Complementary treatment of ankylosing spondylitis: anti-inflammatory diet
Ankylosing spondylitis (AS) is a chronic inflammatory disease that mainly affects young and middle-aged men with the best brain and physical strength. The prevalence of As in our general population is 0.3% to 0.5%L2 3. Since disability can occur at an early stage of the disease, the disease also often prevents individuals, families and society from receiving education, participating in work and living a normal life due to low back pain and arthritis at the beginning of the disease. In addition to pharmacological treatment, diet is one of the most important adjuncts for AS patients and their relatives.
However, clinicians seldom pay attention to and guide the diet of AS patients. How to eat properly is mostly limited to patient-to-patient communication. A proper diet not only improves nutritional deficiencies, but also reduces the inflammatory process and delays disease recurrence. In recent years, foreign literature has referred to diets that have the ability to reduce inflammation and reduce disease recurrence as anti-inflammatory diets. In view of its importance to the treatment and rehabilitation of AS patients, we now summarize the relevant literature and discuss it with our colleagues in the context of clinical practice in order to improve the therapeutic effect of AS.
1. Effects of anti-inflammatory diet on arthritis other than AS and complementary treatment.
Anti-inflammatory diet, as the most important adjuvant treatment for arthritis, has been effective in rheumatoid arthritis (RA), osteoarthritis and childhood idiopathic arthritis. By reducing blood TNF only, IL-1 and IL-6 levels in arthritis patients, the anti-inflammatory diet reduces joint inflammation and pain, decreases disease activity, prevents relapse or delays relapse, and can reduce the dosage of non-steroidal anti-inflammatory drugs (NSAIDs) HJ.
The Mediterranean diet is a dietary pattern recommended by modern nutrition and is a style of eating (lots of vegetables, fruits, seafood, grains, nuts and olive oil, and small amounts of beef and dairy products and alcohol) specific to the inhabitants living in the Mediterranean region (Greece, Spain, France and southern Italy, among other countries along the Mediterranean coast). This high-fiber, high-vitamin, low-fat, low-calorie diet has long been advocated by the nutritional community.
McKellar et al. investigated 75 female RA patients on a Mediterranean diet and 55 RA patients on a normal diet in a control group, and showed a significant improvement in overall assessment of disease and time to morning stiffness at 6 months and pain scores at 3 and 6 months compared to the control group. of patients felt that diet had a greater impact on disease symptoms.
Katayama et al. Twenty patients with RA who were poorly treated with conventional therapy and in the active phase of the disease were given oral whey protein concentrate with high levels of natural milk antibodies.
The results showed a significant reduction in joint symptoms in the test group compared to the non-treatment group, with 44% of the patients showing a significant effect. Another study in RA showed that clinical symptoms such as morning stiffness, fatigue, joint pain index, and the ability to bend down and pick up clothes from the floor were significantly improved in RA patients given fish oil, soybean oil, or olive oil compared to the non-consumed group. Fasting or vegetarianism through dietary control may also benefit some patients.
When Karatay et al. gave allergenic foods to RA patients with stable disease, not only did the disease worsen, but TNF, IL-B, ESR, and C-reactive protein (CRP) levels increased, and the worsening disease did not stop when the allergenic foods were removed. An epidemiological study in the UK showed that fruit and vegetables, and reduced intake of vitamin C, increased the risk of arthritis in the population. Therefore, a more reasonable anti-inflammatory diet may be more helpful in the treatment of RA patients by eliminating some foods that may worsen the disease.
2. Pathophysiological effects of anti-inflammatory diet on animal models of arthritis.
The therapeutic effect of anti-inflammatory diet on arthritis was also confirmed in animal experiments. After adjuvant-induced arthritis rats were treated with linoleic acid or linolenic acid, the degree of edema reduction in the foot pads of rats was similar to that of the induced perindomethacin treatment group.
In mice with collagen-induced arthritis, the arthritis score and hind paw swelling were significantly reduced in the krill oil supplemented group compared to the model group, and joint pathology also suggested that inflammatory cell infiltration and synovial layer hyperplasia were lower than in the model group Knott et al. showed that polyunsaturated fatty acids reduced the condition of osteoarthritis in guinea pigs, and decreased the levels of most disease markers such as matrix metalloproteinase-2.
3. Anti-inflammatory diet for the complementary treatment of AS.
Diet cannot alter the genetic and immunopathological mechanisms of AS patients, but as an important adjunctive therapy, an anti-inflammatory diet can help reduce inflammation and delay disease recurrence. It has been documented that Klebsiella in the intestinal flora may be a trigger for As, and therefore reducing the intestinal flora can be beneficial in the treatment of patients with As. The growth of intestinal flora is dependent on daily starch intake.
Therefore, reducing starch intake is beneficial for the treatment of AS patients. A “low-starch diet” with reduced intake of bread, potatoes, cakes, and pasta may reduce inflammation and symptoms in patients with AS. In a Norwegian dietary study involving 87 patients with AS and 51 patients with psoriatic arthritis (PsA), one third of the patients with AS and PsA experienced worsening of their disease symptoms after consuming certain foods.
