THE IMPACT OF DIET ON RHEUMATOID ARTHRITIS (RA) TREATMENT AND ACTIVITY

Keywords: Rheumatoid Arthritis, Diet, Anti-Inflammatory Diet, Omega-3 Fatty Acids, Fiber, Polyphenols

Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation, destructive changes, and numerous systemic complications. Treatment is based on disease-modifying antirheumatic drugs (DMARDs) and biological therapies. In recent years, increasing attention has been paid to the impact of diet on the risk of developing RA and disease activity, as well as the role of diet as an adjunctive therapy in the treatment of RA. Many studies indicate that an appropriately selected diet can modulate the inflammatory response, affect the gut microbiota and the overall clinical condition of patients with RA. We analyse publications from 2018–2025, including observational studies, randomized controlled trials (RCTs) and systematic reviews on the role of diet in RA. We discuss the effect of selected types of anti-inflammatory diets and omega-3 fatty acids, fiber, polyphenols, and vitamin D in patients with RA. We highlight also the role of the gut microbiota in RA.

Aim of this study: The objective of this study is to summarise the latest reports on how diet and its components impact RA activity and treatment.

Materials and methods: A literature review was conducted using the professional PubMed database. Articles published between 2018 and 2025 were included. The searches included combinations of the following keywords: “rheumatoid arthritis,” “diet,” “anti-inflammatory diet,” “omega-3 fatty acids,” “fiber” and “polyphenols”.

References

Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS, Kavanaugh A, McInnes IB, Solomon DH, Strand V, Yamamoto K. Rheumatoid arthritis. Nat Rev Dis Primers. 2018 Feb 8;4:18001. doi: 10.1038/nrdp.2018.1.

Singh JA. Treatment Guidelines in Rheumatoid Arthritis. Rheum Dis Clin North Am. 2022 Aug;48(3):679-689. doi: 10.1016/j.rdc.2022.03.005.

Karami J, Aslani S, Jamshidi A, Garshasbi M, Mahmoudi M. Genetic implications in the pathogenesis of rheumatoid arthritis; an updated review. Gene. 2019 Jun 20;702:8-16. doi: 10.1016/j.gene.2019.03.033.

Rudan I, Sidhu S, Papana A, Meng SJ, Xin-Wei Y, Wang W, Campbell-Page RM, Demaio AR, Nair H, Sridhar D, Theodoratou E, Dowman B, Adeloye D, Majeed A, Car J, Campbell H, Wang W, Chan KY; Global Health Epidemiology Reference Group (GHERG). Prevalence of rheumatoid arthritis in low- and middle-income countries: A systematic review and analysis. J Glob Health. 2015 Jun;5(1):010409. doi: 10.7189/jogh.05.010409.

Alpízar-Rodríguez D, Finckh A, Gilbert B. The Role of Nutritional Factors and Intestinal Microbiota in Rheumatoid Arthritis Development. Nutrients. 2020 Dec 30;13(1):96. doi: 10.3390/nu13010096.

Wells PM, Adebayo AS, Bowyer RCE, Freidin MB, Finckh A, Strowig T, Lesker TR, Alpizar-Rodriguez D, Gilbert B, Kirkham B, Cope AP, Steves CJ, Williams FMK. Associations between gut microbiota and genetic risk for rheumatoid arthritis in the absence of disease: a cross-sectional study. Lancet Rheumatol. 2020 Jun 25;2(7):e418-e427. doi: 10.1016/S2665-9913(20)30064-3. Erratum in: Lancet Rheumatol. 2025 May;7(5):e311. doi: 10.1016/S2665-9913(25)00098-0.

Mena-Vázquez N, Ruiz-Limón P, Moreno-Indias I, Manrique-Arija S, Tinahones FJ, Fernández-Nebro A. Expansion of Rare and Harmful Lineages is Associated with Established Rheumatoid Arthritis. J Clin Med. 2020 Apr 7;9(4):1044. doi: 10.3390/jcm9041044.

Vadell AKE, Bärebring L, Hulander E, Gjertsson I, Lindqvist HM, Winkvist A. Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA)-a randomized, controlled crossover trial indicating effects on disease activity. Am J Clin Nutr. 2020 Jun 1;111(6):1203-1213. doi: 10.1093/ajcn/nqaa019. Erratum in: Am J Clin Nutr. 2023 Oct 28:S0002-9165(23)66227-6. doi: 10.1016/j.ajcnut.2023.10.023.

