FAQ in Clinical Practice

1
FAQ in Clinical Practice

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• Gout ??????????????
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Suggestion diet in RA
Balance, healthy diet for ideal weight
evidence support
reduce red meat
eat more fish (eg. mackerel, sardines) three or
four times a week.
Suggestion diet in Gout
reduce purine rich diet especially from animal
protein
consume low fat daily product eg. skim milk,
yogurt
avoid alcohol consumption particularly beer
drink more water
evidence support
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Scientific Backgroud Diet for RA
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Diet and arthritis
Little scientific evidence confirming the
benefits of modified diets for patients with
arthritis, and mostly focus on diet and RA
Consumption of large amounts of red meat ? linked
to development of RA
Possible explanations

• proinflammatory property of meat fats from iron
  accumulated in syn tissue
• collagen sensitization from a high level of
  protein intake
• the role of nitrite and nitric oxide
• infectious mechanisms such as alterations in
  intestinal flora

Pattison DJ, Symmons DPM, Lunt M et al. Dietary
risk factors for the development of inflammatory
polyarthritis. Evidence for a role of high level
of red meat consumption. Arthritis Rheum 2004
50 3804-3812.
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Diet and arthritis
increase in intake of 30 g fat fish per day ? 49
reduction in the risk of RA Whereas medium fat
fish (3-7 g fat/100 g fish) ? significantly
increased risk
Intake of fruit and coffee was not associated
with risk of RA
no associations were found between risk of RA and
other dietary factors (long chain FA, olive oil,
vitamins A, E, C, D, zinc, selenium, iron, and
meat.
J Rheumatol. 2005 Jul32(7)1249-52
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Fish oil could help ?
the right balance of EFAs is important to control
inflammation.
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There are two groups of EFAs
omega-3 ? found naturally in oily fish
(mackerel, sardines, pilchards, salmon)
main omega-3 EPA DHA
fish liver oil (cod or halibut) also contains
these EFAs vit D, ? helps the body to absorb
calcium
omega-6 ? the best known source is evening
primrose oil, also in
sunflower oil. main omega-6 GLA
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Scientific Backgroud Diet for RA
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Diet and Gout
association of purine-rich foods with gout had
long been suspected but never proven
N Engl J Med. 20043501071-1073, 1093-1103
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Diet and Gout

• Incidence of gout 1.0-1.8 / 1,000

• high intake of meat seafood consumption ? ?
  risk of gout (RR 1.4-1.5)
• high intake of low-fat dairy products (skim
  milk,yogurt) ? ? risk. (RR 0.5)

• for seafood intake ? risk of gout was stronger
  for men with BMI lt 25

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Diet and Gout
there was a potential protective effect from
vegetable and dairy proteins
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Diet and Gout
four weeks of a dairy-free diet ? associated
with a significant increase in uric acid levels
June 1995 issue of the European Journal of
Epidemiology,
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Diet and Gout
"Dietary manipulation and behavioral modification
to reduce risk of gout may have a much more
substantial impact than currently believed
Individual who have family history of gout are at
high risk
"Reducing red meat consumption may be recommended
because it also has been associated with such
problems as colon cancer and diabetes
healthy foods such as vegetables do not need to
be restricted
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Gout and alcohol consumption
The risk of gout is significantly raised with
alcohol intake as low as 10.0 to 14.9 g / day
with a dose-response relationship.
Risk is 2.5 times higher in men who consume 50 g
or more / day independent of BMI and other
dietary factors
Beer and liquor consumption carry the greatest
risk, while moderate wine consumption does not
increase risk of incident gout.
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Gout and alcohol consumption

• For alcohol consumption of 5.0 to 9.9 g per day,
  the RR of gout was 1.3

• For daily consumption of 50 g or more per day,
  the RR was 3.02

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Mechanism of ethanol in inducing hyperuricemia
Both increased urate production and decreased
urate excretion Beer having predominantly
guanosine as its high purine content
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Calcium and Osteophytes in OA
In OA patients, no data supports the relationship
between osteophyte formation and calcium
supplement
evidence support
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Mechanism of osteophyte formation in OA
Although osteophyte is viewed as a remodelling
and reparative feature of OA, the factors that
determine osteophyte formation and growth are
unknown.
Growth factors (TGF-b, IGF-1) influence both
chondrocyte synthesis and osteophyte formation
in experimental joint damage.
Evidence from animal and human studies shows that
cartilage damage initiates "secondary"
osteophyte growth.
However, osteophyte may also develop as an
isolated feature associated with age and precede
rather than follow cartilage loss in animal
studies.
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Mechanism of osteophyte formation in OA
Joint instability has been emphasised as a
biomechanical trigger to osteophyte formation,
with osteophyte and bone remodelling being viewed
as an attempt to stabilise and broaden the
compromised joint to better withstand loading
forces.
Chondrocalcinosis due to calcium pyrophosphate
crystals has also been suggested to be
associated with a tendency to osteophyte
formation and a "hypertrophic" form of OA.
Possibly, multiple factors may influence
osteophyte formation and contribute to the marked
heterogeneity of OA.
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High calorie diet with lower protein
Raw egg ? incomplete protein digestion
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