Conclusions

Of the two primary approaches to the dietary management of inflammatory arthritis - supplementation and elimination diets - it appears that dietary supplementation with fish oil may result in the most consistent clinical benefits, although improvements still remain modest. Elimination diets, including fasting and vegetarian regimens, may provide some benefit for a limited number of patients with RA, but consistent alleviation of disease activity by objective clinical measures has not been demonstrated.

In neither case does the use of dietary management warrant discontinuing a patient's medical regimen; rather, diet may be useful as an adjunct to other more substantiated therapies. Perhaps the most prudent approach for patients with RA interested in attempting to control their disease activity through diet is to recommend a diet consistent with current recommendations for all individuals, including an intake high in fresh fruits, vegetables, and grains, with moderate amounts of lean meats and poultry, and an emphasis on fish, particularly marine fish high in n-3 fatty acid content. More definitive research demonstrating consistent, objective clinical benefits is needed before specific dietary manipulations for patients with RA can be recommended. In addition, there is growing evidence that exercise, both resistance and aerobic, has important beneficial effects on both inflammatory and degenerative arthritis.

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