Background Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatologic illness and can lead to significant disability. Complementary and alternative treatments are commonly practiced by families of patients with JIA, and >40% of patients with chronic arthritis seek dietary changes after their diagnosis. Dietary intervention studies in adults with rheumatoid arthritis showed moderate improvement in joint symptoms. Dietary supplements of omega-3 fatty acids have been tested in children with chronic arthritis and found to be associated with less NSAID use and lower serum IL-1 and TNF levels. There is an increasing need to understand if there is a role for dietary therapy in chronic arthritis.
Objectives We aimed to evaluate the prevalence of special diets and the perception of the effectiveness of these diets on arthritis in JIA. We also assessed the interest of dietary interventions and perceived barriers.
Methods An online survey was designed through a REDCap database capturing demographic information, self- or parent-initiated special dietary interventions and self- or parent-observing effects on joint symptoms, willingness to participate in a dietary intervention study. The survey link was posted on social media websites and distributed by the Arthritis Foundation. Descriptive statistical analyses were performed.
Results A total of 265 responses were received from adult patients who had JIA and parents of children with JIA. We excluded 14 patients with inflammatory bowel disease or celiac disease-related arthritis and 24 responders with incomplete answers. Demographic and JIA characteristics of adult and pediatric patients are listed in Table 1. Ninety patients (63 children with JIA, 27 adults with history of JIA) had tried a special diet for arthritis. The top three special diets reported by parents included a gluten-free diet (62%), an anti-inflammatory diet (53%), and a lactose-free diet (26%). There were similar clinical responses among the three diets (Figure 1). Twenty-five to thirty percent reported no change in joint symptoms whereas 20–30% reported improved pain or joint swelling. Sixty-one (34%) parents were willing to participate in a 3-month dietary intervention study and 78 (44%) parents answered “it depends”.
Conclusions This is the first report of the family/patient perspective of the role of dietary intervention on JIA. Almost half of the affected patients attempted special diets, and many reported improvement in symptoms. Future interventional studies with objective outcome measurements are needed to validate these reports.
Acknowledgements The authors would like to thank all the patients and families who have taken the survey. Arthritis Foundation and Facebook JA groups have helped distribute the survey.
Disclosure of Interest E. Little: None declared, S. Grevich Grant/research support from: supported by Pfizer Medical and Academic partnership program, J. Huber: None declared, D. Suskind: None declared, M. Bradford: None declared, A. Stevens Grant/research support from: funded by Kineta Inc and Seattle Genetics. She has a license agreement with Quest Diagnostics., Y. Zhao: None declared
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