Role of Diet in Influencing DAS28 Score in Rheumatoid Arthritis

Diet and DAS28 in Rheumatoid Arthritis

Authors

  • Fatima Tehsin Department of Rheumatology and Immunology, Shaikh Zayed Federal Postgraduate Medical Institute, Lahore, Pakistan
  • Aflak Rasheed Associate Professor, Department of Rheumatology and Immunology, Shaikh Zayed Federal Postgraduate Medical Institute, Lahore, Pakistan
  • Usman Hafeez Assistant Professor, Department of Medicine, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
  • Aftab Alam Department of Rheumatology and Immunology, Shaikh Zayed Federal Postgraduate Medical Institute, Lahore, Pakistan
  • Asad Ullah Nawaz Department of Rheumatology and Immunology, Shaikh Zayed Federal Postgraduate Medical Institute, Lahore, Pakistan
  • Komal Khan Department of Rheumatology and Immunology, Shaikh Zayed Federal Postgraduate Medical Institute, Lahore, Pakistan

DOI:

https://doi.org/10.61919/jhrr.v4i3.1581

Keywords:

rheumatoid arthritis, diet, DAS28, depression, anxiety, inflammation, dietary intervention, mental health, RA management

Abstract

Background: Rheumatoid arthritis (RA) is a chronic inflammatory condition that significantly impacts quality of life. Emerging evidence suggests that dietary modifications can influence disease activity and mental health in RA patients.
Objective: To investigate the effect of dietary patterns on disease activity, depression, and anxiety in patients with RA.
Methods: A cross-sectional study was conducted among 150 RA patients. Dietary intake was assessed using a Food Frequency Questionnaire (FFQ), while disease activity was measured using the Disease Activity Score in 28 joints (DAS28). Depression and anxiety were evaluated using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales. Multiple linear regression analyses were used to explore the relationship between diet and outcomes, controlling for age, gender, ESR, and CRP levels.
Results: Higher FFQ scores were significantly associated with lower DAS28 (β = -0.42, p = 0.002), depression (β = -0.55, p = 0.008), and anxiety (β = -0.60, p = 0.003) scores. Age, ESR, and CRP also significantly predicted outcomes (p < 0.05).
Conclusion: Dietary patterns significantly influenced disease activity and mental health in RA patients. Integrating dietary counseling into RA management may improve clinical and psychological outcomes.

Downloads

Download data is not yet available.

References

Sköldstam L, Hagfors L, Johansson G. An Experimental Study of a Mediterranean Diet Intervention for Patients with Rheumatoid Arthritis. Annals of the Rheumatic Diseases. 2003;62(3):208-14.

Badsha H. Role of Diet in Influencing Rheumatoid Arthritis Disease Activity. The Open Rheumatology Journal. 2018;12:19.

Forsyth C, Kouvari M, D'Cunha NM, Georgousopoulou EN, Panagiotakos DB, Mellor DD, et al. The Effects of the Mediterranean Diet on Rheumatoid Arthritis Prevention and Treatment: A Systematic Review of Human Prospective Studies. Rheumatology International. 2018;38(5):737-47.

Tedeschi SK, Bathon JM, Giles JT, Lin TC, Yoshida K, Solomon DH. Relationship Between Fish Consumption and Disease Activity in Rheumatoid Arthritis. Arthritis Care & Research. 2018;70(3):327-32.

Winkvist A, Bärebring L, Gjertsson I, Ellegård L, Lindqvist HM. A Randomized Controlled Cross-Over Trial Investigating the Effect of Anti-Inflammatory Diet on Disease Activity and Quality of Life in Rheumatoid Arthritis: The Anti-Inflammatory Diet in Rheumatoid Arthritis (ADIRA) Study Protocol. Nutrition Journal. 2018;17:1-8.

García-Morales JM, Lozada-Mellado M, Hinojosa-Azaola A, Llorente L, Ogata-Medel M, Pineda-Juárez JA, et al. Effect of a Dynamic Exercise Program in Combination with Mediterranean Diet on Quality of Life in Women with Rheumatoid Arthritis. Journal of Clinical Rheumatology. 2020;26(7S).

Ingegnoli F, Schioppo T, Scotti I, Ubiali T, De Lucia O, Murgo A, et al. Adherence to Mediterranean Diet and Patient Perception of Rheumatoid Arthritis. Complementary Therapies in Medicine. 2020;52:102519.