Kishikawa T, Maeda Y, Nii T, Motooka D, Matsumoto Y, Matsushita M, Matsuoka H, Yoshimura M, Kawada S, Teshigawara S, Oguro E, Okita Y, Kawamoto K, Higa S, Hirano T, Narazaki M, Ogata A, Saeki Y, Nakamura S, Inohara H, Kumanogoh A, Takeda K, Okada Y. Metagenome-wide association study of gut microbiome revealed novel aetiology of rheumatoid arthritis in the Japanese population. Ann Rheum Dis. 2020 Jan;79(1):103-111. doi: 10.1136/annrheumdis-2019-215743.

Zhao T, Wei Y, Zhu Y, Xie Z, Hai Q, Li Z, Qin D. Gut microbiota and rheumatoid arthritis: From pathogenesis to novel therapeutic opportunities. Front Immunol. 2022 Sep 8;13:1007165. doi: 10.3389/fimmu.2022.1007165.

Li M, Wang F. Role of Intestinal Microbiota on Gut Homeostasis and Rheumatoid Arthritis. J Immunol Res. 2021 Jun 4;2021:8167283. doi: 10.1155/2021/8167283.

Chen Y, Ma C, Liu L, He J, Zhu C, Zheng F, Dai W, Hong X, Liu D, Tang D, Dai Y. Analysis of gut microbiota and metabolites in patients with rheumatoid arthritis and identification of potential biomarkers. Aging (Albany NY). 2021 Oct 20;13(20):23689-23701. doi: 10.18632/aging.203641.

Bodkhe R, Balakrishnan B, Taneja V. The role of microbiome in rheumatoid arthritis treatment. Ther Adv Musculoskelet Dis. 2019 Jul 30;11:1759720X19844632. doi: 10.1177/1759720X19844632.

Yang Y, Hong Q, Zhang X, Liu Z. Rheumatoid arthritis and the intestinal microbiome: probiotics as a potential therapy. Front Immunol. 2024 Mar 6;15:1331486. doi: 10.3389/fimmu.2024.1331486.

Häger J, Bang H, Hagen M, Frech M, Träger P, Sokolova MV, Steffen U, Tascilar K, Sarter K, Schett G, et al. The Role of Dietary Fiber in Rheumatoid Arthritis Patients: A Feasibility Study. Nutrients. 2019; 11(10):2392. doi: 10.3390/nu11102392.

Dürholz K, Hofmann J, Iljazovic A, Häger J, Lucas S, Sarter K, Strowig T, Bang H, Rech J, Schett G, Zaiss MM. Dietary Short-Term Fiber Interventions in Arthritis Patients Increase Systemic SCFA Levels and Regulate Inflammation. Nutrients. 2020 Oct 20;12(10):3207. doi: 10.3390/nu12103207.

Bakinowska E, Stańska W, Kiełbowski K, Szwedkowicz A, Boboryko D, Pawlik A. Gut Dysbiosis and Dietary Interventions in Rheumatoid Arthritis—A Narrative Review. Nutrients. 2024; 16(18):3215. doi: 10.3390/nu16183215.

Jiang L, Shang M, Yu S, Liu Y, Zhang H, Zhou Y, Wang M, Wang T, Li H, Liu Z, Zhang X. A high-fiber diet synergizes with Prevotella copri and exacerbates rheumatoid arthritis. Cell Mol Immunol. 2022 Dec;19(12):1414-1424. doi: 10.1038/s41423-022-00934-6.

Frangos T, Maret W. Zinc and Cadmium in the Aetiology and Pathogenesis of Osteoarthritis and Rheumatoid Arthritis. Nutrients. 2020 Dec 26;13(1):53. doi: 10.3390/nu13010053.

Liu Y, Wang X, You M, Zheng M, Yu M, Leng X. Association between vitamin B6 levels and rheumatoid arthritis: a two-sample Mendelian randomization study. Front Nutr. 2024 Oct 11;11:1442214. doi: 10.3389/fnut.2024.1442214.

