Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy.
Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy; ULSS 6 Euganea Company, Padova, Italy.
Joint Bone Spine. 2023 Mar;90(2):105476. doi: 10.1016/j.jbspin.2022.105476. Epub 2022 Oct 28.
Our study aimed to systematically review the evidence about the effect of diet or dietary supplements on spondyloarthritis (SpA) disease activity.
a systematic literature review (SLR) was conducted in MEDLINE, EMBASE, Cochrane and SCOPUS according to the "PEO" format (Population, Exposure, Outcome). The population was SpA (axial or peripheral, axSpA/pSpA, including Psoriatic Arthritis-PsA); the intervention any kind of diet/dietary supplement; the outcome disease activity. Inclusion criteria were: adult patients, Randomized Controlled Trials (RCTs) and longitudinal studies (so that a pre-and post-intervention assessment were available), papers in English. Risk of bias (RoB) was conducted with different tools according to the design of the study.
Literature search yielded 1390 publications, of which 15 were finally inlcuded: 12 interventional and 3 observational studies. Among those with the lower RoB: a) 2 RCTs, one at unclear and one at low RoB, failed to show benefit of probiotics in SpA b) Two RCTs at unclear RoB provided evidence that weight loss, but not hypocaloric diet, was associated to MDA achievement in PsA. The remaining interventional studies were at high RoB. Among the observational studies, one study on Mediterranean diet demonstrated an association between diet adherence and a ≥ 20% decrease of ASDAS in axSpA. The other two observational studies were judged of poor quality.
weight loss seem to be able to impact disease activity in PsA, while probiotics do not seem useful in SpA; evidence for dietary behaviors is scarce and heterogeneous.
本研究旨在系统回顾饮食或膳食补充剂对脊柱关节炎（SpA）疾病活动的影响的证据。
根据“PEO”格式（人群、暴露、结局），在 MEDLINE、EMBASE、Cochrane 和 SCOPUS 中进行系统文献综述（SLR）。人群为 SpA（轴性或外周性，axSpA/pSpA，包括银屑病关节炎-PsA）；干预措施为任何类型的饮食/膳食补充剂；结局为疾病活动。纳入标准为：成年患者、随机对照试验（RCT）和纵向研究（以便进行干预前后评估）、英文论文。根据研究设计，使用不同的工具进行偏倚风险（RoB）评估。
文献检索得到 1390 篇出版物，最终纳入 15 篇：12 项干预性研究和 3 项观察性研究。其中 RoB 较低的研究包括：a）两项 RCT，一项 RoB 不明确，另一项 RoB 较低，均未能显示益生菌对 SpA 的益处；b）两项 RoB 不明确的 RCT 提供了证据，表明体重减轻而不是低热量饮食与 PsA 中 MDA 达标有关。其余干预性研究的 RoB 较高。在观察性研究中，一项关于地中海饮食的研究表明，饮食依从性与 axSpA 中 ASDAS 下降≥20%之间存在关联。另外两项观察性研究被认为质量较差。
体重减轻似乎能够影响 PsA 的疾病活动，而益生菌似乎对 SpA 没有作用；饮食行为的证据稀缺且存在异质性。
