Can diamine oxidase (DAO) supplementation help manage rheumatoid arthritis (RA) symptoms?

Diamine Oxidase in Rheumatoid Arthritis Management

There is no evidence supporting the use of diamine oxidase (DAO) supplementation for managing rheumatoid arthritis symptoms based on current rheumatology treatment guidelines.

Current Treatment Recommendations for RA

First-Line Treatments

• Disease-modifying antirheumatic drugs (DMARDs), particularly methotrexate, remain the anchor drug and first-line treatment for rheumatoid arthritis due to established efficacy in controlling disease activity and preventing joint damage 1
• Treatment should aim at remission or low disease activity as the primary therapeutic target 2
• Early and aggressive treatment with DMARDs is recommended to prevent joint destruction and functional disabilities 2

Integrative Approaches with Evidence

• Exercise received the only strong recommendation among non-pharmacological interventions for RA management 2
• Conditional recommendations exist for rehabilitation interventions, Mediterranean-style diet, and certain mind-body approaches 2
• The American College of Rheumatology (ACR) has developed specific guidelines for integrative interventions to be used alongside DMARDs 2

Dietary Interventions in RA

Evidence-Based Dietary Approaches

• Mediterranean-style diet received a conditional recommendation for RA management based on available evidence 2
• The ACR supports a "food first" approach that emphasizes high-quality foods to obtain necessary nutrients rather than supplements 2
• Dietary supplements in general lack sufficient evidence to be recommended for RA management 2

Specific Dietary Interventions

• Some research suggests that privative diets (avoiding meat, gluten, and lactose) may help reduce inflammation and pain in RA patients, but this is not yet incorporated into official guidelines 3
• No mention of diamine oxidase supplementation appears in any current rheumatology treatment guidelines 2

Treatment Strategy Considerations

Pharmacological Treatment

• Methotrexate should be part of the first treatment strategy for active RA 2
• For patients with inadequate response to methotrexate, adding or switching to other conventional synthetic DMARDs or biological DMARDs is recommended 2
• Glucocorticoids may be considered as part of the initial treatment strategy in combination with DMARDs but should be tapered as rapidly as clinically feasible 2

Monitoring and Adjustment

• Frequent monitoring (every 1-3 months) is recommended in active disease 2
• If no improvement is seen within 3 months or the target is not reached by 6 months, therapy should be adjusted 2
• Treatment decisions should follow a shared decision-making process between clinician and patient 2, 1

Conclusion on Diamine Oxidase

• Current rheumatology guidelines from EULAR and ACR do not mention diamine oxidase as a treatment option for rheumatoid arthritis 2
• No evidence from high-quality clinical trials supports the use of diamine oxidase supplementation specifically for RA symptom management 2
• Patients interested in dietary interventions should consider evidence-based approaches like Mediterranean-style diet and consult with registered dieticians as part of their comprehensive RA management plan 2