DIETARY INTERVENTIONS FOR SUPPORTIVE MANAGEMENT OF RHEUMATOID ARTHRITIS, SJÖGREN'S SYNDROME, AND SYSTEMIC LUPUS ERYTHEMATOSUS: A LITERATURE REVIEW

Monika Błądek; Gabriela Barszcz; Natalia Bębenek; Karolina Drygała; Sylwia Wit; Paulina Frączkiewicz; Izabela Harpula; Radosław Ramotowski; Justyna Bogdan; Benedykt Baljon; Patryk Brzezicki

doi:10.31435/ijitss.1(49).2026.4871

Authors

Monika Błądek College of Medical Sciences, University of Rzeszów, Rzeszów, Poland https://orcid.org/0009-0005-1939-0891
Gabriela Barszcz College of Medical Sciences, University of Rzeszów, Rzeszów, Poland https://orcid.org/0009-0004-0127-6225
Natalia Bębenek College of Medical Sciences, University of Rzeszów, Rzeszów, Poland https://orcid.org/0009-0006-6976-6698
Karolina Drygała College of Medical Sciences, University of Rzeszów, Rzeszów, Poland https://orcid.org/0009-0002-0049-3856
Sylwia Wit College of Medical Sciences, University of Rzeszów, Rzeszów, Poland https://orcid.org/0009-0004-9866-2092
Paulina Frączkiewicz 5 Military Clinical Hospital SPZOZ in Cracow, Cracow, Poland https://orcid.org/0000-0002-4163-2843
Izabela Harpula Clinical Provincial Hospital No. 2 in Rzeszów, Rzeszów, Poland https://orcid.org/0009-0005-3167-159X
Radosław Ramotowski Clinical Provincial Hospital No. 2 in Rzeszów, Rzeszów, Poland https://orcid.org/0009-0007-2880-7788
Justyna Bogdan CM Łańcut Sp. z o.o., St. Michael the Archangel Hospital, Łańcut, Poland https://orcid.org/0009-0002-8599-3656
Benedykt Baljon CM Łańcut Sp. z o.o., St. Michael the Archangel Hospital, Łańcut, Poland https://orcid.org/0009-0008-0843-4627
Patryk Brzezicki Infant Jesus Clinical Hospital UCC MUW (University Clinical Centre, Medical University of Warsaw), Warsaw, Poland https://orcid.org/0000-0003-1788-807X

DOI:

https://doi.org/10.31435/ijitss.1(49).2026.4871

Keywords:

Dietary Interventions, Rheumatoid Arthritis, Sjögren's Syndrome, Systemic Lupus Erythematosus

Abstract

Rheumatological diseases, including rheumatoid arthritis (RA), Sjögren’s syndrome (SS), and systemic lupus erythematosus (SLE), affect millions worldwide. Standard therapy includes pharmacological treatment, physiotherapy, and, if needed, surgery; however, clinical improvement is not always achieved. Consequently, additional strategies such as dietary interventions are being explored. Chronic inflammation plays a key role in these diseases. Diets rich in anti-inflammatory components, particularly the Mediterranean diet, may reduce disease severity, symptoms, and inflammatory markers in RA and SLE. Intermittent fasting, ketogenic, and plant-based diets may also be beneficial. A literature review of PubMed using the terms “rheumatoid arthritis AND diet,” “Sjögren’s syndrome AND diet,” and “systemic lupus erythematosus AND diet,” alongside current rheumatology treatment guidelines, identified 30 relevant articles. Although evidence remains limited, positive findings support further research. Well-designed, evidence-based diets could complement pharmacological therapy, enhancing treatment outcomes and patient quality of life.

References

Termine, M., Davidson, Z., Choi, T., & Leech, M. (2024). What do we know about dietary perceptions and beliefs of patients with rheumatoid arthritis? A scoping review. Rheumatology International, 44(10), 1861–1874. https://doi.org/10.1007/s00296-024-05691-5

Ramos-Casals, M., Brito-Zerón, P., Bombardieri, S., & EULAR-Sjögren Syndrome Task Force Group. (2020). EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies. Annals of the Rheumatic Diseases, 79, 3–18.

Fanouriakis, A., Kostopoulou, M., Alunno, A., Aringer, M., Costenbader, K., Daikh, D., et al. (2019). 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Annals of the Rheumatic Diseases, 78, 736–745.

