{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T04:15:13Z","timestamp":1789186513915,"version":"build-2803163510"},"reference-count":59,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,10,9]],"date-time":"2021-10-09T00:00:00Z","timestamp":1633737600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Introduction: Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease affecting the synovial joints and causing severe disability. Environmental and lifestyle factors, including diet, have been proposed to play a role in the onset and severity of RA. Dietary manipulation may help to manage the symptoms of RA by lowering inflammation and potentially decreasing pain. Methods: In 40 patients with long-standing RA with stable symptoms and treated with conventional (c-) and biological (b-) disease modifying anti-rheumatic drugs (DMARDs), the effect of a 3-month diet avoiding meat, gluten, and lactose (and all dairy products; privative diet) was evaluated in comparison with a control balanced diet including those foods. Both diets were designed to reduce weight since all patients were overweight or obese. Patients were randomly assigned to one of the diets, and RA was clinically assessed at Time 0 (T0), through the Visual Analogue Scale (VAS), for pain, and the Disease Activity Score of 28 joints (DAS 28) for RA activity. Patients were also administered the Short Form Health survey (SF-36) and the Health Assessment Questionnaire (HAQ). At T0, a blood sample was collected for laboratory tests and adipokines measurements, and anthropometric measurements were compared. These evaluations were repeated at the end of the 3 months\u2019 dietary regimens. Results: A significant decrease in VAS and the improvement of the overall state of physical and mental health, assessed through SF-36, was observed in patients assigned to the privative diet. Both dietary regimens resulted in the improvement of quality of life compared to baseline values; however, the change was significant only for the privative diet. With either diet, patients showed significant decreases in body weight and body mass index, with a reduction in waist and hips circumference and lower basal glucose and circulating leptin levels. A privative diet was also able to significantly reduce systolic (p = 0.003) and diastolic (p = 0.025) arterial pressure. The number of circulating leukocytes and neutrophils, and the level of hs-C-Reactive Protein also decreased after 3 months of the meat-, lactose-, and gluten-free diet. Conclusions: Our results suggest that a privative diet can result in a better control of inflammation in RA patients under stable optimized drug treatment.<\/jats:p>","DOI":"10.3390\/nu13103535","type":"journal-article","created":{"date-parts":[[2021,10,10]],"date-time":"2021-10-10T21:37:29Z","timestamp":1633901849000},"page":"3535","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["Improvement of Inflammation and Pain after Three Months\u2019 Exclusion Diet in Rheumatoid Arthritis Patients"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7225-0891","authenticated-orcid":false,"given":"Maria Teresa","family":"Guagnano","sequence":"first","affiliation":[{"name":"Department of Medicine and Aging Sciences, University \u201cG. d\u2019Annunzio\u201d of Chieti-Pescara, 66013 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1477-0706","authenticated-orcid":false,"given":"Chiara","family":"D\u2019Angelo","sequence":"additional","affiliation":[{"name":"Department of Medicine and Aging Sciences, University \u201cG. d\u2019Annunzio\u201d of Chieti-Pescara, 66013 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Caniglia","sequence":"additional","affiliation":[{"name":"Department of Medicine and Aging Sciences, University \u201cG. d\u2019Annunzio\u201d of Chieti-Pescara, 66013 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6448-8960","authenticated-orcid":false,"given":"Pamela","family":"Di Giovanni","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, University \u201cG. d\u2019Annunzio\u201d of Chieti-Pescara, 66013 Chietii, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Celletti","sequence":"additional","affiliation":[{"name":"Department of Medicine and Aging Sciences, University \u201cG. d\u2019Annunzio\u201d of Chieti-Pescara, 66013 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Sabatini","sequence":"additional","affiliation":[{"name":"Department of Medicine and Aging Sciences, University \u201cG. d\u2019Annunzio\u201d of Chieti-Pescara, 66013 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenza","family":"Speranza","sequence":"additional","affiliation":[{"name":"Department of Medicine and Aging Sciences, University \u201cG. d\u2019Annunzio\u201d of Chieti-Pescara, 66013 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Bucci","sequence":"additional","affiliation":[{"name":"Department of Medicine and Aging Sciences, University \u201cG. d\u2019Annunzio\u201d of Chieti-Pescara, 66013 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Cipollone","sequence":"additional","affiliation":[{"name":"Department of Medicine and Aging Sciences, University \u201cG. d\u2019Annunzio\u201d of Chieti-Pescara, 66013 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3467-9317","authenticated-orcid":false,"given":"Roberto","family":"Paganelli","sequence":"additional","affiliation":[{"name":"Department of Medicine and Aging Sciences, University \u201cG. d\u2019Annunzio\u201d of Chieti-Pescara, 66013 Chieti, Italy"},{"name":"YDA, Institute of Clinical Immunotherapy and Advanced Biological Treatments, 65121 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"ITC1","DOI":"10.7326\/AITC201901010","article-title":"Rheumatoid Arthritis","volume":"170","author":"Sparks","year":"2019","journal-title":"Ann. Intern. