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Rheumatoid Arthritis and Nutrition: Bridging Diet and Disease Management

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (15 December 2025) | Viewed by 12618

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Special Issue Editors

Prof. Dr. Maurizio Cutolo

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Guest Editor

1. Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Viale Benedetto XV, 6, 16132 Genoa, Italy
2. IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy
Interests: rheumatoid arthritis; nutrition; autoimmunity; Raynaud phenomenon; systemic sclerosis; capillaroscopy; interstitial lung disease; vitamin D; glucocorticoids; polymyalgia rheumatica
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Dr. Elvis Hysa

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Guest Editor

Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Viale Benedetto XV, 6, 16132 Genoa, Italy
Interests: rheumatoid arthritis; nutrition; autoimmunity; polymyalgia rheumatica; giant cell arteritis; capillascopy; systemic sclerosis; immunotherapy; immune checkpoint inhibitor

Dr. Francesca Anna Ingegnoli

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Guest Editor

Clinical Rheumatology Unit, ASST Pini-CTO, Department of Clinical Science and Community Health, Università degli Studi di Milano, Milan, Italy
Interests: systemic sclerosis; rheumatoid arthritis; nutrition; patient-reported outcomes; capillaroscopy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Rheumatoid arthritis (RA) is a chronic autoimmune condition that is characterized by systemic inflammation and joint damage, significantly impacting patients' quality of life. Emerging evidence suggests that nutritional intake plays a critical role in modulating the immune system, influencing inflammatory pathways, and potentially affecting the onset, progression, and management of RA. Dietary patterns, specific nutrients, and bioactive compounds have been linked to disease activity, comorbidities, and treatment outcomes in RA.

This Special Issue of Nutrients aims to explore the intricate relationship between diet/nutrients and RA, focusing on both mechanistic insights and clinical applications. We welcome original research articles, systematic reviews, meta-analyses, and comprehensive narrative reviews that address topics such as the effects of dietary interventions, beverages, the role of micronutrients and macronutrients, and the impact of nutrition on the gut microbiome and immune regulation in RA.

By gathering contributions from leading researchers and clinicians, this Special Issue seeks to advance our understanding of how correct nutrition can complement current therapeutic approaches and improve patient outcomes in RA. We invite submissions that provide innovative perspectives and contribute to shaping future optimal dietary recommendations in the context of autoimmune diseases.

Prof. Dr. Maurizio Cutolo
Dr. Elvis Hysa
Dr. Francesca Anna Ingegnoli
Guest Editors

Manuscript Submission Information

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Keywords

rheumatoid arthritis
nutrition
diet
inflammation
outcomes
Mediterranean diet

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Published Papers (4 papers)

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Research

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14 pages, 1344 KB

Open AccessArticle

A 14-Day Plant-Based Dietary Intervention Modulates the Plasma Levels of Rheumatoid Arthritis-Associated MicroRNAs: A Bioinformatics-Guided Pilot Study

by Mario Peña-Peña, Elyzabeth Bermúdez-Benítez, José L. Sánchez-Gloria, Karla M. Rada, Mauricio Mora-Ramírez, Luis M. Amezcua-Guerra, Martha A. Ballinas-Verdugo, Claudia Tavera-Alonso, Carlos A. Guzmán-Martín, Leonor Jacobo-Albavera, Aarón Domínguez-López, Rogelio F. Jiménez-Ortega, Luis H. Silveira, Laura A. Martínez-Martínez and Fausto Sánchez-Muñoz

