Rheumatology Advance Access originally published online on August 10, 2004
Rheumatology 2004 43(11):1429-1433; doi:10.1093/rheumatology/keh366
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Rheumatology Vol. 43 No. 11 © British Society for Rheumatology 2004; all rights reserved
PAPER |
The effect of individualized diet challenges consisting of allergenic foods on TNF-
and IL-1ß levels in patients with rheumatoid arthritis
Departments of 1 MD, Physical Medicine and Rehabilitation, 2 MD, Dermatology, 3 MD, Biochemistry, Medical Faculty, Atatürk University, Erzurum, Turkey.
Correspondence to: S. Karatay, Atatürk üniversitesi T
p Fakültesi Fiziksel Tp ve Rehabilitasyon Anabilim Dal, 25240 Erzurum, Turkey. E-mail: skaratay73{at}hotmail.com
Objective. To investigate the effect of individualized diet challenges consisting of allergenic foods, defined by the skin prick test (SPT), on tumour necrosis factor-
(TNF-) and interleukin-1ß (IL-1ß) levels in patients with rheumatoid arthritis (RA).
Methods. Twenty patients with a positive SPT response for food extracts and 20 with a negative SPT response were enrolled. None of the patients had active disease. All patients were fasted for the most common allergenic foods for 12 days and then allocated to two groups according to SPT results. Food challenges were performed with allergenic foods in the prick-positive group (PPG) and with corn and rice in the prick-negative group (PNG) for a period of 12 days. Then, allergenic foods were excluded from the PPG patients’ diet and corn and rice were removed from the PNG patients’ diet. Clinical examinations were performed after fasting (baseline), at the end of the challenge phase and at the end of the re-elimination phase. Stiffness, pain, tender and swollen joint counts, health assessment questionnaire (HAQ), Ritchie's articular index, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and serum TNF- and IL-1ß levels were measured.
Results. TNF- (P<0.01), IL-1ß (P<0.05), ESR (P<0.05) and CRP (P = 0.001) levels and all of the clinical variables, except HAQ, were increased with food challenges in the PPG. These increases were also recorded after the re-elimination phase. In the PNG, no significant change was seen in any of the variables, except pain (P<0.05). During the study, important differences were observed for most of the variables between the two groups. Thirteen (72%) patients in the PPG and three (18%) in the PNG experienced disease exacerbation with challenges. This aggravation continued after elimination.
Conclusions. Our results suggest that individualized dietary revisions may regulate TNF- and IL-1ß levels in selected patients with RA.
KEY WORDS: Rheumatoid arthritis, Cytokines, Diet therapy