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2205","DOI":"10.1056\/NEJMra1004965","article-title":"The pathogenesis of rheumatoid arthritis","volume":"365","author":"McInnes","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1016\/j.autrev.2018.05.009","article-title":"Are we really what we eat? Nutrition and its role in the onset of rheumatoid arthritis","volume":"17","author":"Philippou","year":"2018","journal-title":"Autoimmun. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1111\/imr.12556","article-title":"The nutrition-gut microbiome-physiology axis and allergic diseases","volume":"278","author":"McKenzie","year":"2017","journal-title":"Immunol. Rev."},{"key":"ref_5","first-page":"w14190","article-title":"How the Mediterranean diet and some of its components modulate inflammatory pathways in arthritis","volume":"145","author":"Oliviero","year":"2015","journal-title":"Swiss Med. Wkly."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.berh.2018.10.005","article-title":"Update on the epidemiology, risk factors, and disease outcomes of rheumatoid arthritis","volume":"32","year":"2018","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.3389\/fimmu.2017.01745","article-title":"Aging, Obesity, and Inflammatory Age-Related Diseases","volume":"8","author":"Frasca","year":"2017","journal-title":"Front. Immunol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"439","DOI":"10.3389\/fimmu.2018.00439","article-title":"Interrelation of Diet, Gut Microbiome, and Autoantibody Production","volume":"9","author":"Petta","year":"2018","journal-title":"Front. Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"D\u2019Angelo, C., Reale, M., and Costantini, E. (2017). Microbiota and Probiotics in Health and HIV Infection. Nutrients, 9.","DOI":"10.3390\/nu9060615"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/j.micinf.2013.07.004","article-title":"The role of diet in triggering human inflammatory disorders in the modern age","volume":"15","author":"Huang","year":"2013","journal-title":"Microbes Infect."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1038\/nri.2017.7","article-title":"Dysbiosis and the immune system","volume":"17","author":"Levy","year":"2017","journal-title":"Nat. Rev. Immunol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1002\/eji.202048876","article-title":"Crossing the barriers: Revisiting the gut feeling in rheumatoid arthritis","volume":"51","author":"Brandl","year":"2021","journal-title":"Eur. J. Immunol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1038\/s41584-021-00585-3","article-title":"The gut\u2013joint axis in rheumatoid arthritis","volume":"17","author":"Zaiss","year":"2021","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Gioia, C., Lucchino, B., Tarsitano, M.G., Iannuccelli, C., and Di Franco, M. (2020). Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations?. Nutrients, 12.","DOI":"10.3390\/nu12051456"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s11926-021-01031-9","article-title":"Modificatin of Gut Microbiota in Inflammatory Arthritis: Highlights and Future Challenges","volume":"23","year":"2021","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_16","first-page":"167","article-title":"Antibodies against dietary antigens in rheumatoid arthritis patients treated with fasting and a one-year vegetarian diet","volume":"13","author":"Hvatum","year":"1995","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Hagen, K.B., Byfuglien, M.G., Falzon, L., Olsen, S.U., and Smedslund, G. (2009). Dietary interventions for rheumatoid arthritis. Cochrane Database Syst. Rev., CD006400.","DOI":"10.1002\/14651858.CD006400.pub2"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"233","DOI":"10.2174\/157339709790192486","article-title":"Mediterranean Food Pattern in Rheumatoid Arthritis","volume":"5","author":"Oliviero","year":"2009","journal-title":"Curr. Rheumatol. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1016\/j.autrev.2018.06.007","article-title":"The Mediterranean diet, fish oil supplements and Rheumatoid arthritis outcomes: Evidence from clinical trials","volume":"17","author":"Petersson","year":"2018","journal-title":"Autoimmun. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1093\/nutrit\/nuaa033","article-title":"Rheumatoid arthritis and dietary interventions: Systematic review of clinical trials","volume":"79","author":"Philippou","year":"2021","journal-title":"Nutr. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"222","DOI":"10.5114\/reum.2017.71629","article-title":"Nutrition and quality of life referring to physical abilities\u2014A comparative analysis of a questionnaire study of patients with rheumatoid arthritis and osteoarthritis","volume":"55","author":"Grygielska","year":"2017","journal-title":"Reumatologia"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.1002\/acr.23225","article-title":"Diet and Rheumatoid Arthritis Symptoms: Survey Results from a Rheumatoid Arthritis Registry","volume":"69","author":"Tedeschi","year":"2017","journal-title":"Arthritis Care Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1017\/S0007114500001926","article-title":"The role of meat in the expression of rheumatoid arthritis","volume":"84","author":"Grant","year":"2000","journal-title":"Br. J. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3745","DOI":"10.1002\/art.20732","article-title":"Diet and rheumatoid arthritis: Red meat and beyond","volume":"50","author":"Choi","year":"2004","journal-title":"Arthritis Rheum."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"157","DOI":"10.3184\/003685005783238408","article-title":"The Molecular basis of Lactose Intolerance","volume":"88","author":"Campbell","year":"2005","journal-title":"Sci. Prog."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.mehy.2009.01.008","article-title":"Milk--the promoter of chronic Western diseases","volume":"72","author":"Melnik","year":"2009","journal-title":"Med. Hypotheses"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1177\/0884533611405538","article-title":"Gluten-Free Diet in Nonceliac Disease","volume":"26","author":"Danner","year":"2011","journal-title":"Nutr. Clin. Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2569","DOI":"10.1002\/art.27584","article-title":"2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology\/European League Against Rheumatism collaborative initiative","volume":"62","author":"Aletaha","year":"2010","journal-title":"Arthritis Rheum."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Mazzocchi, A., Leone, L., Agostoni, C., and Pali-Sch\u00f6ll, I. (2019). The Secrets of the Mediterranean Diet. Does [Only] Olive Oil Matter?. Nutrients, 11.","DOI":"10.3390\/nu11122941"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA) (2010). Scientific Opinion on Dietary Reference Values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. EFSA J., 8, 1461. Available online: https:\/\/efsa.onlinelibrary.wiley.com\/doi\/10.2903\/j.efsa.2010.1461.","DOI":"10.2903\/j.efsa.2010.1461"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA) (2010). Scientific Opinion on Dietary Reference Values for carbohydrates and dietary fibre. EFSA J., 8, 1462.","DOI":"10.2903\/j.efsa.2010.1462"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1111\/j.1365-2702.2005.01121.x","article-title":"Pain: A review of three commonly used pain rating scales","volume":"14","author":"Williamson","year":"2005","journal-title":"J. Clin. Nurs."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection","volume":"30","author":"Ware","year":"1992","journal-title":"Med. Care"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1002\/acr.20620","article-title":"Measures of functional status and quality of life in rheumatoid arthritis: Health Assessment Questionnaire Disability Index (HAQ), Modified Health Assessment Questionnaire (MHAQ), Multidimensional Health Assessment Questionnaire (MDHAQ), Health Assessment Questionnaire II (HAQ-II), Improved Health Assessment Questionnaire (Improved HAQ), and Rheumatoid Arthritis Quality of Life (RAQoL)","volume":"63","author":"Maska","year":"2011","journal-title":"Arthritis Care Res."},{"key":"ref_35","first-page":"S40","article-title":"The Disease Activity Score (DAS) and the Disease Activity Score using 28 joint counts (DAS28) in the management of rheumatoid arthritis","volume":"34","author":"Renskers","year":"2016","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.5603\/KP.a2017.0149","article-title":"New indexes of body fat distribution, visceral adiposity index, body adiposity index, waist-to-height ratio, and metabolic disturbances in the obese","volume":"75","author":"Wrzosek","year":"2017","journal-title":"Kardiol. Pol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/BF00280883","article-title":"Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man","volume":"28","author":"Matthews","year":"1985","journal-title":"Diabetologia"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"k1036","DOI":"10.1136\/bmj.k1036","article-title":"Increased cardiovascular risk in rheumatoid arthritis: Mechanisms and implications","volume":"361","author":"England","year":"2018","journal-title":"BMJ"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"R131","DOI":"10.1186\/ar3442","article-title":"Cardiovascular events in early RA are a result of inflammatory burden and traditional risk factors: A five year prospective study","volume":"13","author":"Innala","year":"2011","journal-title":"Arthritis Res. Ther."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"101268","DOI":"10.1016\/j.diabet.2021.101268","article-title":"Adiponectin to leptin ratio reflects inflammatory burden and survival in COVID-19","volume":"47","author":"Sciorati","year":"2021","journal-title":"Diabetes Metab."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1080\/21623945.2017.1402151","article-title":"Adiponectin-leptin ratio: A promising index to estimate adipose tissue dysfunction. Relation with obesity-associated cardiometabolic risk","volume":"7","year":"2018","journal-title":"Adipocyte"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1515\/hmbci-2013-0053","article-title":"The role of leptin\/adiponectin ratio in metabolic syndrome and diabetes","volume":"18","year":"2014","journal-title":"Horm. Mol. Biol. Clin. Investig."