Miggiano G A D, Gagliardi L
Centro di Ricerche in Nutrizione Umana, Istituto di Biochimica e Biochimica Clinica, Facoltà di Medicina e Chirurgia, Università Cattolica S.Cuore, Roma, Italia.
Clin Ter. 2005 May-Jun;156(3):115-23.
Rheumatoid Arthritis (RA) is a chronic inflammatory disease resulting in diarthrodial joints inflammation (particularly joints of hands, wrists, feet, knees, cubitus, ankles, shoulder, etc.) that is manifested by swelling and functional impairment. The associated complications, osteoporosis and cardiovascular disease, make RA important in public health terms. During the active phase of disease, elevated plasma concentrations of inflammatory cytokines, such as interleukin-6 (IL-6), interleukin-1beta (IL-1beta), tumour necrosis factor-alpha (TNF-alpha) and acute-phase proteins, lead to reduction of fat free body mass (FFM) with a loss mean of 15% of cell body mass (CM) and consequent reduction of muscle strength. The pharmacological therapy (non steroidal anti inflammatory drugs (NSAIDs), slow acting antirheumatic drugs and corticosteroids), have the potential to cause side-effects, such as gastrointestinal bleeding, bone loss beyond to increase the requirement of some nutrients and reduce their absorption. The diet may play role in the management of RA, particularly in alleviating the symptoms of the disease, combating the side-effects of therapy and reducing the risk of complications. The increase of the caloric and proteic intake is not sufficient to offset a increased metabolic rhythm and important proteic catabolism but a diet balanced may warrant an adequate intake of nutrients. The carbohydrates of the diet provide 55-60% of the caloric intake, the diet is normo-proteinic or hyper-proteinic in the active phase of disease, and lipids represent 25-30% of the caloric intake (saturated, monounsaturated, polyunsaturated fatty acids in the ratio 1:1:1). omega-3 fatty acids supplementation, in combination with reduction of fatty acids omega-6 and adequate intake of monounsaturated fatty acids induce improvement in symptoms and sometimes a reduction in NSAIDs usage. Proper antioxidant nutrients (Vitamin A, Vitamin C, selenium) may provide an important defence against the increased oxidant stress and a supplementation of folate and vitamin B12, in patients treated with methotrexate (MTX), reduce the incidence of side effects and offset the elevation in plasma homocysteine frequent in these patients. Calcium and vitamin D, in patients treated with corticosteroids, reduce the bone loss, while a supplementation with iron may prevent anaemia. Finally, elimination diets may be feasible therapy only in patients with positive skin prick test.
类风湿关节炎（RA）是一种慢性炎症性疾病，可导致滑膜关节炎症（尤其是手、腕、足、膝、肘、踝、肩等关节），表现为肿胀和功能障碍。相关并发症骨质疏松症和心血管疾病，使类风湿关节炎在公共卫生方面具有重要意义。在疾病的活动期，炎症细胞因子如白细胞介素-6（IL-6）、白细胞介素-1β（IL-1β）、肿瘤坏死因子-α（TNF-α）和急性期蛋白的血浆浓度升高，导致去脂体重（FFM）减少，平均细胞体重（CM）损失15%，进而导致肌肉力量下降。药物治疗（非甾体抗炎药（NSAIDs）、慢作用抗风湿药和皮质类固醇）有可能引起副作用，如胃肠道出血、骨质流失，此外还会增加对某些营养素的需求并减少其吸收。饮食可能在类风湿关节炎的管理中发挥作用，特别是在缓解疾病症状、对抗治疗副作用和降低并发症风险方面。热量和蛋白质摄入量的增加不足以抵消代谢节奏加快和重要的蛋白质分解代谢，但均衡的饮食可以保证充足的营养素摄入。饮食中的碳水化合物提供55 - 60%的热量摄入，在疾病活动期饮食为正常蛋白质或高蛋白，脂质占热量摄入的25 - 30%（饱和脂肪酸、单不饱和脂肪酸、多不饱和脂肪酸的比例为1:1:1）。补充ω-3脂肪酸，同时减少ω-6脂肪酸的摄入并适当摄入单不饱和脂肪酸，可改善症状，有时还可减少NSAIDs的使用。适当的抗氧化营养素（维生素A、维生素C、硒）可能对增加的氧化应激提供重要防御，对于接受甲氨蝶呤（MTX）治疗的患者，补充叶酸和维生素B12可降低副作用的发生率并抵消这些患者中常见的血浆同型半胱氨酸升高。对于接受皮质类固醇治疗的患者，钙和维生素D可减少骨质流失，而补充铁可预防贫血。最后，排除饮食可能仅对皮肤点刺试验呈阳性的患者可行。
