Gastrointestinal disorders and rheumatic diseases.

Although we continue to learn more about the persistence of bacterial antigens in patients with HLA-B27, the significance of this persistence in the pathogenesis of the spondyloarthropathies remains unclear. The role of dietary antigen exposure and the ability of true food allergy to produce rheumatic complaints is even less definite, although most authors now agree that dietary manipulation using allergen-free or allergen-restricted diets may benefit a small number of patients with rheumatic disease complaints. Dietary manipulation substituting omega-3 for omega-6 fatty acids, however, is frequently beneficial to rheumatoid patients. Is this the way of the future? It is certain that dietary manipulation is less toxic than the standard therapies. It is also certain that we cannot guarantee that any standard therapy will work, except perhaps for prednisone administration. We really have nothing to lose by pursuing this therapeutic approach, and I am surprised that although we have become very diet conscious, dietary manipulation as therapy for patients with rheumatic diseases continues to be underinvestigated, particularly in systemic lupus erythematosus and Sjögren's syndrome.