title: Anti-inflammatory effect of exclusive enteral nutrition in patients with juvenile idiopathic arthritis.
abstract: OBJECTIVE
  There is extensive evidence for an influence of gut microbiota on the immune system, which has consequences for inflammatory diseases. Exclusive enteral nutrition (EEN), which may change the gut microbiota, is an effective anti-inflammatory treatment for Crohn's disease in children. We wanted to explore the immediate anti-inflammatory effect of EEN in children with juvenile idiopathic arthritis (JIA).
  
  
  METHODS
  Thirteen patients with JIA (7-17 years of age), in a disease flare-up, were included in the study. Six children dropped out within 1.5-2.0 weeks of treatment, and seven patients continued, constituting the study cohort. EEN was given for three to eight weeks, with clinical and laboratory status assessed before and after treatment periods. In addition to conventional laboratory tests, 92 inflammatory proteins were analysed with a multiplex system (Proseek Multiplex Inflammation I, Olink Bioscience).
  
  
  RESULTS
  EEN had a significant anti-inflammatory effect on active joints (p=0.031), JADAS27 (p=0.016) and morning stiffness (p=0.031). In the multiplex analysis of inflammatory proteins, MMP-1 (matrix metalloproteinase), involved in the degradation of collagens in chondrocytes, decreased significantly (p=0.047), as did MCP-4 (p=0.031) and 4E-BP1 (p=0.031).
  
  
  CONCLUSIONS
  Exclusive enteral nutrition for three to eight weeks had anti-inflammatory effect in all children with JIA that continued with EEN for more than two weeks. The study is only exploratory but the result supports an immunologically important role for the intestinal canal in these patients.
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Sweden. lillemor.berntson@telia.com.
authors.forename: Lillemor
authors.initials: L
authors.lastname: Berntson
authors.affiliation: Sachs' Children's Hospital, Karolinska Institutet at Sodersjukhuset, Stockholm, Sweden.
authors.forename: Iris
authors.initials: I
authors.lastname: Hedlund-Treutiger
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Sweden.
authors.forename: Kjell
authors.initials: K
authors.lastname: Alving
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000097:blood / Q000276:immunology / Q000382:microbiology / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D002648:Child; D004750:Enteral Nutrition; D005260:Female; D000069196:Gastrointestinal Microbiome; D041981:Gastrointestinal Tract / Q000276:immunology / Q000382:microbiology; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D011446:Prospective Studies; D040081:Protein Array Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators