1. Introduction
rheumatoid arthritis, Rheumatoid Arthritis, RA, CVD
RHEUMATOID ARTHRITIS, RHEUMATOID ARTHRITIS, EROSION, CHRONIC INFLAMMATION, CARDIOVASCULAR DISEASES, CVD, DISEASE, AUTOIMMUNE DISEASES, PATHOPHYSIOLOGY, SECONDARY, REMISSION, RHEUMATOID ARTHRITIS, PATHOGENESIS
These authors contributed equally to this work.In rheumatoid arthritis (RA), diet quality and nutritional status have been shown to impact the disease activity and adherence to the Mediterranean diet (MD) has been suggested as an anti-inflammatory regime to improve disease status and reduce cardiovascular risk. The Mediterranean DiEt In Rheumatoid Arthritis (MADEIRA) was a single-blind (statistician), two-arm randomized clinical trial, investigating the effects of a 12-week lifestyle intervention, including a personalized isocaloric MD plan with the promotion of physical activity (PA), supported through a clinical decision support systems (CDSS) platform, versus usual care in women with RA. Forty adult women with RA on remission were randomly allocated (1:1 ratio) to either the intervention or the control arm. The intervention group received personalized MD plans and lifestyle consultation on improving PA levels, whereas the controls were given generic dietary and PA advice, based on the National Dietary Guidelines. The primary outcome was that the difference in the MD adherence and secondary outcomes included change in disease activity (DAS28), anthropometric indices (BodPod), dietary intake, PA, vitamin D concentrations, and blood lipid profiles after 12 weeks from the initiation of the trial. At 3 months post-baseline, participants in the MD arm exhibited greater adherence to the MD compared with the controls (Rheumatoid arthritis (RA) is one of the most common autoimmune diseases, inducing a systematic inflammatory state of the joints, gradually leading to bone resorption and cartilage erosion and the destruction of the affected joints [A plethora of genetic and environmental factors have been implicated in the pathogenesis of RA, with diet quality playing a significant role in the development of the entity, its pathophysiology, the manifestation of symptoms, and the management of RA [The MD is a predominantly plant-based diet that includes a variety of fruits, vegetables, whole grains, seeds, legumes, olive oils, and fish, characterized by a moderate intake of dairy products and a low consumption of animal fats [The risk for the development of cardiovascular diseases (CVD) is markedly increased in RA as a result of the chronic inflammation in various body systems, including the heart and the vascular system [With both RA and CVD being predominantly a “female challenge” [