Kavanaghi R, Workman E, Nash P, Smith M, Hazleman B L, Hunter J O
Department of Rheumatology, Addenbrooke's Hospital, Cambridge.
Br J Rheumatol. 1995 Mar;34(3):270-3. doi: 10.1093/rheumatology/34.3.270.
The role of diet in rheumatoid arthritis (RA) remains controversial and there have been no controlled studies on the use of elemental diet in the treatment of RA. Elemental diet is an hypoallergenic protein-free artificial diet consisting of essential amino acids, glucose, trace elements and vitamins. This study was carried out to assess the role of elemental diet and subsequent food reintroduction in RA. Elemental diet (E028) (and a small number of foods) was given to 24 patients with definite RA in order to induce a remission and then foods were gradually introduced. Where a food was suspected of causing symptoms it was removed from the diet. Twenty-three control patients supplemented their usual diet with E028. After the elemental diet there was a statistically significant improvement in the diet group in grip strength (P = 0.008) and Ritchie score (P = 0.006) but not in ESR, CRP, thermographic joint score or functional score. The diet group lost more weight than the control group and this correlated with the improvement in grip strength. This improvement was not present following food reintroduction. As the improvements took place in more subjective disease parameters and because of the difficulties in adequately blinding studies of diet in arthritis, a placebo effect must be considered. There was a high default rate, only 38% of those patients originally enrolled completed the study. In conclusion, this study shows that elemental diet can cause an improvement in a number of disease parameters in RA but this is not sustained by an individualized diet. It also illustrates some of the difficulties involved in the study of diet in arthritis.
饮食在类风湿关节炎（RA）中的作用仍存在争议，目前尚无关于使用要素饮食治疗RA的对照研究。要素饮食是一种低变应原性无蛋白人工饮食，由必需氨基酸、葡萄糖、微量元素和维生素组成。本研究旨在评估要素饮食及随后重新引入食物在RA中的作用。对24例确诊为RA的患者给予要素饮食（E028）（以及少量食物）以诱导缓解，然后逐渐引入食物。若怀疑某种食物引起症状，则将其从饮食中去除。23例对照患者在其日常饮食基础上补充E028。给予要素饮食后，饮食组的握力（P = 0.008）和里奇评分（P = 0.006）有统计学意义的改善，但血沉、C反应蛋白、热成像关节评分或功能评分无改善。饮食组比对照组体重减轻更多，且这与握力的改善相关。重新引入食物后这种改善未出现。由于改善发生在更主观的疾病参数方面，且由于对关节炎饮食进行充分设盲研究存在困难，必须考虑安慰剂效应。失访率很高，最初纳入的患者中只有38%完成了研究。总之，本研究表明要素饮食可使RA的一些疾病参数得到改善，但个体化饮食无法维持这种改善。它还说明了关节炎饮食研究中存在的一些困难。