Mallon KM. Dietary Interventions for Reduced Disease Activity in Patients with Rheumatoid Arthritis: A Critical Review. 2020.

Markaki AG, Gkiouras K, Papakitsos C, Grammatikopoulou MG, Papatsaraki A, Ioannou R, et al. Disease Activity, Functional Ability and Nutritional Status in Patients with Rheumatoid Arthritis: An Observational Study in Greece. Mediterranean Journal of Rheumatology. 2020;31(4):406-11.

Picchianti Diamanti A, Panebianco C, Salerno G, Di Rosa R, Salemi S, Sorgi ML, et al. Impact of Mediterranean Diet on Disease Activity and Gut Microbiota Composition of Rheumatoid Arthritis Patients. Microorganisms. 2020;8(12):1989.

Vadell AK, Bärebring L, Hulander E, Gjertsson I, Lindqvist HM, Winkvist A. Anti-Inflammatory Diet in Rheumatoid Arthritis (ADIRA)—A Randomized, Controlled Crossover Trial Indicating Effects on Disease Activity. The American Journal of Clinical Nutrition. 2020;111(6):1203-13.

Guagnano MT, D'Angelo C, Caniglia D, Di Giovanni P, Celletti E, Sabatini E, et al. Improvement of Inflammation and Pain After Three Months' Exclusion Diet in Rheumatoid Arthritis Patients. Nutrients. 2021;13(10):3535.

Hulander E, Bärebring L, Turesson Wadell A, Gjertsson I, Calder PC, Winkvist A, et al. Diet Intervention Improves Cardiovascular Profile in Patients with Rheumatoid Arthritis: Results from the Randomized Controlled Cross-Over Trial ADIRA. Nutrition Journal. 2021;20:1-12.

Matsumoto Y, Shivappa N, Sugioka Y, Tada M, Okano T, Mamoto K, et al. Change in Dietary Inflammatory Index Score is Associated with Control of Long-Term Rheumatoid Arthritis Disease Activity in a Japanese Cohort: The TOMORROW Study. Arthritis Research & Therapy. 2021;23:1-10.

Philippou E, Petersson SD, Rodomar C, Nikiphorou E. Rheumatoid Arthritis and Dietary Interventions: Systematic Review of Clinical Trials. Nutrition Reviews. 2021;79(4):410-28.

Walrabenstein W, van der Leeden M, Weijs P, van Middendorp H, Wagenaar C, van Dongen JM, et al. The Effect of a Multidisciplinary Lifestyle Program for Patients with Rheumatoid Arthritis, an Increased Risk for Rheumatoid Arthritis or with Metabolic Syndrome-Associated Osteoarthritis: The “Plants for Joints” Randomized Controlled Trial Protocol. Trials. 2021;22:1-11.

Nayebi A, Soleimani D, Mostafaei S, Elahi N, Pahlavani N, Bagheri A, et al. Association Between Dietary Inflammatory Index Scores and the Increased Disease Activity of Rheumatoid Arthritis: A Cross-Sectional Study. Nutrition Journal. 2022;21(1):53.

Sadeghi A, Tabatabaiee M, Mousavi MA, Mousavi SN, Abdollahi Sabet S, Jalili N. Dietary Pattern or Weight Loss: Which One is More Important to Reduce Disease Activity Score in Patients with Rheumatoid Arthritis? A Randomized Feeding Trial. International Journal of Clinical Practice. 2022;2022(1):6004916.

Charneca S, Ferro M, Vasques J, Carolino E, Martins-Martinho J, Duarte-Monteiro AM, et al. The Mediterranean Diet, and Not Dietary Inflammatory Index, is Associated with Rheumatoid Arthritis Disease Activity, the Impact of Disease and Functional Disability. European Journal of Nutrition. 2023;62(7):2827-39.

El-Mohsen A, Ali S, Ahmed FG, El-Rahman A, Abd Algaid S, Ismael MAE-F, et al. Effect of Designing Dietary and Physical Activity Guidelines on Quality of Life Among Rheumatoid Arthritis Patients. Assiut Scientific Nursing Journal. 2023;11(36):252-62.

Ranganath VK, La Cava A, Vangala S, Brook J, Kermani TA, Furst DE, et al. Improved Outcomes in Rheumatoid Arthritis with Obesity After a Weight Loss Intervention: Randomized Trial. Rheumatology. 2023;62(2):565-74.

