Diet therapy of rheumatoid arthritis

Reumatoidni artritis (RA) je kronična sistemska autoimuna bolest koja se najčešće očituje simetričnim poliartritisom. Obzirom da ne postoji lijek za RA, glavni terapijski cilj jest smanjenje boli i kontrola upale, čime se nastoje ublažiti simptomi. Najčešće korišteni lijekovi su NSAID, DMARD, salicilati i kortikosteroidi koji imaju svoje neželjene reakcije te mogu utjecati na nutritivni status pacijenta. Mnoga istraživanja upućuju na povezanost nutritivnog unosa i načina prehrane i stupnja aktivnosti bolesti, a i sami pacijenti često se raspituju o mogućnostima ublažavanja simptoma promjenom prehrambenih navika ili uzimanjem dodataka prehrani. Cilj ovog rada bio je dati pregled najnovijih znanstvenih spoznaja o učinku pojedinih obrazaca prehrane i/ili konzumacije određenih namirnica na ishod bolesti uz kritički osvrt na razinu dokaza i primjenjivost u kliničkoj praksi. Pri tome je najvažnije naglasiti da je za pacijente s RA izuzetno važan adekvatan unos proteina, a što se tiče lipida, potrebno je povećati unos omega-3 a smanjiti unos omega-6 masnih kiselina (s izuzetkom GLA i DGLA). Od popularnih pristupa prehrani koji se često predlažu pacijentima (isključujuća, elementarna, vegetarijanska, mediteranska dijeta), najpogodnija za prehranu pacijenata s RA je mediteranska dijeta. U okviru rada također je pretražena literatura koja opisuje učinkovitost različitih dodataka prehrani na RA uz osvrt na preporučene režime doziranja i trajanja suplementacije. Osim održavanja adekvatnog vitaminsko-mineralnog statusa, dodatnu korist pruža suplemenatacija vitaminom E i vitaminom D. Od ostalih dodataka prehrani najčešće se koriste antioksidansi i visokovrijedni izvori određenih masnih kiselina kao što su zeleni čaj, đumbir, vražja kandža, kurkuma, ulje boražine te Tripterygium wilfordii.Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease most commonly manifested by symmetric polyarthritis. Given that there is no cure for RA, the main therapeutic goal is to reduce pain and control the inflammation. The most commonly used drugs are NSAIDs, DMARDs, salicylates and corticosteroids that can exert different adverse reactions and affect the nutritional status of the patient. Many studies point out the possible relationship between nutritional intake and/or eating habits and the degree of the activity of disease. Therefore patients often inquire about the possibilities of alleviating the symptoms by changing dietary habits or by taking dietary supplements. The aim of this work was to give an overview of the latest scientific findings on the effect of certain dietary patterns and/or consumption of certain foods on the outcome of the disease. The special emphasis has been set on reviewing the level of evidence and estimating the applicability in clinical practice. The most important nutritional guidelines for patients with RA are to insure adequate protein intake and to increase the omega-3 and reduce omega-6 fatty acid intake (with the exception of GLA and DGLA). Among popular dietary approaches that are often suggested to patients (excluding-, elementary-, vegetarian-, mediterranean diet), the most suitable diet for RA patients is Mediterranean diet. Another goal of this work was to review the current level of evidence on the efficacy of various dietary supplements used by RA patients and to recommend dose regimens and the duration of supplementation. In this regard, in addition to maintaining adequate vitamin-mineral status, supplementation with vitamin E and vitamin D might provide additional benefits. Among other dietary supplements antioxidants and high-value sources of certain fatty acids, such as green tea, ginger, cranberry, turmeric, boron oil and Tripterygium wilfordii are most commonly used