Nutrients 2025, 17(13), 2222; https://doi.org/10.3390/nu17132222 - 4 Jul 2025

Viewed by 1343

Abstract

Background/Objectives: MicroRNAs (miRNAs) have emerged as molecular mediators involved in the pathogenesis of rheumatoid arthritis (RA). Given the influence of diet on gene expression and inflammation, plant-based diets represent a potential non-pharmacological strategy for modulating disease activity. This study aimed to explore and validate, through a bioinformatic-guided pilot approach, the regulation of miRNAs associated with RA in response to a 14-day plant-based dietary intervention. Methods: Candidate miRNAs were identified through differential expression analysis of the GSE124373 dataset using GEO2R and were further supported by a literature review. Target gene prediction and functional enrichment analyses were conducted to assess the biological relevance of these findings. Twenty-three RA patients followed a plant-based diet for 14 days. The clinical activity (DAS28-CRP), biochemical markers, and plasma expression of five selected miRNAs (miR-26a-5p, miR-125a-5p, miR-125b-5p, miR-146a-5p, and miR-155-5p) were evaluated before and after the intervention using RT-qPCR. Results: Significant reductions were observed in DAS28-CRP scores, C-reactive protein, glucose, and lipid levels after 14 days of intervention. Three of the five miRNAs (miR-26a-5p, miR-125a-5p, and miR-155-5p) were significantly downregulated post-intervention. Bioinformatic analyses indicated that these miRNAs regulate immune–inflammatory pathways relevant to RA pathogenesis. Conclusions: This pilot study suggests that a short-term plant-based dietary intervention may modulate circulating miRNAs and improve clinical and biochemical parameters in RA patients. These findings support further research into dietary strategies as complementary approaches for RA management. Full article

(This article belongs to the Special Issue Rheumatoid Arthritis and Nutrition: Bridging Diet and Disease Management)

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14 pages, 1394 KB

Open AccessArticle

Measures of Adiposity and Risk of Rheumatoid Arthritis in Middle-Aged UK Women: A Prospective Cohort Study

by Yuanyuan Dong, Darren C. Greenwood, Laura J. Hardie and Janet E. Cade

Nutrients 2025, 17(9), 1557; https://doi.org/10.3390/nu17091557 - 30 Apr 2025

Cited by 2 | Viewed by 1352

Abstract

Objectives: To estimate the association between various indicators of obesity-related health risk and the incidence of rheumatoid arthritis (RA) in a large cohort of women. Methods: The UK Women’s Cohort Study is a prospective cohort of 35,372 middle-aged women (aged 35–69 at recruitment) initiated in 1995–1998. Obesity was assessed using body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), categorised according to WHO and NICE guidelines, as well as clothing size. Incident RA cases were identified via Hospital Episode Statistics (HES) linkage up to March 2019. Cox regression models were used to estimate RA risk, adjusting for demographics, reproductive factors, and lifestyle factors. Non-linear associations were examined using restricted cubic splines. Results: Among 27,968 eligible subjects with complete data linkage (625,269 person-years of follow-up), there were 255 incident RA cases. Obesity (≥30.0 kg/m²) was associated with increased RA risk (HR (95% CI) 1.48 (1.02, 2.17), as were abdominal obesity (WC > 88 cm: 1.58 (1.10, 2.27)), WHR ≥ 0.85 (1.56 (1.03, 2.36)), and WHtR ≥ 0.6 (2.25 (1.34, 3.80)). Each 2.5 kg/m² increase in BMI was associated with a 9% higher risk of RA; each 5 cm increase in WC with 6%; each 0.1 increase in WHR with 20%, and each 0.1 increase in WHtR with 27%. Larger clothing sizes were associated with a greater RA risk: for each onesize increment in blouse size and skirt size, the HRs were 1.13 (95% CI: 1.04, 1.22) and 1.13 (95% CI: 1.05, 1.22), respectively. Notably, skirt size ≥ 20 was associated with a 2.36-fold increased risk of RA. There was evidence of effect modification by weight change and menopausal status in obesity-related RA risk. Conclusions: Our findings suggest that managing obesity and central adiposity in middle-aged women may be associated with the risk of developing RA. WHtR may serve as a practical alternative to BMI in assessing RA risk. Clothing size, particularly skirt size, could provide a simple, cost-effective proxy for identifying at high risk of RA. Full article

(This article belongs to the Special Issue Rheumatoid Arthritis and Nutrition: Bridging Diet and Disease Management)

