The Triad of Nutrition, Intestinal Microbiota and Rheumatoid Arthritis (TASTY)

The Triad of Nutrition, Intestinal Microbiota and Rheumatoid Arthritis (TASTY)

The main goal of this trial is to investigate whether a dietary intervention based on a typical Mediterranean Diet enriched with fermented foods (MedDiet+) can impact gut microbiota and RA-related outcomes.

100 RA patients will be recruited at ULS Santa Maria in Lisbon, Portugal, and randomly assigned to either the intervention (MedDiet+) or the control group. The 12-week nutritional intervention will include a personalized dietary plan based on the MedDiet+ pattern, educational resources, food basket deliveries, and clinical culinary workshops, all developed and monitored weekly by registered dietitians. The control group will receive general recommendations for a healthy diet at baseline. The intervention's effects will be assessed by evaluating disease activity, functional status, quality of life, intestinal permeability, endotoxemia, inflammatory biomarkers, intestinal and oral microbiota, serum proteomics, and serum glycome profile characterisation.

Inclusion Criteria:

• RA patients (ACR/EULAR2010 criteria)
• Age >18-years
• Disease duration >1-year
• Active disease (DAS28 > 2.6units)
• On stable medication for 12 weeks
• Low/medium MedDiet adherence (PREDIMED<10)
• Willing to comply with study protocol

Exclusion Criteria:

• Prednisolone dose ≥ 7.5 mg/day
• Antibiotic therapy 4-weeks prior to baseline
• Persistent use of NSAID's
• Inflammatory or irritable bowel disease
• Celiac disease
• Chronic diarrhea
• Diabetes
• Other immune-mediated inflammatory diseases besides RA
• Major organ dysfunction
• Cancer diagnosed in the last five years
• Health conditions which may difficult participation (cognitive impairment/psychiatric disease)
• Pregnant or lactating individuals