Walrabenstein W, Wagenaar CA, van der Leeden M, Turkstra F, Twisk JW, Boers M, et al. A Multidisciplinary Lifestyle Program for Rheumatoid Arthritis: The ‘Plants for Joints’ Randomized Controlled Trial. Rheumatology. 2023;62(8):2683-91.

Barnard ND, Levin S, Crosby L, Flores R, Holubkov R, Kahleova H. A Randomized, Crossover Trial of a Nutritional Intervention for Rheumatoid Arthritis. American Journal of Lifestyle Medicine. 2022:15598276221081819.

Nelson J, Sjöblom H, Gjertsson I, Ulven SM, Lindqvist HM, Bärebring L. Do Interventions with Diet or Dietary Supplements Reduce the Disease Activity Score in Rheumatoid Arthritis? A Systematic Review of Randomized Controlled Trials. Nutrients. 2020;12(10):2991.

van Riel PL, Renskers L. The Disease Activity Score (DAS) and the Disease Activity Score Using 28 Joint Counts (DAS28) in the Management of Rheumatoid Arthritis. Clinical and Experimental Rheumatology. 2016;34(5 Suppl 101).

Alawadhi B, Alsaber A, Shatawan I, Al-Herz A, Setiya P, Saleh K, et al. Adherence to the Mediterranean Diet is Associated with a Reduced DAS28 Index Among Patients with Rheumatoid Arthritis: Case Study from KRRD. International Journal of Rheumatic Diseases. 2023;26(12):2430-40.

Min HK, Kim HR, Lee SH, Kang KY, Park SH, Kwok SK. Time-Averaged DAS28 and HAQ Predict Cardiovascular Disease in Patients with Rheumatoid Arthritis: Data from KORONA Registry. Joint Bone Spine. 2022;89(5):105401.

Furuya T. Clinical Observations of Osteoporosis in Japanese Patients with Rheumatoid Arthritis. Modern Rheumatology. 2022;32(5):839-45.

Ramírez J, Inciarte-Mundo J, Cuervo A, Celis R, Ruiz-Esquide V, Castellanos-Moreira R, et al. Comparable Long-Term Outcomes Between DAS28-ESR Remission Criteria and ACR/EULAR Definitions in Patients with Established Rheumatoid Arthritis. Clinical Rheumatology. 2021;40(7):2665-72.

Miladi S, Ben Ayed H, Fazaa A, Boussaa H, Makhlouf Y, Souabni L, et al. Rheumatoid Arthritis with Concomitant Fibromyalgia: The Role of Ultrasound in Assessing Disease Activity. Musculoskeletal Care. 2023;21(4):1011-9.

Silvestre FJ, Silvestre-Rangil J, Bagán L, Bagán JV. Effect of Nonsurgical Periodontal Treatment in Patients with Periodontitis and Rheumatoid Arthritis: A Systematic Review. Medicina Oral, Patologia Oral y Cirugia Bucal. 2016;21(3).

Pincus T, Yazici Y, Bergman MJ. RAPID3, an Index to Assess and Monitor Patients with Rheumatoid Arthritis, Without Formal Joint Counts: Similar Results to DAS28 and CDAI in Clinical Trials and Clinical Care. Rheumatic Diseases Clinics of North America. 2009;35(4):773-8, viii.

Ibrahem EM, El-Gendi SS, Mahmoud AA, Abdel-Aal SM, El Nouby FH, El-Deen Mohammed HS. Predictors of Cardiovascular Affection in Patients with Active Rheumatoid Arthritis: Secondary Analysis of a Randomized Controlled Trial. Current Rheumatology Reviews. 2021;17(2):258-66.

Muñoz JGB, Giraldo RB, Santos AM, Bello-Gualteros JM, Rueda JC, Saldarriaga EL, et al. Correlation Between RAPID-3, DAS28, CDAI and SDAI as a Measure of Disease Activity in a Cohort of Colombian Patients with Rheumatoid Arthritis. Clinical Rheumatology. 2017;36(5):1143-8.

Downloads

Published

2024-09-24

How to Cite

Fatima Tehsin, Aflak Rasheed, Usman Hafeez, Aftab Alam, Asad Ullah Nawaz, & Komal Khan. (2024). Role of Diet in Influencing DAS28 Score in Rheumatoid Arthritis: Diet and DAS28 in Rheumatoid Arthritis. Journal of Health and Rehabilitation Research, 4(3), 1–5. https://doi.org/10.61919/jhrr.v4i3.1581