Bekar, C., Armagan, B., Sari, A., & Ayaz, A. (2025). Evaluation of serum total antioxidant level, nutritional status and Mediterranean diet adherence of adult women with rheumatoid arthritis: A case-control study. British Journal of Nutrition, 133(2), 239–245. https://doi.org/10.1017/S0007114524003386

Djordjevic, K., Milojevic Samanovic, A., Veselinovic, M., Zivkovic, V., Mikhaylovsky, V., Mikerova, M., Reshetnikov, V., Jakovljevic, V., & Nikolic Turnic, T. (2023). Oxidative stress mediated therapy in patients with rheumatoid arthritis: A systematic review and meta-analysis. Antioxidants, 12(11), 1938. https://doi.org/10.3390/antiox12111938

England, B. R., Smith, B. J., Baker, N. A., Barton, J. L., Oatis, C. A., Guyatt, G., Anandarajah, A., Carandang, K., Chan, K. K., Constien, D., Davidson, E., Dodge, C. V., Bemis-Dougherty, A., Everett, S., Fisher, N., Fraenkel, L., Goodman, S. M., Lewis, J., Menzies, V., Moreland, L. W., et al. (2023). 2022 American College of Rheumatology guideline for exercise, rehabilitation, diet, and additional integrative interventions for rheumatoid arthritis. Arthritis & Rheumatology, 75(8), 1299–1311. https://doi.org/10.1002/art.42507

Johansson, K., Askling, J., Alfredsson, L., Di Giuseppe, D., & EIRA Study Group. (2018). Mediterranean diet and risk of rheumatoid arthritis: A population-based case-control study. Arthritis Research & Therapy, 20(1), 175. https://doi.org/10.1186/s13075-018-1680-2

Zhan, Y., Yang, Z., Liu, Y., Zhan, F., & Lin, S. (2023). Interaction between rheumatoid arthritis and Mediterranean diet on the risk of cardiovascular disease for the middle aged and elderly from National Health and Nutrition Examination Survey (NHANES). BMC Public Health, 23(1), 620. https://doi.org/10.1186/s12889-023-15478-1

Búr, Z., Vendl, B., Sűdy, Á. R., Lumniczky, Z., Szántó, C. G., Mócsai, A., Káldi, K., & Ella, K. (2025). Time-restricted feeding alleviates arthritis symptoms augmented by high-fat diet. Frontiers in Immunology, 16, 1512328. https://doi.org/10.3389/fimmu.2025.1512328

Tavakoli, A., Akhgarjand, C., Ansar, H., Houjaghani, H., Khormani, A., Djafarian, K., Rostamian, A., Ranjbar, M., & Farsani, G. M. (2025). The effects of intermittent fasting on antioxidant and inflammatory markers and liver enzymes in postmenopausal, overweight and obese women with rheumatoid arthritis: A randomized controlled trial. Scientific Reports, 15(1), 2357. https://doi.org/10.1038/s41598-025-86734-0

Heidt, C., Pons-Kühnemann, J., Kämmerer, U., Marquardt, T., & Reuss-Borst, M. (2023). MCT-induced ketosis and fiber in rheumatoid arthritis (MIKARA)—Study protocol and primary endpoint results of the double-blind randomized controlled intervention study indicating effects on disease activity in RA patients. Nutrients, 15(17), 3719. https://doi.org/10.3390/nu15173719

Walrabenstein, W., Wagenaar, C. A., van der Leeden, M., Turkstra, F., Twisk, J. W. R., Boers, M., van Middendorp, H., Weijs, P. J. M., & van Schaardenburg, D. (2023). A multidisciplinary lifestyle program for rheumatoid arthritis: The “Plants for Joints” randomized controlled trial. Rheumatology, 62(8), 2683–2691. https://doi.org/10.1093/rheumatology/keac693

Goncerz, G. (2020). Local and systemic treatment of Sjögren's syndrome: Summary of the European League Against Rheumatism 2019 guidelines. Medycyna Praktyczna, 2, 62–68.

Goldner, B., & Staffier, K. L. (2024). Case series: Raw, whole, plant-based nutrition protocol rapidly reverses symptoms in three women with systemic lupus erythematosus and Sjögren's syndrome. Frontiers in Nutrition, 11, 1208074. https://doi.org/10.3389/fnut.2024.1208074

Tsigalou, C., Stavropoulou, E., & Bezirtzoglou, E. (2018). Current insights in microbiome shifts in Sjogren's syndrome and possible therapeutic interventions. Frontiers in Immunology, 9, 1106. https://doi.org/10.3389/fimmu.2018.01106

Sciascia, S., Ferrara, G., Roccatello, L., Rubini, E., Foddai, S. G., Radin, M., Cecchi, I., Rossi, D., Barinotti, A., Ricceri, F., Gilcrease, W., Baldovino, S., Ferreira Poshar, A., Conti, A., & Fenoglio, R. (2024). The interconnection between systemic lupus erythematosus and diet: Unmet needs, available evidence, and guidance—A patient-driven, multistep-approach study. Nutrients, 16(23), 4132. https://doi.org/10.3390/nu16234132

