Background: Nutritional therapy could be a promising adjunct to pharmacological therapy in rheumatic disease (RMD).

Objectives: The aim of this talk is to provide evidence and recommendations on dietary management of rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythromatosus, psoriatric arthritis and osteoarthritis.

Methods: Research studies, systematic reviews and recommendations associating diet and RMDs were identified through MEDLINE.

Results: Maintenance or achievement of a healthy body weight is central to RMDs since weight gain is common and often results as a side-effect of pharmacotherapy, further increasing inflammation. Adherence to the Mediterranean diet (MD) by consumption of plant-based foods such as wholegrains, legumes, fruit, vegetables, daily consumption of extra virgin olive oil, and reduced (monthly) consumption of red meat and desserts, is beneficial for all RMDs. The MD should be supplemented with extra omega-3 polyunsaturated fatty acids (PUFAs) and thus consumption of ‘fatty fish” such as seabeam, seabass, trout, salmon, sardines or mackerel ≥2/week, and walnuts, flaxseeds and chia seeds, daily is recommended, all providing different kinds of omega-3 fatty acids. The MD not only provides all the necessary vitamins and minerals with a balanced ratio of MUFA:PUFA to reduce inflammation, but also has long term benefits on the cardiovascular system. Additional recommendations to manage high cholesterol, include the consumption of plant stanols/sterols, oats, unsalted nuts and soy protein and limiting intake of foods high in saturated and trans fats. It is also recommended that plasma Vitamin D concentration, important for bone and cartilage health, is assessed and a daily supplement is taken if necessary especially during the winter months. Additionally, it is important to consume enough calcium daily, this being equivalent to 3-4 glasses of milk or slices of cheese (preferably low in fat). Finally, evidence on possible relationships between RMDs and diet is limited and inconclusive and dietary restrictions are not recommended. In psoriatric arthritis, a gluten-free diet is recommended only in patients who test positive for serologic markers of gluten sensitivity. Use of unnecessary supplements should be avoided.

Conclusion: In conclusion, adherence to a healthy diet can aid in disease management in RMDs by reducing inflammation and the risk of cardiovascular disease.

References: [1] Aparicio-Soto M, Sánchez-Hidalgo M and Alarcon-de-la Lastra C (2017) An update on diet and nutritional factors in systemic lupus erythematosus management Nutrition Research Reviews 30:118-137

[2] British Dietetic Association (2017) Diet and Osteoarthritis. Available at: https://www.bda.uk.com/foodfacts/OsteoArthritis.pdf. Accessed: 1.3.19

[3] Ford AR, Siegel M, Bagel J, et al. (2018) Dietary Recommendations for AdultsWith Psoriasis or Psoriatic Arthritis From the Medical Board of the National Psoriasis Foundation: A Systematic Review. JAMA Dermatol. doi:10.1001/jamadermatol.2018.1412.

[4] Macfarlane TV, Abbood HM, Pathan E, et al. (2018) Relationship between diet and ankylosing spondylitis: a systematic review. European Journal of Rheumatology 5: 45-52.

[5] Petersson S*, Philippou E*, Rodomar C, Nikiphorou E. (2018) The Mediterranean diet, fish oil supplements and Rheumatoid arthritis outcomes: evidence from clinical trials. Autoimmunity Reviews 17(11):1105 (*joint first authors).

Disclosure of Interests: None declared