- Design
- 12-week parallel-group randomised controlled trial
- Population
- 82 adults with seropositive rheumatoid arthritis (49 completed)
- Primary outcome
- Change in DAS28-ESR
- Effect
- −0.92 vs −0.17; difference −0.75 (p = 0.001)
A randomised trial assigned 82 people with seropositive rheumatoid arthritis to the Dietary Approaches to Stop Hypertension (DASH) diet or their usual diet for 12 weeks; 49 completed it.
DAS28-ESR fell by 0.92 with DASH and 0.17 with usual diet, a 0.75-point greater reduction. DAS28-CRP, ESR, pain, global health, HAQ and several SF-36 domains also improved more with DASH. CRP and tender and swollen joint counts did not differ significantly. Greater adherence correlated with larger falls in disease activity.
Attrition was high (40%), the trial was short and unblinded by nature, and the main improvements came from components influenced by ESR and patient-reported scores rather than joint counts.
The DASH diet carries cardiovascular benefits that matter in RA anyway. Recommending it as an adjunct is low-risk, provided it is not presented as a replacement for DMARDs.
- Consider recommending a DASH-style diet as an adjunct in RA.
- Present it as complementary to DMARDs, not a substitute.
- Link dietary advice to cardiovascular risk, which is raised in RA.
- Involve a dietitian where possible to support adherence.
Why it matters
Patients often ask what to eat, and this gives an evidence-informed, low-risk answer.
Don't overread it
Forty per cent dropped out and joint counts did not change; the effect on inflammation is uncertain.
The statistics, in plain English
A 0.75-point greater fall in DAS28 is around the threshold usually taken as a meaningful change. With 40% attrition, those who stayed may have been more motivated, which can inflate the effect.
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