A PLANT-BASED, whole-food diet in combination with physical exercise and a stress management regime significantly reduces the 28-joint disease activity score (DAS28) in patients with rheumatoid arthritis, with effects lasting over 2 years. The groundbreaking results from the Plants for Joints trial were recently presented at the 2024 European Alliance of Associations for Rheumatology (EULAR) congress in Vienna, showcasing the importance of a holistic approach to care.
Following an initial 16-week intervention period, 62% of patients continued the trial for two years. The 2-year intervention consisted of a calorie-unrestricted plant-based version of the Guidelines on Healthy Nutrition from the Health Council of the Netherlands, and the implementation of 150 minutes a week of moderate to intense physical activity and 2 days a week of musculoskeletal strengthening activities. Additionally, patients received continuous education from registered dietitians, physiotherapists, personal trainers and therapists with expertise in sleep and stress reduction. Patients were provided with weekly menus containing recipes, articles, podcasts and six adherence-promoting webinars, presented by the PFJ dieticians or physical therapist, on topics like sustainable weight loss, unprocessed foods, the gut microbiome and guided (mindfulness) exercises. Patients also supplemented methylcobalamin (1500 µg) and cholecalciferol (50 µg) daily.
The improvements seen after the initial 16-week intervention period continued for the 2-year period, with significantly improved DAS28 scores in 65% of participants, including 11 with a DAS28 below 2.6. In particular, significant improvements were demonstrated for tender joint count and general health components of the DAS28, whilst the initially low erythrocyte sedimentation rate and swollen joint count remained low. A proportion of patients with a DAS28 below 2.6 underwent a protocol to taper off their antirheumatic medication during the trial, resulting in 17 (44%) reducing or stopping their medication. Meanwhile, 10 (26%) remained on a stable medication regime, and 12 (31%) increased medication.
Compared to the 16-week intervention, it was revealed that HDL cholesterol increased after 2 years. However, there was no longer a significant difference in weight, waist circumference, LDL cholesterol, or HbA1c, following the 2-year intervention. Similarly to the 16-week follow-up, C-reactive protein remained significantly lower than baseline values.
The data presented at EULAR 2024 demonstrate the significant, long-term impact that a healthy lifestyle intervention can have on disease activity in patients with rheumatoid arthritis, as measured by the DAS28, specifically regarding a plant-based diet with exercise and stress-management strategies. The observed effects are maintained for up to two years, with a majority of patients able to reduce their medication. These findings indicate that a holistic approach to care for patients with rheumatoid arthritis can induce long-lasting beneficial effects.
Katrina Thornber, EMJ
Reference
Wagenaar C, et al. Long-term effectiveness of a lifestyle intervention for rheumatoid arthritis: two-year follow-up after the “Plants for Joints” randomized clinical trial. OP0330. Ann Rheum Dis. 2024;DOI:10.1136/annrheumdis-2024-eular.885.