Wang, B., Wang, H., Huang, J., & Zhao, T. (2024). Association between unsaturated fatty acid-type diet and systemic lupus erythematosus: A systematic review with meta-analyses. Nutrients, 16(12), 1974. https://doi.org/10.3390/nu16121974

Knippenberg, A., Robinson, G. A., Wincup, C., Ciurtin, C., Jury, E. C., & Kalea, A. Z. (2022). Plant-based dietary changes may improve symptoms in patients with systemic lupus erythematosus. Lupus, 31(1), 65–76. https://doi.org/10.1177/09612033211063795

Islam, M. A., Khandker, S. S., Kotyla, P. J., & Hassan, R. (2020). Immunomodulatory effects of diet and nutrients in systemic lupus erythematosus (SLE): A systematic review. Frontiers in Immunology, 11, 1477. https://doi.org/10.3389/fimmu.2020.01477

Correa-Rodríguez, M., Pocovi-Gerardino, G., Callejas-Rubio, J. L., Ríos Fernández, R., Martín-Amada, M., Cruz-Caparros, M. G., Medina-Martínez, I., Ortego-Centeno, N., & Rueda-Medina, B. (2020). Dietary intake of free sugars is associated with disease activity and dyslipidemia in systemic lupus erythematosus patients. Nutrients, 12(4), 1094. https://doi.org/10.3390/nu12041094

Mok, C. C. (2013). Vitamin D and systemic lupus erythematosus: An update. Expert Review of Clinical Immunology, 9, 453–463. https://doi.org/10.1586/eci.13.19

Andreoli, L., Dall’Ara, F., Piantoni, S., Zanola, A., Piva, N., Cutolo, M., & Tincani, A. (2015). A 24-month prospective study on the efficacy and safety of two different monthly regimens of vitamin D supplementation in pre-menopausal women with systemic lupus erythematosus. Lupus, 24, 499–506. https://doi.org/10.1177/0961203314559089

Aranow, C., Kamen, D. L., Dall’Era, M., Massarotti, E. M., Mackay, M. C., Koumpouras, F., Coca, A., Chatham, W. W., Clowse, M. E. B., Criscione-Schreiber, L. G., et al. (2015). Randomized, double-blind, placebo-controlled trial of the effect of vitamin D3 on the interferon signature in patients with systemic lupus erythematosus. Arthritis & Rheumatology, 67, 1848–1857. https://doi.org/10.1002/art.39108

Jiao, H., Acar, G., Robinson, G. A., Ciurtin, C., Jury, E. C., & Kalea, A. Z. (2022). Diet and systemic lupus erythematosus (SLE): From supplementation to intervention. International Journal of Environmental Research and Public Health, 19(19), 11895. https://doi.org/10.3390/ijerph191911895

Zhang, X., Meng, J., Shi, X., Quinet, R. J., Davis, W., Zakem, J., Keshavamurthy, C., Patel, R., Lobo, G., Hellmers, L., Ray, A. N., Rivers, L. E., Ali, H., Posas-Mendoza, T., Hille, C., & You, Z. (2023). Lupus pathogenesis and autoimmunity are exacerbated by high fat diet-induced obesity in MRL/lpr mice. Lupus Science & Medicine, 10(1), e000898. https://doi.org/10.1136/lupus-2023-000898

Choi, E. W., Kim, H. J., Jung, Y. C., Go, H. S., & Seong, J. K. (2022). Effects of high fat diet-induced obesity on pathophysiology, immune cells, and therapeutic efficacy in systemic lupus erythematosus. Scientific Reports, 12(1), 18532. https://doi.org/10.1038/s41598-022-21381-3

Meza-Meza, M. R., Vizmanos-Lamotte, B., Muñoz-Valle, J. F., Parra-Rojas, I., Garaulet, M., Campos-López, B., Montoya-Buelna, M., Cerpa-Cruz, S., Martínez-López, E., Oregon-Romero, E., & De la Cruz-Mosso, U. (2019). Relationship of excess weight with clinical activity and dietary intake deficiencies in systemic lupus erythematosus patients. Nutrients, 11(11), 2683. https://doi.org/10.3390/nu11112683

La Cava, A. (2019). The influence of diet and obesity on gene expression in SLE. Genes, 10(5), 405. https://doi.org/10.3390/genes10050405

Liu, Y., Yu, Y., Matarese, G., & La Cava, A. (2012). Cutting edge: Fasting-induced hypoleptinemia expands functional regulatory T cells in systemic lupus erythematosus. Journal of Immunology, 188(5), 2070–2073. https://doi.org/10.4049/jimmunol.1102835

Hsieh, C. C., & Lin, B. F. (2011). Dietary factors regulate cytokines in murine models of systemic lupus erythematosus. Autoimmunity Reviews, 11(1), 22–27. https://doi.org/10.1016/j.autrev.2011.06.009