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“Reversing and preventing adverse lifestyle factors could potentially reduce the incidence and burden of rheumatoid arthritis, as well as alleviate its comorbidities,” investigators hypothesized.
A 16-week “Plants for Joints” (PFJ) multidisciplinary lifestyle program significantly improved metabolic status while decreasing disease activity in patients with rheumatoid arthritis (RA) with low-moderate disease activity, according to a randomized controlled study published in Rheumatology.1
“Reversing and preventing adverse lifestyle factors could potentially reduce the incidence and burden of RA, as well as alleviate its comorbidities,” investigators hypothesized. “Specifically, beneficial effects have been found in interventions directed at single lifestyle factors, such as dietary interventions with plant-based or Mediterranean diets, physical exercise programs, or stress reduction techniques.”
The PFJ parallel-arm, assessor-blind, randomized controlled trial enrolled patients with RA and Disease Activity Score-28 (DAS28) between ≥2.6 and ≤5.1 were randomized to the PFJ cohort or the control group. The 16-week program was based on previous protocols and guidelines regarding a whole-food, plant-based diet, stress management, and physical activity. Groups of 6 to 12 participants met for 2- to 3-hour meetings for a total of 10 sessions. Although 17 patients had live meetings, 23 patients received the intervention in hybrid form due to COVID-19 restrictions. Patients in the control group received usual care. Stable medication was maintained 3 months before and during the trial, when possible.
Investigators hypothesized that the PFJ program would lower disease activity, which was defined as the primary outcome. Other outcomes including patient-reported, metabolic, and anthropometric measurements. The differences between groups were evaluated through intention-to-treat analysis with a linear mixed model adjusted for baseline values.
In total, 77 patients completed the study (mean age of 55 years, 92% female, mean DAS28 of 3.8 [0.7], and a body mass index [BMI] of 26  kg/m2). At the 16-week mark, the PFJ cohort had a mean 0.9-point greater improvement of DAS28 (95% CI 0.41, 1.29; P <0.0001) when compared with the controls. The intervention also led to greater decreases in low-density lipoprotein (–0.32 mmol/l), Hemoglobin A1C (HbA1c; -1.3 mmol/mol), fat mass (-2.8 kg), waist circumference (-3 cm), and body weight (difference -3.9 kg) when compared with controls. However, blood pressure, glucose, other lipids, and patient-reported outcome measures did not change during the intervention period.
The low drop-out rate, coupled with the ability to demonstrate substantial effects despite low disease activity, strengthened the study. Further, findings highlight the health benefits of a plant-based diet, emphasizing the advantages of this type of diet as a part of a more sustainable lifestyle. However, the intervention group received extra attention, which may have partially attributed to improvement in subjected measures. Lastly, participants may have been more interested in lifestyle changes instead of medication when compared with average patients with RA. However, investigators stress that this factor should not lessen the potential of this intervention protocol.
A 2-year extension evaluating cost effectiveness, critical nutrients, disease-modifying antirheumatic drug (DMARD)-tapering protocol, bone mineral density, and body composition will be offered to all participants in the control group. Future studies are needed to determine whether plant-based diet can mirror the anabolic effect of animal-based proteins.
“The program is readily compatible with drug therapy and could potentially lower the need for medication for both RA as well as for metabolic syndrome–related conditions,” investigators concluded.
Wendy Walrabenstein, Carlijn A Wagenaar, Marike van der Leeden, Franktien Turkstra, Jos W R Twisk, Maarten Boers, Henriët van Middendorp, Peter J M Weijs, Dirkjan van Schaardenburg, A multidisciplinary lifestyle program for rheumatoid arthritis: the ‘Plants for Joints’ randomized controlled trial, Rheumatology, 2023;, keac693, https://doi.org/10.1093/rheumatology/keac693