Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease that is associated with local and systemic inflammation, resulting in chronic pain and physical function limitations that may negatively impact quality of life (QOL). Despite advances in pharmacological therapies, currently available treatment options may be associated with adverse events and come at a high price tag. As a result, research efforts have grown to focus on nutritional interventions to support pharmacological therapies, reduce inflammation (targeting biomarkers of disease activity) and improve QOL.

Objectives: In this systematic review, data was collected on the most recent non-pharmacological interventions used for RA management. The efficacy, safety, and potential practical applications of various nutritional interventions used in the RA management will be discussed. This review has been divided into three parts. In the last section of our 3-part series we will discuss interventions involving fruits and herbs and their clinical impact on patients with RA. The compounds discussed in this article include cranberry juice, curcumin, garlic, ginger, pomegranate, saffron, and sesamin. For more information on the other contents of this systematic review you may refer back to Part 1: Dieting and Part 2: Supplementation.

Methods: A search of the literature was conducted to identify nutritional interventions in the progression and management of RA. Eligible study designs included meta-analyses, systematic reviews, randomized control trials (RCT), and prospective/retrospective studies. Exclusion criteria included non, in vivo human studies, n<40, cross-sectional studies, case-studies, and lack of access to available text.
Results: Initially, 334 articles were identified. After removing studies for lack of relevance, exclusion criteria and duplicates, 22 articles remained. The eligible articles were divided into five groups based on design: Meta analyses, systematic reviews, RCTs, literature reviews, and prospective studies. The eligible articles were grouped together based on intervention type: diets, supplementation and the implementation of fruits and herbs. Seven articles were placed under the category of fruits and herbs which includes six RCTs and one literature review.

Conclusion: Dietary interventions may be an effective method for reducing inflammation and symptoms associated with RA. Several studies showed that dietary interventions improved various markers of disease activity, symptomatology, with minimal adverse event risk. Still, most nutritional remedies studied require further research effort before they can be confidently recommended as alternative therapies. These remedies include cranberry juice, garlic, ginger, pomegranate extract, saffron, and sesamin. All of these remedies with the exception of garlic, improved DAS-28 scores. Curcumin was the only compound that lacked sufficient evidence to justify a recommendation. Clinical practitioners can use these remedies in their treatment algorithms without specific recommendations on dosing and use, as nearly all present with minimal risk.

Arthritis, Intervention, Nutrition, Review, Rheumatoid arthritis