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An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis
  1. L Sköldstam1,
  2. L Hagfors2,
  3. G Johansson2
  1. 1Department of Medicine, Kalmar County Hospital, S-391 85 Kalmar, Sweden
  2. 2Department of Food and Nutrition, Umeå University, S-901 87 Umeå, Sweden
  1. Correspondence to:
    L Hagfors, Department of Food and Nutrition, Umeå University, S-901 87 Umeå, Sweden;


Objective: To investigate the efficacy of a Mediterranean diet (MD) versus an ordinary Western diet for suppression of disease activity in patients with rheumatoid arthritis (RA).

Methods: Patients with well controlled, although active RA of at least two years’ duration, who were receiving stable pharmacological treatment, were invited to participate. All patients were randomly allocated to the MD or the control diet (CD). To achieve good compliance with prescribed diets all patients were for the first three weeks served the MD or the CD, respectively, for lunch and dinner at the outpatient clinic’s canteen. Clinical examinations were performed at baseline, and again in the 3rd, 6th, and 12th week. A composite disease activity index (DAS28), a physical function index (Health Assessment Questionnaire (HAQ)), a health survey of quality of life (Short Form-36 (SF-36)), and the daily consumption of non-steroidal anti-inflammatory drugs were used as primary efficacy variables.

Results: From baseline to the end of the study the patients in the MD group (n=26) showed a decrease in DAS28 of 0.56 (p<0.001), in HAQ of 0.15 (p=0.020), and in two dimensions of the SF-36 Health Survey: an increase in “vitality” of 11.3 (p=0.018) and a decrease in “compared with one year earlier” of 0.6 (p=0.016). For the control patients (n=25) no significant change was seen at the end of the study. This difference between the two treatment groups was notable only in the second half of the trial.

Conclusion: The results indicate that patients with RA, by adjusting to a Mediterranean diet, did obtain a reduction in inflammatory activity, an increase in physical function, and improved vitality.

  • rheumatoid arthritis
  • Mediterranean diet
  • omega-3 fatty acids
  • antioxidants
  • BMI, body mass index
  • CD, control diet
  • CRP, C reactive protein
  • CVD, cardiovascular disease
  • DAS, disease activity score
  • DMARD, disease modifying antirheumatic drug
  • ESR, erythrocyte sedimentation rate
  • GAT, grip ability test
  • HAQ, Health Assessment Questionnaire
  • MD, Mediterranean diet
  • NSAID, non-steroidal anti-inflammatory drug
  • ORP, outpatient based rehabilitation programme
  • RA, rheumatoid arthritis
  • SF-36, Short Form-36 Health Survey
  • SOFI, signals of functional impairment
  • VAS, visual analogue scale

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  • * Outpatient based rehabilitation programme (ORP): For years the rheumatology unit at Kalmar Hospital has run a rehabilitation programme for outpatients. Every third week, groups of six patients are scheduled to start on the programme, which runs for three weeks and covers Monday to Friday from 0900 to 1700. The programme offers patient education, strength and fitness training, and individual physiotherapy and occupational therapy.