In November, RNS Board member Teri Puhalsky, BSN, RN, CRNI, attended the American College of Rheumatology (ACR) Convergence 2022. Throughout our ACR 2022 recap series, Teri provides her perspective and insight into the sessions she attended. This session, presented by Dr. Roberta Ramonda MD, PhD, and Dr. Francesca Oliviero, PhD, MS, PharmD, offered critical findings on the diet’s intricate impact on patients with rheumatic diseases and the many trends that can lead patients astray. Dr. Ramonda spoke on “The Impact of Diet in Arthritis
Session Recap: Food for Thought: DATA for the Impact of Nutrition on Rheumatic Disease
Faculty: Roberta Ramonda, MD, PhD / Francesca Oliviero, PhD, MS, PharmD
Dr. Roberta Ramonda, MD, PhD, spoke on “The Impact of Diet in Arthritis” emphasizing diet’s complex role in the development of rheumatic diseases. The effects of diet are not limited to inflammation and interaction with the immune system. Dr. Ramonda discussed nutrients that affect the immune system in the gut and explained how activated immune cells migrate to the joints and lymphoid tissues.
Overviewing pro-inflammatory and anti-inflammatory nutrients, Dr. Ramonda highlighted PUFA and the risk of rheumatoid arthritis. She discussed the limited role that vitamins play in rheumatic disorders, how sodium will increase the development of pro-inflammatory macrophages and IL-17 production, reminding that Resveratrol proved to have anti-inflammatory and antioxidant properties. Dr. Ramonda also addressed that caffeine can increase risk of RA and seropositive RA.
Dr. Ramonda reviewed specific powerful nutrients that can benefit patients with RA: cocoa and green tea have antioxidant properties, capsaicin can increase the expression of anti-inflammatory macrophages, nanopowdered red ginseng decreases proinflammatory cytokines, and curcumin has many anti-inflammatory properties.
Dr. Ramonda also discussed the beneficial effects of omega 3 fatty acids, although they are dose-dependent at >2gm/day. She discussed the dangers of elimination diets such as being vegan or vegetarian, which lack data on beneficial effects in inflammatory arthritides and rather present possible protein, iron, vit B12, zinc, and calcium deficiencies. A dairy-free diet has no evidence of benefitting inflammatory arthritides, and the reduction of calcium increases the risks of bone fractures. Dairy-free diets also present a loss of beneficial effects of fermented dairy (cardiovascular disease and cancer). Equally, gluten-free diets offer insufficient data in offering benefits to PA patients, and rather eliminate essential minerals and fibers.
As healthcare providers we need to be able to counsel our patients on diet, informing them that while supplements may complement treatments it does not replace them. For patients in need of weight loss, physical exercise should be recommended. Patients with comorbidities will need further specific dietary recommendations. Providers should promote a balanced diet and avoid elimination diets. Omega 3 supplementation may be suggested and that omega3 is effective in SLE.
The Mediterranean diet may also be recommended for its benefits on comorbidities. Spices should be encouraged, but coffee and alcohol should be gauged at a moderate consumption, and salt and sugar should be discouraged.
Dr. Francesca Oliviero, PhD, MS, PharmD, spoke on “Modulatory Mechanisms of Food Components in Inflammation and Autoimmunity.” Her presentation addressed how the mediterranean diet modulates inflammation in arthritis, highlighting nutritive components such as long-chain n-3 PUFA and oleic acid (found in extra virgin olive oil), non-nutritive components like phenolic compounds (found in blueberries and grapes), which also includes resveratrol, and non-nutritive components with nutritional interest like fibers and probiotics.
Dr. Oliviero went on to discuss how polyphenols work in RA and SLE, influencing uric acid levels and crystal-induced inflammation. She diagramed the effectiveness of extra virgin olive oil, describing that it is high in Vitamins E & K, reduces inflammation, cytokines, lowers the risk of autoimmune disease, decreases leukocytes and increases drug absorption.
In closing Dr. Oliverio discussed the bioavailability of bioactive compounds found in plants, emphasizing the importance of eating fruits and vegetables in season.
Teri Puhalsky, BSN, RN, CRNI
Membership Development Chair Registered Nurse
Medstar Orthopaedic Institute
Teri Puhalsky currently resides in Maryland, where she works as an infusion RN at Medstar Orthopaedic Institute. She studied nursing at Excelsior College School of Nursing and has been practicing rheumatology since 2011. Teri received the Outstanding Clinical Performance Award as an LPN, obtained her CRNI in 2012, and is a member of Sigma Theta Tau International PhiPi Chapter. She strives for positive patient outcomes and firmly believes that collaboration with the healthcare team is critical for chronic disease management. With a patient-focused and evidence-based nursing practice, she knows all patients can receive quality, safe, and effective care.