Du X, Yang Y, Zhan X, Huang Y, Fu Y, Zhang Z, Liu H, Zhang L, Li Y, Wen Q, Zhou X, Zuo D, Zhou C, Li L, Hu S, Ma L. Vitamin B6 prevents excessive inflammation by reducing accumulation of sphingosine-1-phosphate in a sphingosine-1-phosphate lyase-dependent manner. J Cell Mol Med. 2020 Nov;24(22):13129-13138. doi: 10.1111/jcmm.15917.

Schönenberger KA, Schüpfer AC, Gloy VL, Hasler P, Stanga Z, Kaegi-Braun N, Reber E. Effect of Anti-Inflammatory Diets on Pain in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Nutrients. 2021 Nov 24;13(12):4221. doi: 10.3390/nu13124221.

Song X, Ma X, Yang B, Zhang D, Zou Y, Lei B, Xiang R, Zhao X, Qu Y, Zheng S, Yu T, Zhou J, Han T, Zhong Y, Xia M, Alfredsson L, Leander K, Fan M, Jiang X. Mediterranean diet, metabolic signature, genetic predisposition, and risk of rheumatoid arthritis: a large-scale population-based prospective cohort study. Am J Clin Nutr. 2025 Oct 3:S0002-9165(25)00604-5. doi: 10.1016/j.ajcnut.2025.09.051.

Charneca S, Ferro M, Vasques J, Carolino E, Martins-Martinho J, Duarte-Monteiro AM, Dourado E, Fonseca JE, Guerreiro CS. The Mediterranean diet, and not dietary inflammatory index, is associated with rheumatoid arthritis disease activity, the impact of disease and functional disability. Eur J Nutr. 2023 Oct;62(7):2827-2839. doi: 10.1007/s00394-023-03196-8.

Hu, P., Lee, E.KP., Li, Q. et al. Mediterranean diet and rheumatoid arthritis: A nine-year cohort study and systematic review with meta-analysis. Eur J Clin Nutr 79, 888–896 (2025). doi: 10.1038/s41430-025-01628-8.

Johansson K, Askling J, Alfredsson L, Di Giuseppe D; EIRA study group. Mediterranean diet and risk of rheumatoid arthritis: a population-based case-control study. Arthritis Res Ther. 2018 Aug 9;20(1):175. doi: 10.1186/s13075-018-1680-2.

Papandreou P, Gioxari A, Daskalou E, Grammatikopoulou MG, Skouroliakou M, Bogdanos DP. Mediterranean Diet and Physical Activity Nudges versus Usual Care in Women with Rheumatoid Arthritis: Results from the MADEIRA Randomized Controlled Trial. Nutrients. 2023 Jan 28;15(3):676. doi: 10.3390/nu15030676.

Abdel-Aal NM, Kamil RM, Tayel DI, Hamed RH, Ragab MM, Abd El-Azeim AS. Impact of adding Mediterranean diet to aerobic and strengthening exercise program on pain, inflammation, and muscle performance in females with rheumatoid arthritis: a randomized controlled trial. Physiother Theory Pract. 2025 Mar;41(3):571-587. doi: 10.1080/09593985.2024.2358122.

Ciaffi J, Mitselman D, Mancarella L, Brusi V, Lisi L, Ruscitti P, Cipriani P, Meliconi R, Giacomelli R, Borghi C, Ursini F. The Effect of Ketogenic Diet on Inflammatory Arthritis and Cardiovascular Health in Rheumatic Conditions: A Mini Review. Front Med (Lausanne). 2021 Dec 14;8:792846. doi: 10.3389/fmed.2021.792846.

Kawasaki R, Sakata A, Tatsumi K, Mitani S, Takeda M, Kasuda S, Matsumoto N, Harada S, Soeda T, Nishida Y, Yoshimura Y, Shima M. β-hydroxybutyrate suppresses pathological changes of blood-induced arthropathy in rats. Sci Rep. 2024 Nov 29;14(1):29696. doi: 10.1038/s41598-024-77074-6.

Ruskin, D.N., Sturdevant, I.C., Wyss, L.S. et al. Ketogenic diet effects on inflammatory allodynia and ongoing pain in rodents. Sci Rep 11, 725 (2021). doi: 10.1038/s41598-020-80727-x.

