Hansen Bérénice, Sánchez-Castro Marta, Schintgen Lynn, Khakdan Arefeh, Schneider Jochen G, Wilmes Paul
Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
Department of Life Sciences and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
Clin Nutr. 2025 Jun;49:178-186. doi: 10.1016/j.clnu.2025.04.025. Epub 2025 Apr 29.
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease affecting approximately 1 % of the global population. It is characterized by swollen and painful joints eventually evolving into bone erosion, cartilage degradation and systemic inflammation, that significantly reduce patients' quality of life. While modern pharmacological treatments often lead to symptom improvement, they are also accompanied by substantial side effects, which can further impair patient wellbeing. Dietary interventions, particularly fasting and caloric restriction (CR), have gained increasing attention as adjunctive strategies for RA prevention and treatment. Their anti-inflammatory potential and ability to modulate the gut microbiome render them an attractive option to accompany or modify medical treatment. However, high-quality research on fasting and CR interventions in humans with RA remains limited, and the underlying mechanisms are not yet fully understood. The present narrative review reflects our current knowledge regarding fasting and CR, emphasising their impact on clinical outcomes, potential underlying mechanism and the sustainability of their effects. Evidence suggests that fasting and CR may lead to short-term improvements in RA disease activity, including reductions in inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6). However, their long-term efficacy remains uncertain due to the limited duration of most studies. Future research should focus on identifying optimal fasting and CR protocols and their feasibility in long-term disease management, along with investigating patient adherence and potential risks associated with fasting interventions.
类风湿性关节炎（RA）是一种慢性全身性自身免疫性疾病，影响着全球约1%的人口。其特征是关节肿胀疼痛，最终发展为骨质侵蚀、软骨退化和全身性炎症，这会显著降低患者的生活质量。虽然现代药物治疗通常能改善症状，但也伴随着大量副作用，这可能会进一步损害患者的健康。饮食干预，特别是禁食和热量限制（CR），作为RA预防和治疗的辅助策略越来越受到关注。它们的抗炎潜力和调节肠道微生物群的能力使其成为伴随或调整药物治疗的一个有吸引力的选择。然而，关于RA患者禁食和CR干预的高质量研究仍然有限，其潜在机制尚未完全了解。本叙述性综述反映了我们目前关于禁食和CR的知识，强调它们对临床结果的影响、潜在的机制以及其效果的可持续性。有证据表明，禁食和CR可能会使RA疾病活动在短期内得到改善，包括降低炎症标志物如C反应蛋白（CRP）和白细胞介素-6（IL-6）。然而，由于大多数研究的持续时间有限，它们的长期疗效仍不确定。未来的研究应侧重于确定最佳的禁食和CR方案及其在长期疾病管理中的可行性，同时调查患者的依从性以及与禁食干预相关的潜在风险。
