Does Rheumatoid Arthritis begin in the Gut?

2007 Feb;83(976):128-31.

Is rheumatoid arthritis a disease that starts in the intestine? A pilot study comparing an elemental diet with oral prednisolone.



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.


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.


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).


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.

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I agree, Megan. Indeed, for anyone with any pathology involving inflammation (which is likely all of them…), not addressing nutrition/lifestyle will make the road back to health longer than it has to be. It will probably be a destination that’s never reached.

Megan F.

It’s good to see that researchers are approaching RA from a holistic viewpoint, but just to be clear, the study didn’t compare elemental diet vs. steroids as the only treatment. These two treatments were instead added to patients’ existing medications: “Patients taking non‐steroidal anti‐inflammatory drugs (NSAIDs), disease‐modifying drugs (DMARDs) or prednisolone at a dose below 15 mg/day were eligible, providing they had been on the same dose for the previous 6 weeks.” Treating only subjective symptoms, and not the underlying inflammation is also high problematic. It’s great that patients feel better on the elemental diet (which in this case was just nutritional shakes), but if the underlying inflammation is still untreated, those patients are still at risk for join damage and other issues related to systemic inflammation. This approach is in stark contrast to current treat-to-target guidelines ( Nevertheless, as someone who has found significant relief by omitting refined carbohydrates and sugars, I would love to see a longer term study like this involving a vegan or paleo-style whole foods diet intervention.

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