Rondanelli M, Patelli Z, Gasparri C, Mansueto F, Ferraris C, Nichetti M, Alalwan TA, Sajoux I, Maugeri R, Perna S. Very low calorie ketogenic diet and common rheumatic disorders: A case report. World J Clin Cases. 2023 Mar 26;11(9):1985-1991. doi: 10.12998/wjcc.v11.i9.1985.

Gioia C, Lucchino B, Tarsitano MG, Iannuccelli C, Di Franco M. Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations? Nutrients. 2020 May 18;12(5):1456. doi: 10.3390/nu12051456.

Heidt C, Pons-Kühnemann J, Kämmerer U, Marquardt T, Reuss-Borst M. MCT-Induced Ketosis and Fiber in Rheumatoid Arthritis (MIKARA)-Study Protocol and Primary Endpoint Results of the Double-Blind Randomized Controlled Intervention Study Indicating Effects on Disease Activity in RA Patients. Nutrients. 2023 Aug 25;15(17):3719. doi: 10.3390/nu15173719.

Karami J, Aslani S, Jamshidi A, Garshasbi M, Mahmoudi M. Genetic implications in the pathogenesis of rheumatoid arthritis; an updated review. Gene. 2019 Jun 20;702:8-16. doi: 10.1016/j.gene.2019.03.033.

Jensen KY, Søndergaard CS, Thomsen T, Bjørnsbo KS, Linneberg A, Wagenaar CA, Esbensen BA, Hansen CW. Effects of vegetarian and vegan diets on disease activity, pain, fatigue, and physical function in patients with rheumatoid arthritis: A systematic review and meta-analysis. Joint Bone Spine. 2025 Sep 2;92(6):105958. doi: 10.1016/j.jbspin.2025.105958.

Warjri SB, Ete T, Beyong T, Barman B, Lynrah KG, Nobin H, Perme O. Coeliac Disease With Rheumatoid Arthritis: An Unusual Association. Gastroenterology Res. 2015 Feb;8(1):167-168. doi: 10.14740/gr641w.

Kostoglou-Athanassiou I, Athanassiou L, Athanassiou P. The Effect of Omega-3 Fatty Acids on Rheumatoid Arthritis. Mediterr J Rheumatol. 2020 Jun 30;31(2):190-194. doi: 10.31138/mjr.31.2.190.

Marchand NE, Choi MY, Oakes EG, Cook NR, Stevens E, Gomelskaya N, Kotler G, Manson JE, Lasky-Su J, Mora S, Lee IM, Tatituri R, Costenbader KH. Over-the-counter fish oil supplementation and pro-resolving and pro-inflammatory lipid mediators in rheumatoid arthritis. Prostaglandins Leukot Essent Fatty Acids. 2023 Mar;190:102542. doi: 10.1016/j.plefa.2023.102542.

Hahn J, Cook NR, Alexander EK, Friedman S, Walter J, Bubes V, Kotler G, Lee IM, Manson JE, Costenbader KH. Vitamin D and marine omega 3 fatty acid supplementation and incident autoimmune disease: VITAL randomized controlled trial. BMJ. 2022 Jan 26;376:e066452. doi: 10.1136/bmj-2021-066452.

Gioxari A, Kaliora AC, Marantidou F, Panagiotakos DP. Intake of ω-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: A systematic review and meta-analysis. Nutrition. 2018 Jan;45:114-124.e4. doi: 10.1016/j.nut.2017.06.023.

Raad T, Griffin A, George ES, Larkin L, Fraser A, Kennedy N, Tierney AC. Dietary Interventions with or without Omega-3 Supplementation for the Management of Rheumatoid Arthritis: A Systematic Review. Nutrients. 2021 Oct 4;13(10):3506. doi: 10.3390/nu13103506.

Jannas-Vela S, Candia AA, Peñailillo L, Barrios-Troncoso P, Zapata-Urzúa J, Rey-Puente J, Aukema HM, Mutch DM, Valenzuela R, Valladares-Ide D. Role of specialized pro-resolving mediators on inflammation, cardiometabolic health, disease progression, and quality of life after omega-3 PUFA supplementation and aerobic exercise training in individuals with rheumatoid arthritis: a randomized 16-week, placebo-controlled interventional trial. F1000Res. 2023 Aug 7;12:942. doi: 10.12688/f1000research.138392.1.

