由致敏食物组成的个体化饮食挑战对类风湿性关节炎患者肿瘤坏死因子-α和白细胞介素-1β水平的影响。

The effect of individualized diet challenges consisting of allergenic foods on TNF-alpha and IL-1beta levels in patients with rheumatoid arthritis.

作者信息

Karatay S, Erdem T, Yildirim K, Melikoglu M A, Ugur M, Cakir E, Akcay F, Senel K

机构信息

Department of Physical Medicine and Rehabilitation, Atatürk University, Erzurum, Turkey.

出版信息

Rheumatology (Oxford). 2004 Nov;43(11):1429-33. doi: 10.1093/rheumatology/keh366. Epub 2004 Aug 10.

DOI:10.1093/rheumatology/keh366

PMID:15304675

Abstract

OBJECTIVE

To investigate the effect of individualized diet challenges consisting of allergenic foods, defined by the skin prick test (SPT), on tumour necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) levels in patients with rheumatoid arthritis (RA).

METHODS

Twenty patients with a positive SPT response for food extracts and 20 with a negative SPT response were enrolled. None of the patients had active disease. All patients were fasted for the most common allergenic foods for 12 days and then allocated to two groups according to SPT results. Food challenges were performed with allergenic foods in the prick-positive group (PPG) and with corn and rice in the prick-negative group (PNG) for a period of 12 days. Then, allergenic foods were excluded from the PPG patients' diet and corn and rice were removed from the PNG patients' diet. Clinical examinations were performed after fasting (baseline), at the end of the challenge phase and at the end of the re-elimination phase. Stiffness, pain, tender and swollen joint counts, health assessment questionnaire (HAQ), Ritchie's articular index, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and serum TNF-alpha and IL-1beta levels were measured.

RESULTS

TNF-alpha (P < 0.01), IL-1beta (P < 0.05), ESR (P < 0.05) and CRP (P = 0.001) levels and all of the clinical variables, except HAQ, were increased with food challenges in the PPG. These increases were also recorded after the re-elimination phase. In the PNG, no significant change was seen in any of the variables, except pain (P < 0.05). During the study, important differences were observed for most of the variables between the two groups. Thirteen (72%) patients in the PPG and three (18%) in the PNG experienced disease exacerbation with challenges. This aggravation continued after elimination.

CONCLUSIONS

Our results suggest that individualized dietary revisions may regulate TNF-alpha and IL-1beta levels in selected patients with RA.

摘要

目的

研究由皮肤点刺试验（SPT）确定的致敏食物组成的个体化饮食激发试验对类风湿关节炎（RA）患者肿瘤坏死因子-α（TNF-α）和白细胞介素-1β（IL-1β）水平的影响。

方法

招募20名对食物提取物皮肤点刺试验反应阳性的患者和20名反应阴性的患者。所有患者均无活动性疾病。所有患者禁食最常见的致敏食物12天，然后根据皮肤点刺试验结果分为两组。点刺阳性组（PPG）用致敏食物进行饮食激发试验，点刺阴性组（PNG）用玉米和大米进行饮食激发试验，为期12天。然后，PPG患者的饮食中排除致敏食物，PNG患者的饮食中去除玉米和大米。在禁食后（基线）、激发阶段结束时和重新排除阶段结束时进行临床检查。测量僵硬、疼痛、压痛和肿胀关节计数、健康评估问卷（HAQ）、里奇关节指数、红细胞沉降率（ESR）、C反应蛋白（CRP）以及血清TNF-α和IL-1β水平。

结果

PPG组在饮食激发试验后TNF-α（P < 0.01）、IL-1β（P < 0.05）、ESR（P < 0.05）和CRP（P = 0.001）水平以及除HAQ外的所有临床变量均升高。在重新排除阶段后也记录到了这些升高。在PNG组中，除疼痛（P < 0.05）外，任何变量均未观察到显著变化。在研究期间，两组之间的大多数变量观察到重要差异。PPG组中有13名（72%）患者和PNG组中有3名（18%）患者在激发试验后病情加重。这种加重在排除后仍持续。