一项为期12周的终止高血压膳食疗法（DASH）饮食在血清阳性类风湿关节炎中的随机对照试验：对疾病活动度和结局的影响。
完整摘要 · 中文译文
背景与目的：饮食干预可能通过抗炎和代谢途径改善类风湿关节炎（RA）的结局。本研究旨在评估终止高血压膳食疗法（DASH）饮食对血清阳性RA患者疾病活动度和治疗结局的影响。 方法：在这项为期12周的平行组随机对照试验中，82例血清阳性RA患者被随机分配至DASH饮食干预组（n = 40）或维持其日常饮食的对照组（n = 42）。主要结局为使用基于红细胞沉降率的28关节疾病活动度评分（DAS-28 ESR）评估的疾病活动度变化。次要结局包括基于C反应蛋白的DAS-28（DAS-28 CRP）变化，以及压痛关节数和肿胀关节数、ESR、CRP、疼痛和总体健康的视觉模拟量表（VAS）评分、健康评估问卷（HAQ）和简表-36（SF-36）。使用DASH饮食评分评估对干预的依从性。在基线和第4、8、12周进行评估。数据按意向性治疗原则分析。重复临床结局酌情使用稳健混合方差分析或广义估计方程（GEE）进行分析。 结果：在82例随机化患者中，49例完成了12周研究。与对照组相比，干预组对DASH饮食的依从性显著增加（p < 0.001）。从基线至第12周，DASH组DAS-28 ESR下降0.92分，而对照组下降0.17分 在对照组中，对应于多降低0.75分（组×时间交互作用，p = 0.001）。在DAS-28 CRP（-0.62）、ESR（-3.90 mm/h）、VAS-疼痛（-2.19）、VAS-总体健康（-2.12）和HAQ（-0.38）的变化方面，也观察到显著的组间差异（所有组×时间交互作用p˂0.05）。对于SF-36，在躯体功能（+10.15）、角色-躯体（+47.30）、躯体疼痛（+22.17）、活力（+18.52）、角色-情绪（+38.61）和心理健康（+12.06）的变化方面，观察到显著的组间差异（所有组×时间交互作用p < 0.05）。CRP、压痛关节数和肿胀关节数未显示显著的组×时间交互作用（p > 0.05）。此外，在干预组中，DASH饮食依从性的改善与DAS-28 ESR和DAS-28 CRP评分的变化呈负相关（两者p < 0.05）。 结论：为期12周的DASH饮食干预可能为血清阳性RA患者的疾病活动度和患者报告结局提供具有临床意义的改善。这些发现支持DASH饮食模式作为补充RA管理的一种有前景的饮食方法的潜在作用。然而，在解释这些发现时应考虑相对较高的脱落率。 试验注册：本试验已在Clinicaltrials.gov注册（ID：NCT07170033）。https://clinicaltrials.gov/study/NCT07170033。
完整摘要 · 英文原文
BACKGROUND & AIMS: Dietary interventions may improve rheumatoid arthritis (RA) outcomes through anti-inflammatory and metabolic pathways. This study aimed to evaluate the effects of the Dietary Approaches to Stop Hypertension (DASH) diet on disease activity and treatment outcomes in patients with seropositive RA. METHODS: In this 12-week parallel-group randomized controlled trial, 82 patients with seropositive RA were randomly assigned to a DASH diet intervention (n = 40) or a control group maintaining their usual diet (n = 42). The primary outcome was change in disease activity assessed using the Disease Activity Score in 28 joints based on erythrocyte sedimentation rate (DAS-28 E SR). Secondary outcomes included change in DAS-28 based on C-reactive protein (DAS-28 CRP), as well as tender and swollen joint counts, ESR, CRP, visual analogue scale (VAS) scores for pain and general health, the Health Assessment Questionnaire (HAQ), and the Short Form-36 (SF-36). Adherence to the intervention was evaluated using the DASH diet score. Assessments were performed at baseline and at weeks 4, 8, and 12. Data were analyzed according to the intention-to-treat principle. Repeated clinical outcomes were analyzed using robust mixed ANOVA or generalized estimating equations (GEE), as appropriate. RESULTS: Of the 82 randomized patients, 49 completed the 12-week study. Adherence to the DASH diet increased significantly in the intervention group compared with the control group (p < 0.001). From baseline to Week 12, DAS-28 ESR decreased by 0.92 points in the DASH group versus 0.17 points in the control group, corresponding to a 0.75-point greater reduction (group × time interaction, p = 0.001). Significant between-group differences in change were also observed for DAS-28 CRP (-0.62), ESR (-3.90 mm/h), VAS-pain (-2.19), VAS-general health (-2.12), and HAQ (-0.38) (all group × time p˂0.05). For SF-36, significant between-group differences in change were observed for physical functioning (+10.15), role-physical (+47.30), bodily pain (+22.17), vitality (+18.52), role-emotional (+38.61), and mental health (+12.06) (all group × time p < 0.05). CRP, tender and swollen joint counts did not show significant group × time interactions (p > 0.05). Furthermore, in the intervention group, improvements in DASH diet adherence were negatively correlated with changes in DAS-28 ESR and DAS-28 CRP scores (both p < 0.05). CONCLUSIONS: A 12-week DASH dietary intervention may provide clinically meaningful improvements in disease activity and patient-reported outcomes in patients with seropositive RA. These findings support the potential role of the DASH dietary pattern as a promising dietary approach to complement the management of RA. However, the relatively high attrition rate should be considered when interpreting the findings. TRIAL REGISTRATION: This trial is registered with Clinicaltrials.gov (ID: NCT07170033). https://clinicaltrials.gov/study/NCT07170033.