COMMENTARY

Rheumatology Advances to Know From 2015

Kevin Deane, MD, PhD

Disclosures

December 23, 2015

In This Article

Diet and Lifestyle Factors

Several studies over 2015 expanded our understanding of the role that diet and lifestyle factors may play in both the activity of existing rheumatic disease, and risk for future disease.

In RA, a Japanese study found that smoking appeared to reduce remission rates in men, although perhaps less so in women.[34] This, coupled with a large body of work that has identified a link between smoking and incident RA, response to therapy, and multiple other health factors, continues to support smoking cessation efforts in patients with rheumatic disease.

Sparks and colleagues[35] found that after bariatric surgery and weight loss, patients with RA had improvements in disease activity and systemic inflammation. Somewhat conversely, using a cohort of patients with RA from a Veterans Affairs database, Baker and colleagues[36] found that weight loss in RA patients was a predictor of mortality. These findings are somewhat difficult to integrate, although it may be that they were actually measuring different aspects of weight loss and RA in which intentional weight loss may be of benefit, whereas unintentional weight loss may signal abnormal and potentially deadly underlying pathology.[37]

These issues will need to be evaluated in future studies. However, given the overall well-known benefits of weight loss on multiple health issues—including cardiovascular disease, glucose metabolism, and reduced risks for osteoarthritis and mechanical knee pain[38]—weight loss should still be an important part of management of rheumatic disease.

As for other specific dietary and lifestyle changes that could affect rheumatic disease, using data from the Nurses' Health Study, Hu and colleagues[39] found that a Mediterranean diet did not appear to reduce risk for future RA. Also, vitamin D supplementation did not appear to alter the interferon signature in lupus.[40]

Katz and colleagues[41] did find in a cross-sectional study that fatigue in RA was probably multifactorial, including influences from poor sleep, mood disorders and obesity. The next steps will be to identify means to effectively address these issues.

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