Fifty-seven percent of AS patients and 64% of PsA patients thought that diet had a slight effect on the symptoms of AS, while 43% of AS patients and 36% of PsA patients thought that diet had a greater effect on the symptoms of AS. 14 patients with AS who had been fasted for a short period of 7 to 10 d (not complete fasting, but drinking water, fruit and vegetable juices, etc.; or religious fasting such as Hinduism and Islam), more than half of the patients had improvement in pain, morning stiffness, and joint swelling.
An Australian epidemiological survey showed that 94% of patients with As had or were undergoing dietary supplementation and substitution, and that dietary supplementation and alternative medicine could benefit some AS patients, among others. A case of AS patients with pain in the sacral joint area uncontrolled by nonsteroidal anti-inflammatory drugs (NSAIDs) and tramadol was reported, and after vegetarian treatment, pain and morning stiffness were significantly reduced, and after 3 months of follow-up, not only tramadol was discontinued but also the dosage of NSAIDs was significantly reduced.
Feeding fish oil rich in polyunsaturated fatty acids to mice reduced the production of TNF, IL-l B and IL-6 in macrophages stimulated by endotoxin in vitro. In a randomized controlled study conducted by Sundstr6m et al, 24 patients with AS were randomly divided into 2 groups, one given a low dose of polyunsaturated fatty acids (1.95 gJa) and the other a high dose of polyunsaturated fatty acids (4.55 g/d), and the results showed that patients in the high dose group Bath Ankylosing Spondylitis Disease The results showed that the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) decreased significantly in the high-dose group, while no significant change in disease activity was observed in the low-dose group.
Dairy products are essential foods in people’s daily life. Milk and dairy products contain bacterial fragments that may cause allergy or activate the immune system to induce the development of AS. A study of 25 patients with spondyloarthritis who had morning stiffness, inflammatory lower back pain or polyarticular swelling and pain showed that after 6 weeks of dietary maintenance with the removal of foods such as milk, cheese, yogurt, cream and butter, 13 of the 25 patients had significant improvement in symptoms, and 8 of these 13 patients discontinued treatment with NSAIDs.
After 2 years of follow-up, 6 cases still adhered to no dairy products and no other related treatment was given. Studies on the effects of daily foods such as tea, coffee, and chili peppers on As have not been reported. In addition to promoting anti-inflammatory diet that can help AS disease treatment, we can cooperate with the Department of Nutrition to develop a recipe rich in anti-inflammatory diet for patients’ reference, so that the comprehensive treatment of AS can be more comprehensive.
4. Effects of alcohol consumption, smoking and vitamins on AS, which are closely related to diet.
Alcohol consumption has an important place in our dietary structure, and patients with As are mostly young men who face the intake of alcohol in their daily diet and social activities. A survey by the Finnish National Agency for Disease Insurance showed that the average life expectancy of 71 deceased As patients was 6 to 8 years lower than that of the healthy population, and these patients mostly died from violence and accidents, with excessive alcohol intake being the most important factor causing death. Interestingly, alcohol intake was negatively associated with accidental death in RA patients.
In the treatment of As, methotrexate is commonly used as a treatment for peripheral arthritis. The most common and serious adverse effect of methotrexate is hepatotoxicity, which is increased by alcohol intake. nSAIDs are the cornerstone of AS treatment, and the most frequent side effect of NSAIDs is peptic ulceration, while alcohol consumption causes erosion of the gastrointestinal mucosa, and the risk of gastrointestinal bleeding is significantly increased when both risk factors coexist.
Alcohol consumption is mostly accompanied by smoking or passive smoking, and some studies have shown that AS patients who smoke have a more youthful onset, higher disease activity, more pronounced dysfunction, more severe inflammatory activity and structural damage on imaging, and a poorer quality of life.
In addition, elevated inflammatory markers such as c-reactive protein are closely associated with smoking in AS patients. Cautioning AS patients to quit smoking and alcohol will not only help in the treatment of this disease in AS and avoid other risks associated with alcohol and smoking, but also help to gain further trust and support from patients’ families for the treatment of the disease. Vitamins are a class of organic substances that are necessary to maintain the body’s vital activities and are also important active substances to keep the body healthy. Vitamin A plays an important role in the structure and function of bone, and those with vitamin A deficiency can develop symptoms similar to those of old spondyloarthritis3I.
Some studies have shown that serum vitamin A and vitamin A binding protein levels are significantly lower in AS patients than in healthy controls. Vitamin D is closely related to immune function. In a study of 99 patients with AS, 25 hydroxyvitamin D, deficient individuals not only had higher ESR, C-reactive protein and BASDAI, but also had poorer functional status and quality of life. patients with AS tend to have a combination of localized osteoporosis and may benefit from appropriate active vitamin supplementation, but further studies are needed to prove this.
In conclusion, diet is beneficial for AS, however, to date, the relationship between diet and AS is not only poorly studied, but also has a number of problems: first, the relationship between diet and AS is so involved that current research is only in its infancy and only a few components have been tested; second, the research tools are still based on a pharmacological type approach (one molecule/one target), rather than a more comprehensive type approach (multi-component/multi-target);
Third, there is a lack of rigorous population-controlled studies, except for some longitudinal epidemiological studies of unsaturated fatty acids, and the efficacy of dietary effects on AS remains to be evaluated; in particular, population-specific intervention studies are rare. Given that there are no more therapeutic options for AS, more, better, and more refined studies on anti-inflammatory diet for complementary treatment of AS are expected to open up new ideas and avenues for the treatment of AS.