Is diet important in rheumatoid arthritis?

There is evidence from several well documented case reports that occasional patients with rheumatoid arthritis (RA) may develop aggravation of their arthritis as a result of allergy to some ingredient in the diet. A variety of foodstuffs have been implicated including milk and milk products, corn and cereals. Total fasting results in improvement in rheumatoid arthritis, but appears to be mediated by diminution in production of chemical mediators of inflammation, rather than by elimination of a dietary allergen. There is conflicting evidence from studies using various intestinal probes that patients with rheumatoid arthritis may have a 'leaky' intestinal mucosa allowing food allergens to be more easily absorbed. Clinical therapeutic trials of exclusion diets have employed the standard strategy of the double-blind randomized method. However, this presupposes that patients entered into such a study are capable of improvement with dietary manipulation. Since this is often not the case, a more appropriate method would be to employ the 'intensive research design' also known as 'single case experiment' and 'N of 1' study. 'Masked food intolerance' is an attractive hypothesis, but extremely difficult to prove. It is doubtful whether fish oils and/or evening primrose oil will be of significant long term benefit for patients with RA. However, they do provide for the possibility that a fatty acid-like substance may be found which may be incorporated into cell membranes, thereby preventing production of mediators of inflammation, such as prostaglandin E2 and leukotriene B4.

Radiological changes in rheumatoid arthritis: measurement of area of juxta-articular bone as outcome event in clinical therapeutic trials of antirheumatic drugs.

A high degree of intra - and inter - rater reproducibility was obtained in measurement of a standardized area of the head of the first right metacarpal using a precision digitizer. This instrument had an accuracy for every point digitized of 0.127 mm. Intra-rater difference between readings at approximately a month's interval showed no significant differences. The method is reasonably simple to perform and is applicable to small joints such as the proximal interphalangeal joints. The method may prove useful in following progression of joint damage in rheumatoid arthritis.

50-foot walking time: a critical assessment of an outcome measure in clinical therapeutic trials of antirheumatic drugs.

Fifty-foot walking time was used in 51 of 187 clinical therapeutic trials of antirheumatic drugs and in only 21 instances was statistical significance reached. Measurement of the 50-foot walking time showed no better performance in long-term trials of SAARDs than in short-term trials of NSAIDs. It is concluded that the 50-foot walking time is a poor outcome measure in rheumatic disease trials, despite a high intra- and interobserver reproducibility.

Are 'homeopathic' doses of oral corticosteroids effective in rheumatoid arthritis?

When patients with rheumatoid arthritis whose clinical disease activity was stable had their oral prednisolone of less than 5 mg per day (mean 3.5 mg) replaced by placebo, there was an almost immediate flare in their arthritis. This confirms that such low dose prednisolone therapy is effective in controlling joint inflammation.

Evaluation of pain threshold using a simple pressure algometer.

Pain threshold was measured using a simple pressure algometer in 190 subjects. The measurement had a highly acceptable intra-observer error. Significantly lower pain thresholds were observed in all of the five areas of the body studied in females. The most sensitive area was the forehead. There was a higher pain threshold in the dominant hand. Anxiety and fear of pain significantly reduced the threshold.