Available online 7 July 2023

Author links open overlay panel, , AbstractBackground

Rheumatoid arthritis (RA) is one of the most common rheumatologic diseases worldwide causing high morbidity and mortality and a high socioeconomic burden. Current medications offer several therapeutic options. Additionally, increasing evidence endorses the positive influence of certain diets on the disease activity in RA.

Case presentation

Here we present a case of a female patient with a history of 3 years of active seronegative RA under current medication with prednisolone and methotrexate. Additionally, she received dietary counselling and started a plant-based diet including RA-specific dietary recommendations from Traditional Indian Medicine as well as intermittent fasting. This dietary regimen included meatless vegetable-based main meals, a high amount of whole food products, home-made food from fresh, organic products, and warm servings. While implementing the dietary recommendations for three years, inflammatory parameters decreased. At a 3-years-follow-up, she was able to cease her pharmacotherapy completely due to a complete clinical remission of RA disease activity.

Conclusions

This case highlights the value of additional nutritional therapy in RA as well as the potential role of the gut microbiota in the pathogenesis of RA. Well-planned prospective clinical trials are warranted in this promising field of medicine.

Section snippetsBAckground

Rheumatoid arthritis (RA) is one of the most frequently occurring inflammatory diseases and is associated with high morbidity and mortality, resulting in a significant socioeconomic burden worldwide. [1], [2] The etiology of RA is considered multifactorial, even though the exact mechanisms remain unclear to date. [3]

Environmental factors seem to trigger RA in genetically predisposed individuals. Among those individuals, the oral and intestinal microbiota seems to play an essential role:

case presentation

A 65-year-old woman presented to the outpatient department of our clinic for Internal and Integrative Medicine in July 2015 with diagnosed RA for 3 years. She reported persisting joint pain and swelling under disease-modifying anti-rheumatic drug therapy (DMARD). Medication at clinical presentation included methotrexate and prednisolone (Table 1). Besides from RA the patient reported suffering from hypothyroidism. Due to familial hypercholesterolemia, she was in regular cardiologic follow-up.

In

Discussion and conclusions

A plant-based diet is associated with numerous health benefits, not only for rheumatic diseases like RA, but also for the prevention of cardiovascular diseases and some types of cancer. [24]

Amid the climate crisis a whole food plant-based diet supports responsible stewardship of global resources and the prevention of non-communicable diseases in form of a planetary health diet. [25], [26] It can also contribute to the prevention of pandemics, which are mostly of zoonotic origin promoted by

Ethics approval and consent to participate

Written informed consent was obtained from the individual for the publication of any potentially identifiable data included in this article.

Data avail ability statement

Data are available upon request. Requests on data sharing can be made by contacting the corresponding author.

Consent for publication

The patient provided her written informed consent to participate in this case study. Written informed consent was obtained from the individual for the publication of any potentially identifiable data included in this article.

Avail ability of data and materials

Data are available upon request.

Funding

There was no funding for this manuscript.

CRediT authorship contribution statement

AMH drafted the manuscript. KK and CK reviewed and edited manuscript drafts. All authors read and approved the final manuscript.

Declaration of Competing Interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Hartmann: Travel Bursary for National Research Exchange from German Society for Rheumatology 2020, Travel bursary for the European Congress of Rheumatology 2022 from European Alliance of Associations for Rheumatology, Honoraria from German Medical Association of Fasting & Nutrition (ÄGHE), Board member of the German Society for Fasting and Nutrition (ÄGHE).

Acknowledgements

We would like to thank the patient we reported in this article.

Competing interests

AH is a board member of the German Society for Fasting and Nutrition (ÄGHE e.V.). CK is a member of the German Medical Association for Ayurveda Medicine (DÄGAM e.V.) and scientific advisor to the company Bruno Zimmer. The other authors declare that they have no conflicts of interest related to the content of this manuscript.

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