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"104915","DOI":"10.1016\/j.psyneuen.2020.104915","article-title":"Adipose tissue dysregulation at the onset of psychosis: Adipokines and social determinants of health","volume":"123","author":"Guay","year":"2021","journal-title":"Psychoneuroendocrinology"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"H\u00e4ger, J., Bang, H., Hagen, M., Frech, M., Tr\u00e4ger, P., Sokolova, M.V., Steffen, U., Tascilar, K., Sarter, K., and Schett, G. (2019). The Role of Dietary Fiber in Rheumatoid Arthritis Patients: A Feasibility Study. Nutrients, 11.","DOI":"10.3390\/nu11102392"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1002\/art.1780330607","article-title":"Dietary fish oil and olive oil supplementation in patients with rheumatoid arthritis. Clinical and immunologic effects","volume":"33","author":"Kremer","year":"1990","journal-title":"Arthritis Rheum."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/S0049-0172(97)80009-1","article-title":"Dietary n-3 fatty acids and therapy for rheumatoid arthritis","volume":"27","author":"James","year":"1997","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1007\/s00296-017-3912-1","article-title":"The effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment: A systematic review of human prospective studies","volume":"38","author":"Forsyth","year":"2018","journal-title":"Rheumatol. Int."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1016\/0140-6736(91)91770-U","article-title":"Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis","volume":"338","author":"Haugen","year":"1991","journal-title":"Lancet"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1136\/ard.62.3.208","article-title":"An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis","volume":"62","author":"Hagfors","year":"2003","journal-title":"Ann. Rheum. Dis."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Dourado, E., Ferro, M., Guerreiro, C.S., and Fonseca, J. (2020). Diet as a Modulator of Intestinal Microbiota in Rheumatoid Arthritis. Nutrients, 12.","DOI":"10.3390\/nu12113504"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Diamanti, A.P., Panebianco, C., Salerno, G., Di Rosa, R., Salemi, S., Sorgi, M.L., Meneguzzi, G., Mariani, M.B., Rai, A., and Iacono, D. (2020). Impact of Mediterranean Diet on Disease Activity and Gut Microbiota Composition of Rheumatoid Arthritis Patients. Microorganisms, 8.","DOI":"10.3390\/microorganisms8121989"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"201","DOI":"10.31138\/mjr.30.4.201","article-title":"Fasting mimicking diets: A literature review of their impact on inflammatory arthritis","volume":"30","author":"Venetsanopoulou","year":"2019","journal-title":"Mediterr. J. Rheumatol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2487","DOI":"10.7150\/ijms.49314","article-title":"Intake of dietary fibre, red and processed meat and risk of late-onset Chronic Inflammatory Diseases: A prospective Danish study on the \u201cdiet, cancer and health\u201d cohort","volume":"17","author":"Rubin","year":"2020","journal-title":"Int. J. Med. Sci."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Nelson, J., Sj\u00f6blom, H., Gjertsson, I., Ulven, S.M., Lindqvist, H.M., and B\u00e4rebring, L. (2020). Do Interventions with Diet or Dietary Supplements Reduce the Disease Activity Score in Rheumatoid Arthritis? A Systematic Review of Randomized Controlled Trials. Nutrients, 12.","DOI":"10.3390\/nu12102991"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"3804","DOI":"10.1002\/art.20731","article-title":"Dietary risk factors for the development of inflammatory polyarthritis: Evidence for a role of high level of red meat consumption","volume":"50","author":"Pattison","year":"2004","journal-title":"Arthritis Rheum."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"259","DOI":"10.5114\/reum.2018.77979","article-title":"The role of diet in rheumatoid arthritis","volume":"56","year":"2018","journal-title":"Reumatologia"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1002\/acr.22932","article-title":"Impact of Obesity on Remission and Disease Activity in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis","volume":"69","author":"Liu","year":"2017","journal-title":"Arthritis Care Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1007\/s00393-016-0050-1","article-title":"Circulating leptin level in rheumatoid arthritis and its correlation with disease activity: A meta-analysis","volume":"75","author":"Lee","year":"2016","journal-title":"Z. Rheumatol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1017\/S0029665110001564","article-title":"Fish oil and rheumatoid arthritis: Past, present and future","volume":"69","author":"James","year":"2010","journal-title":"Proc. Nutr. Soc."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/10\/3535\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:10:49Z","timestamp":1760166649000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/10\/3535"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,9]]},"references-count":59,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["nu13103535"],"URL":"https:\/\/doi.org\/10.3390\/nu13103535","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,9]]}}}