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19 pages, 552 KB

Open AccessReview

The Role of Nutrition in the Development, Management, and Prevention of Rheumatoid Arthritis: A Comprehensive Review

by Maria Polyzou, Andreas V. Goules and Athanasios G. Tzioufas

Nutrients 2025, 17(24), 3826; https://doi.org/10.3390/nu17243826 - 6 Dec 2025

Viewed by 997

Abstract

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease, with key features being synovial hyperplasia, autoantibody production, and ultimately cartilage and bone destruction. The pathogenesis of rheumatoid arthritis (RA) is not fully understood, but it is estimated that genetic factors account for 50–60% of the risk, with the remainder attributed to environmental factors, including infectious agents, smoking, gut microbiota, and diet. Given that most current clinical trials on RA and nutrition are limited in sample size and duration, there is an unmet need for higher-quality studies in the future, a need that EULAR has already recognized. Objective: This article aims to investigate the impact of diet and nutritional factors on the development, progression, and potential prevention of RA. Specifically, it provides a comprehensive review of certain foods, such as alcohol, gluten, red meat, and saturated and trans fats, and their contribution to the onset and progression of rheumatoid arthritis (RA). In addition, it examines the effect of key anti-inflammatory nutrients in reducing the risk of RA, including olive oil, fatty fish, juices, and certain fruits. Finally, it discusses the potential protective effects of certain dietary patterns, such as the Mediterranean diet (MD) and diets rich in omega-3 polyunsaturated fatty acids (PUFAs). Methods: A comprehensive literature search was conducted in the PubMed/Medline, Science Direct, and Scopus databases (1990–2025). English-language observational studies, clinical trials, and systematic reviews addressing the relationship between diet and dietary patterns and RA were included. Results: High consumption of red and processed meat, saturated and trans fats, sugary drinks, and gluten (in vulnerable individuals) is associated with increased RA risk and greater disease activity, partly through pro-inflammatory pathways and gut dysbiosis. In contrast, regular intake of olive oil, fatty fish rich in omega-3 polyunsaturated fatty acids, fruit juices, cocoa, certain fruits, and vitamin D appears protective and may reduce disease activity and symptom severity. Adherence to anti-inflammatory dietary patterns, particularly the Mediterranean diet and diets rich in omega-3 fatty acids, is consistently associated with a lower incidence of RA, reduced inflammatory markers, and improved clinical outcomes. However, most available studies are limited by small sample sizes, short duration, heterogeneous methodologies, and potential confounding by other lifestyle factors (e.g., smoking, obesity). Conclusions: Although an appropriate diet and dietary habits cannot replace pharmacological therapy, current knowledge supports the inclusion of an anti-inflammatory diet as an adjunct strategy in the prevention and management of RA. The relatively limited studies that have been conducted suggest that high-quality, large-scale, prospective studies are needed to prevent and treat RA. These studies should incorporate genetic, microbiome, and long-term clinical endpoints, so as to establish definitive dietary recommendations and allow for personalized nutritional interventions for patients with RA. Full article

(This article belongs to the Special Issue Rheumatoid Arthritis and Nutrition: Bridging Diet and Disease Management)

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19 pages, 2423 KB

Open AccessEditor’s ChoiceReview

The Role of Diet in Modulating Inflammation and Oxidative Stress in Rheumatoid Arthritis, Ankylosing Spondylitis, and Psoriatic Arthritis

by Daria Kupczyk, Rafał Bilski, Łukasz Szeleszczuk, Katarzyna Mądra-Gackowska and Renata Studzińska

Nutrients 2025, 17(9), 1603; https://doi.org/10.3390/nu17091603 - 7 May 2025

Cited by 10 | Viewed by 8363

Abstract

Rheumatic diseases such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) are chronic autoimmune disorders characterized by persistent inflammation and oxidative stress, leading to joint damage and reduced quality of life. In recent years, increasing attention has been given to diet as a modifiable environmental factor that can complement pharmacological therapy. This review summarizes current evidence on how key dietary components—such as omega-3 fatty acids, fiber, polyphenols, and antioxidant vitamins—affect inflammatory pathways and oxidative balance. Special emphasis is placed on the Mediterranean diet, low-starch diets, and hypocaloric regimens, which have shown potential in improving disease activity. The gut microbiota emerges as a critical mediator between diet and immune function, with dietary interventions capable of restoring eubiosis and strengthening the intestinal barrier. Additionally, this paper discusses challenges in the clinical implementation of diet therapy, the need for personalized nutritional strategies, and the importance of integrating diet into holistic patient care. Collectively, findings suggest that dietary interventions may reduce disease activity, mitigate systemic inflammation, and enhance patients’ overall well-being. Full article

(This article belongs to the Special Issue Rheumatoid Arthritis and Nutrition: Bridging Diet and Disease Management)

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