JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION

1. Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials Geir Smedslund, Ph.D.: Diakonhjemmet Hospital (DH) Marte G Byfuglien: DH Sissel U Olsen: DH Kåre B Hagen: DH JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Smedslund et al.J Am Diet Assoc. 2010; Volume 110 (May).

2. Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials Study overview Background For decades patients have used diet manipulation for possibly altering the symptoms of Rheumatoid Arthritis (RA). Diet manipulations might influence the body through several different mechanisms, like decreasing an inflammatory process, increasing antioxidant levels, changing the lipid profile, and changing the bacterial flora. The question of benefits and harms of certain diets in RA is still a “burning question” for many patients and health care providers. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Smedslund et al.J Am Diet Assoc. 2010; Volume 110 (May).

3. Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials Baseline data Objective To assess the effectiveness and safety of dietary interventions for patients with RA when compared to usual diet. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Smedslund et al.J Am Diet Assoc. 2010; Volume 110 (May).

4. Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials BMI & Psychosocial measures Methods Types of studies: Randomized controlled trials (RCT) Interventions: Any diet manipulation, such as elimination diets, diets labeled as Mediterranean, Cretan, any vegetarian, acid-base balance and fasting were included. Dietary supplement studies were not permitted (including fish oil supplements). JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Smedslund et al.J Am Diet Assoc. 2010; Volume 110 (May).

5. Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials BMI & Psychosocial measures Methods Search strategy for identification of studies: Relevant studies were identified by electronic searches (up to September 2006) in Cochrane Central Register of Controlled Trials, Medline, Embase, AMED and Cinahl. Reference lists of included studies and relevant reviews were scanned and authors of included studies were contacted. Methodological assessment: Two reviewers independently assessed the trials according to: Random generation of allocation, Concealment of allocation, Co-intervention, Blinding of provider or patient, Blinding of outcome assessor, Losses to follow up and Intention-to-treat JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Smedslund et al.J Am Diet Assoc. 2010; Volume 110 (May).

6. Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials Correlation matrix Results • Eight RCTs published between 1979 and 2003 with a total of 366 patients were included. • Six trials were assessed to have moderate risk of bias, while two had high risk of bias. • Due to insufficient data reporting and heterogeneity in interventions and outcome measures, no overall effects were calculated. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Smedslund et al.J Am Diet Assoc. 2010; Volume 110 (May).

7. Correlation matrix Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials Possible beneficial effects Most trials reported small to moderate beneficial effects of the experimental diet in some outcomes JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Smedslund et al.J Am Diet Assoc. 2010; Volume 110 (May).

8. Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials Figure Country, type of diet, duration of diet, number of patients, and summary effects for each of the 8 included studies + followed by JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Smedslund et al.J Am Diet Assoc. 2010; Volume 110 (May).

9. Figure Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials Outcomes for different diets. 7 to 10 days fasting followed by vegetarian diet *Health and Activity Questionnaire JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Smedslund et al.J Am Diet Assoc. 2010; Volume 110 (May).

10. Figure Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials Outcomes for different diets. Vegan diet ACR20 = American College of Rheumatology criteria for improvement in Rheumatoid Arthritis JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Smedslund et al.J Am Diet Assoc. 2010; Volume 110 (May).

11. Figure Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials Outcomes for different diets. Mediterraneandiet *Health and Activity Questionnaire JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Smedslund et al.J Am Diet Assoc. 2010; Volume 110 (May).

12. Figure Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials Outcomes for different diets. Elemental diet JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Smedslund et al.J Am Diet Assoc. 2010; Volume 110 (May).

13. Figure Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials Possible adverse effects Although potential adverse effects were poorly reported, no severe adverse effects were reported. However, the experimental diet was associated with higher weight loss, total drop out rates and treatment related drop out. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Smedslund et al.J Am Diet Assoc. 2010; Volume 110 (May).

14. Figure Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials Meta-analysis of the effect of dietary interventions on total dropout. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Smedslund et al.J Am Diet Assoc. 2010; Volume 110 (May).

15. Figure Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials Meta-analysis of the effect of dietary interventions on treatment-related dropout. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Smedslund et al.J Am Diet Assoc. 2010; Volume 110 (May).

16. Figure Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials Meta-analysis of the effect of dietary interventions on body weight JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Smedslund et al.J Am Diet Assoc. 2010; Volume 110 (May).

17. Figure Effectiveness and safety of dietary interventions for rheumatoid arthritis: A systematic review of randomized controlled trials Conclusions • The effects of dietary manipulation, including vegetarian, Mediterranean, elemental and elimination diets, on rheumatoid arthritis remain uncertain. Studies included in this analysis were small, single arm trials with moderate to high risk of bias. • Higher drop-out rates and weight loss in the groups with dietary manipulation signal potential adverse effects that should not be ignored. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Smedslund et al.J Am Diet Assoc. 2010; Volume 110 (May).