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Diet and obesity 

Diet and obesity
Diet and obesity
Oxford Textbook of Rheumatology (4 ed.)

Dorothy Pattison


The idea that diet might be able to ameliorate the symptoms of arthritis, particularly rheumatoid arthritis (RA), has intrigued patients and researchers for many years. However, ’diets for arthritis’ remain elusive. The costs incurred by the health services and patients in the management of ’arthritis’, particularly osteoarthritis and RA, are high due to surgical interventions, new biological therapies, and hours of work lost due to disability. Other therapies that could prevent or delay such costs, for example diet therapy, should be examined. With the increasing prevalence of obesity in the general population, weight loss is integral in the management of many musculoskeletal conditions; in addition, the increasing understanding and awareness of the presence of systemic disease in such conditions has resulted in a need for dietary advice to address comorbidities such as obesity, insulin resistance, and hypercholesterolaemia. There is a paucity of robust studies to support the use of dietary supplements such as vitamin supplements, alternative remedies, or food exclusions. However, regardless of the number of well-conducted clinical trials of fish oils rich in n-3 polyunsaturated fatty acids (PUFA) showing pain relief, reduction in use of non-steroidal anti-inflammatory drugs (NSAIDs) and other symptomatic benefits in patients with RA, there is no agreed guideline on the possible use of fish oil supplements in clinical practice. The rheumatology team typically includes a nurse, physiotherapist, occupational therapist, and podiatrist alongside the rheumatologist. Given the number of situations where dietary advice is appropriate for rheumatology patients, there should at least be access to dietetic services. There is limited evidence to support dietary intervention in musculoskeletal conditions. Therefore, the opportunity to include dietetics in future clinical research should be seriously considered.

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