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Is rheumatoid arthritis a disease that starts in the intestine? A pilot study comparing an elemental diet with oral prednisolone

¹ Leicester General Hospital, Leicester, UK
² St Mark’s Hospital, Harrow, UK
³ Leicester Royal Infirmary, Leicester, UK
⁴ Edith Cavell Hospital, Peterborough, UK

Correspondence to:
Correspondence to:
Dr J M D Nightingale
St Mark’s Hospital, Watford Road, Harrow, Middlesex HA13UJ, UK; jeremy.nightingale{at}nwlh.nhs.uk

Objectives: This pilot study aimed to determine if an elemental diet could be used to treat patients with active rheumatoid arthritis and to compare its effect to that of oral prednisolone.

Methods: Thirty patients with active rheumatoid arthritis were randomly allocated to 2 weeks of treatment with an elemental diet (n = 21) or oral prednisolone 15 mg/day (n = 9). Assessments of duration of early morning stiffness (EMS), pain on a 10 cm visual analog scale (VAS), the Ritchie articular index (RAI), swollen joint score, the Stanford Health Assessment Questionnaire, global patient and physician assessment, body weight, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and haemoglobin, were made at 0, 2, 4 and 6 weeks.

Results: All clinical parameters improved in both groups (p<0.05) except the swollen joint score in the elemental diet group. An improvement of greater than 20% in EMS, VAS and RAI occurred in 72% of the elemental diet group and 78% of the prednisolone group. ESR, CRP and haemoglobin improved in the steroid group only (p<0.05).

Conclusions: An elemental diet for 2 weeks resulted in a clinical improvement in patients with active rheumatoid arthritis, and was as effective as a course of oral prednisolone 15 mg daily in improving subjective clinical parameters. This study supports the concept that rheumatoid arthritis may be a reaction to a food antigen(s) and that the disease process starts within the intestine.

Abbreviations: CRP, C-reactive protein; EMS, early morning stiffness; ESR, erythrocyte sedimentation rate; DMARDs, disease-modifying drugs; HAQ, Health Assessment Questionnaire; MALT, mucosal associated lymphoid tissue; NSAIDs, non-steroidal anti-inflammatory drugs; RAI, Ritchie articular index; VAS, visual analog scale

Keywords: diet therapy; elemental diet; prednisolone; rheumatoid arthritis