amounts of low-fat dairy and fish
  • Limits added sugars, sodium, highly processed foods, refined carbohydrates, and saturated fats

• Other formally defined diets are conditionally recommended against 1

  • This includes ketogenic, paleo, gluten-free, vegetarian, vegan, intermittent fasting, elemental, elimination, raw foods, and whole food plant-based diets
  • Evidence shows no consistent, clinically meaningful benefit on physical function, pain, or disease activity

• Dietary supplements are conditionally recommended against 1

  • The ACR supports a "food first" approach
  • Supplements like vitamin D and fish oil may have benefits for bone and cardiovascular health but are not specifically recommended for RA management

Diet for Systemic Lupus Erythematosus

For SLE, evidence is more limited:

• Research suggests that a Mediterranean-style diet may be linked with a lower risk of developing SLE 1
• The anti-inflammatory and antioxidant properties of this diet may help control symptoms 1
• A balanced gut microbiota appears important in reducing the likelihood of developing SLE and controlling its symptoms 1

Mechanisms and Evidence

Diet may influence arthritis and lupus through several mechanisms:

• Inflammation control: Mediterranean diet components have anti-inflammatory properties 1
• Gut microbiota: Diet affects gut bacterial composition, which may influence disease activity 1
• Weight management: Obesity is associated with higher disease activity and poorer treatment response in RA 2

A 2021 study found that a diet avoiding meat, gluten, and dairy products for 3 months resulted in:

• Decreased pain (measured by VAS)
• Improved physical and mental health
• Reduced inflammatory markers 3

Clinical Implementation

When discussing diet with patients:

1. Recommend the Mediterranean diet pattern as the primary dietary approach for RA

2. Advise limiting or avoiding:

   • Processed foods
   • Foods high in saturated fats
   • Added sugars and sweetened beverages
   • Refined carbohydrates
   • Red and processed meats

3. Encourage increased consumption of:

   • Fatty fish (rich in omega-3 fatty acids)
   • Olive oil
   • Nuts and seeds
   • Whole grains
   • High-fiber foods

4. Consider referral to a registered dietitian for personalized guidance 1

Important Caveats

• Dietary changes should complement, not replace, prescribed medical treatments
• Patient preferences, costs, access, and burden associated with dietary changes must be considered
• Evidence for dietary interventions is stronger for RA than for SLE
• Long-chain omega-3 fatty acids (fish oil) consistently demonstrate improvement in RA symptoms and reduction in NSAID usage 4, 5, but the ACR still recommends a food-first approach

Remember that while diet can be an important adjunctive therapy, it should be part of a comprehensive approach that includes appropriate pharmacological management for these conditions.