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Randomized Controlled Trial
. 2023 Aug 1;62(8):2683-2691.
doi: 10.1093/rheumatology/keac693.

A multidisciplinary lifestyle program for rheumatoid arthritis: the 'Plants for Joints' randomized controlled trial

Wendy Walrabenstein  1   2   3   4 , Carlijn A Wagenaar  1   2   3 , Marike van der Leeden  1   3   5   6 , Franktien Turkstra  1   3 , Jos W R Twisk  7 , Maarten Boers  7 , Henriët van Middendorp  8 , Peter J M Weijs  4   6   9 , Dirkjan van Schaardenburg  1   2   3
Affiliations
Randomized Controlled Trial

A multidisciplinary lifestyle program for rheumatoid arthritis: the 'Plants for Joints' randomized controlled trial

Wendy Walrabenstein et al. Rheumatology (Oxford). .

Abstract

Objective: To determine the effect of a multidisciplinary lifestyle program in patients with RA with low-moderate disease activity.

Methods: In the 'Plants for Joints' (PFJ) parallel-arm, assessor-blind randomized controlled trial, patients with RA and 28-joint DAS (DAS28) ≥2.6 and ≤5.1 were randomized to the PFJ or control group. The PFJ group followed a 16-week lifestyle program based on a whole-food plant-based diet, physical activity and stress management. The control group received usual care. Medication was kept stable 3 months before and during the trial whenever possible. We hypothesized that PFJ would lower disease activity (DAS28). Secondary outcomes included anthropometric, metabolic and patient-reported measures. An intention-to-treat analysis with a linear mixed model adjusted for baseline values was used to analyse between-group differences.

Results: Of the 83 people randomized, 77 completed the study. Participants were 92% female with mean (s.d.) age of 55 (12) years, BMI of 26 (4) kg/m2 and mean DAS28 of 3.8 (0.7). After 16 weeks the PFJ group had a mean 0.9-point greater improvement of DAS28 vs the control group (95% CI 0.4, 1.3; P < 0.0001). The PFJ intervention led to greater decreases in body weight (difference -3.9 kg), fat mass (-2.8 kg), waist circumference (-3 cm), HbA1c (-1.3 mmol/mol) and low-density lipoprotein (-0.32 mmol/l), whereas patient-reported outcome measures, blood pressure, glucose and other lipids did not change.

Conclusion: The 16-week PFJ multidisciplinary lifestyle program substantially decreased disease activity and improved metabolic status in people with RA with low-moderate disease activity.

Trial registration: International Clinical Trials Registry Platform; https://www.who.int/clinical-trials-registry-platform; NL7800.

Keywords: RA; diet; physical activity; stress management.

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Figures

Figure 1.
Figure 1.
Consolidated Standards of Reporting Trials (CONSORT) diagram flow of participants in the ‘Plants for Joints’ trial
Figure 2.
Figure 2.
DAS with 28 joints (DAS28) at baseline, 8 weeks and at the end of the ‘Plants for Joints’ trial
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References

    1. McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med 2011;365:2205–19. - PubMed
    1. Fraenkel L, Bathon JM, England BR et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol 2021;73:1108–23. - PubMed
    1. Smolen JS, Landewe RBM, Bijlsma JWJ et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis 2020;79:685–99. - PubMed
    1. Einarsson JT, Willim M, Ernestam S et al. Prevalence of sustained remission in rheumatoid arthritis: impact of criteria sets and disease duration, a Nationwide Study in Sweden. Rheumatology (Oxford) 2019;58:227–36. - PubMed
    1. Sloot R, Flinterman L, Heins M et al. Reumatische aandoeningen in Nederland - Ervaringen en kengetallen. Utrecht: NIVEL, 2016.

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