Background: Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that affects synovial joints, leading to inflammation, joint destruction, loss of function, and disability. Although recent pharmaceutical advances have improved treatment of RA, patients with RA often inquire about dietary interventions to improve RA symptoms, as they perceive rapid changes in their symptoms after consumption of certain foods. There is evidence that some ingredients have pro- or anti-inflammatory effects. In addition, recent literature has shown a link between diet and microbiome changes. Both diet and the gut microbiome are linked to circulating metabolites that may modulate inflammation. However, evidence of the effects of an anti-inflammatory and probioticrich diet in patients with RA is scarce. There is also a need for biological data to support its anti-inflammatory effects. Methods: The main goal of this study is to delineate the design process for a diet tailored to our RA population. To achieve this goal, we collected information on diet, supplements, cooking methods, and intake of different ingredients for each patient. Different groups were interviewed, and their feedback was assessed to design a diet that incorporates suggested anti-inflammatory ingredients in a manner that was easy for patients to adopt based on their lifestyles and backgrounds. Results: We designed a diet that includes a high intake of potential anti-inflammatory ingredients. Feedback from highly motivated patients was critical in constructing an anti-inflammatory diet (ITIS diet) with elevated adherence. Conclusion: In order to tailor our diet, we surveyed our patients on several different parameters. We obtained important feedback on how feasible our ITIS diet is for RA patients. Using this feedback, we made minor improvements and finalized the design of the ITIS diet. This diet is being used in an on-going pilot study to determine their anti-inflammatory effect in pain and joint swelling in RA patients. Trial registration: Not applicable.

Background

Rheumatoid arthritis (RA) is a systemic, debilitating, chronic inflammatory autoimmune disorder affecting approximately 1% of the world population [1]. RA is a form of arthritis that causes pain, swelling, stiffness, and loss of function in joints. This disease severely impacts quality of life with increased morbidity and mortality. Although recent pharmaceutical advances have improved the treatment of RA, most RA patients need lifelong pharmacological therapy. RA patients often seek additional sources of relief and/or treatments with less side effects, and often inquire about dietary interventions to improve RA symptoms, as they perceive rapid changes in pain and/or swelling after consumption of certain foods [2]. However, rheumatologists lack information to advise RA patients on nutrition. Diet might modulate RA symptoms by influencing the patient’s metabolic profile and increasing antioxidant levels, but also by altering the microflora of the intestine. The gut microbiome is incredibly dynamic and can change rapidly to dietary perturbations [3].