Vadell AKE, Bärebring L, Hulander E, Gjertsson I, Lindqvist HM, Winkvist A. Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA)-a randomized, controlled crossover trial indicating effects on disease activity. Am J Clin Nutr. 2020 Jun 1;111(6):1203-1213. doi: 10.1093/ajcn/nqaa019. Erratum in: Am J Clin Nutr. 2023 Oct 28:S0002-9165(23)66227-6. doi: 10.1016/j.ajcnut.2023.10.023.

Tedeschi SK, Bathon JM, Giles JT, Lin TC, Yoshida K, Solomon DH. Relationship Between Fish Consumption and Disease Activity in Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2018 Mar;70(3):327-332. doi: 10.1002/acr.23295.

Harrison, S.R., Li, D., Jeffery, L.E. et al. Vitamin D, Autoimmune Disease and Rheumatoid Arthritis. Calcif Tissue Int 106, 58–75 (2020). doi:10.1007/s00223-019-00577-2.

Mouterde G, Gamon E, Rincheval N, Lukas C, Seror R, Berenbaum F, Dupuy AM, Daien C, Daurès JP, Combe B. Association Between Vitamin D Deficiency and Disease Activity, Disability, and Radiographic Progression in Early Rheumatoid Arthritis: The ESPOIR Cohort. J Rheumatol. 2020 Nov 1;47(11):1624-1628. doi: 10.3899/jrheum.190795.

Guan Y, Hao Y, Guan Y, Bu H, Wang H. The Effect of Vitamin D Supplementation on Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2020 Oct 30;7:596007. doi: 10.3389/fmed.2020.596007.

Xie X, Fu J, Gou W, Qin Y, Wang D, Huang Z, Wang L, Li X. Potential mechanism of tea for treating osteoporosis, osteoarthritis, and rheumatoid arthritis. Front Med (Lausanne). 2024 Feb 14;11:1289777. doi: 10.3389/fmed.2024.1289777.

Long Z, Xiang W, He Q, Xiao W, Wei H, Li H, Guo H, Chen Y, Yuan M, Yuan X, Zeng L, Yang K, Deng Y, Huang Z. Efficacy and safety of dietary polyphenols in rheumatoid arthritis: A systematic review and meta-analysis of 47 randomized controlled trials. Front Immunol. 2023 Mar 22;14:1024120. doi: 10.3389/fimmu.2023.1024120.

Liu L, Xie S. Dietary fiber intake associated with risk of rheumatoid arthritis among U.S. adults: NHANES 2010-2020. Medicine (Baltimore). 2023 Mar 24;102(12):e33357. doi: 10.1097/MD.0000000000033357.

Gkiouras K, Grammatikopoulou MG, Myrogiannis I, Papamitsou T, Rigopoulou EI, Sakkas LI, Bogdanos DP. Efficacy of n-3 fatty acid supplementation on rheumatoid arthritis' disease activity indicators: a systematic review and meta-analysis of randomized placebo-controlled trials. Crit Rev Food Sci Nutr. 2024;64(1):16-30. doi: 10.1080/10408398.2022.2104210.

Rexhepi M, Krasniqi B, Hoti K, Daci A, Rexhepi-Kelmendi B, Krasniqi S. Impact of vitamin D supplementation on disease activity and pain management in rheumatoid arthritis: a randomized double-blinded controlled study. BMC Rheumatol. 2025 Jul 11;9(1):87. doi: 10.1186/s41927-025-00543-6.

Published
2025-12-26
Citations
How to Cite
Agnieszka Bajkacz, Izabela Polakowska, Agnieszka Roszyk, Kamil Orczyk, Alicja Dankowska, Małgorzata Zielonka, Zuzanna Głowacka, Jakub Białek, Patrycja Stygar, & Agata Bęben. (2025). THE IMPACT OF DIET ON RHEUMATOID ARTHRITIS (RA) TREATMENT AND ACTIVITY. International Journal of Innovative Technologies in Social Science, 3(4(48). https://doi.org/10.31435/ijitss.4(48).2025.4608