title: Is rheumatoid arthritis a disease that starts in the intestine? A pilot study comparing an elemental diet with oral prednisolone.
abstract: OBJECTIVE
  This pilot study aimed to determine if an elemental diet could be used to treat patients with active rheumatoid arthritis and to compare its effect to that of oral prednisolone.
  
  
  METHODS
  Thirty patients with active rheumatoid arthritis were randomly allocated to 2 weeks of treatment with an elemental diet (n = 21) or oral prednisolone 15 mg/day (n = 9). Assessments of duration of early morning stiffness (EMS), pain on a 10 cm visual analog scale (VAS), the Ritchie articular index (RAI), swollen joint score, the Stanford Health Assessment Questionnaire, global patient and physician assessment, body weight, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and haemoglobin, were made at 0, 2, 4 and 6 weeks.
  
  
  RESULTS
  All clinical parameters improved in both groups (p<0.05) except the swollen joint score in the elemental diet group. An improvement of greater than 20% in EMS, VAS and RAI occurred in 72% of the elemental diet group and 78% of the prednisolone group. ESR, CRP and haemoglobin improved in the steroid group only (p<0.05).
  
  
  CONCLUSIONS
  An elemental diet for 2 weeks resulted in a clinical improvement in patients with active rheumatoid arthritis, and was as effective as a course of oral prednisolone 15 mg daily in improving subjective clinical parameters. This study supports the concept that rheumatoid arthritis may be a reaction to a food antigen(s) and that the disease process starts within the intestine.
authors.affiliation: Leicester General Hospital, Leicester, UK
authors.forename: Thrasyvoulos
authors.initials: T
authors.lastname: Podas
authors.forename: Jeremy M D
authors.initials: JM
authors.lastname: Nightingale
authors.forename: Roger
authors.initials: R
authors.lastname: Oldham
authors.forename: S
authors.initials: S
authors.lastname: Roy
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Sheehan
authors.forename: John F
authors.initials: JF
authors.lastname: Mayberry
mesh_terms: D000284:Administration, Oral; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000178:diet therapy / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005526:Food, Formulated; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011239:Prednisolone / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D011239:Prednisolone