The impact of lifestyle intervention in rheumatoid arthritis

EULAR – the European Alliance of Associations for Rheumatology – has previously made recommendations for lifestyle interventions in people with rheumatic and musculoskeletal disorders, including rheumatoid arthritis (RA). The overarching principles define the need for a healthy lifestyle, with specific recommendations emphasizing the importance of a healthy, balanced diet.

Now, new work shared at the 2024 EULAR Congress in Vienna expands this with data from a randomized controlled trial.

The 16-week Plants for Joints study examined the effects of a multidisciplinary lifestyle intervention in people with RA, compared with usual care. The intervention was based on a whole-food, plant-based diet, in addition to physical activity and stress management.

Previous reports showed that this intervention significantly reduced the 28-joint disease activity score (DAS28) compared to usual care alone. To expand on this, the researchers wanted to determine the long-term effectiveness of the intervention, specifically with regard to disease activity after two years.

After the first 16-week randomized period, the control group also received the intervention and participants were followed for two years with biannual visits and six annual webinars to promote treatment adherence. People with DAS28

A total of 62% of the original participants also completed the two-year follow-up. Those who dropped out most often indicated that this was because they were too busy, unreachable or did not consent to the second year of the follow-up study.

The long-term results showed that the improvement in DAS28 was sustained two years after completing the intervention – and was significantly lower compared to baseline.

The number of tender joints and general health components of the DAS28 also improved significantly, although there was no significant difference in erythrocyte sedimentation rate and number of swollen joints compared to baseline. The results were similar in people who completed the two-year extension study and in those who dropped out early.

Of the 39 participants who completed follow-up and were taking disease-modifying antirheumatic medications, 44% were able to reduce or discontinue use, 26% had stable use, and 31% had increased medication use. Of those with stable or reduced medication compared to baseline, 65% had an improved DAS28.

After the two-year follow-up, HDL cholesterol was increased and C-reactive protein (CRP) remained significantly lower compared to baseline – although there was no longer a significant difference in weight, waist circumference, LDL cholesterol or HbA1c.

These findings indicate that intensive lifestyle modifications may be effective in the long term for people with RA.

Presented by the European Alliance of Rheumatology Societies (EULAR)