{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:28:19Z","timestamp":1792013299684,"version":"4.4.0"},"reference-count":127,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010609","name":"Gda\u0144sk Medical University","doi-asserted-by":"publisher","award":["01-10026\/0010451\/01\/262\/0\/2026"],"award-info":[{"award-number":["01-10026\/0010451\/01\/262\/0\/2026"]}],"id":[{"id":"10.13039\/501100010609","id-type":"DOI","asserted-by":"publisher"}]},{"award":["01-10026\/0010451\/01\/262\/0\/2026"],"award-info":[{"award-number":["01-10026\/0010451\/01\/262\/0\/2026"]}],"id":[{"id":"https:\/\/ror.org\/019sbgd69","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Rheumatoid arthritis (RA) is a chronic inflammatory disease of autoimmune background and unknown etiology. The importance of genetic factors in RA development is well-established. Environmental factors have also been extensively researched in relation to risk of RA and managing its symptoms. Smoking, physical activity, diet, and gut microbiota are considered to be the most essential modifiable factors in RA. Among dietary interventions, the most researched is Mediterranean diet, monounsaturated fatty acids, fish consumption, and fish oil (EPA, eicosapentaenoic acid and DHA, that is, docosahexaenoic acid). Others concerned gluten-free and vegan or vegetarian diet, salt intake, supplementation with vitamin D, antioxidants, prebiotics, and probiotics. Diet modifications can alter the gut environment, and the association between RA development or severity and the composition of gut bacteria has already been shown. This review focuses on effectiveness and usefulness of various dietary approaches and supplements in RA prevention and management, including the influence on disease activity and inflammatory status. The composition of gut microbiota and its changes in response to dietary factors are also considered. There is a great need for further research into mutual dependencies of diet, microbiome, and RA activity. The current state of knowledge provides promising evidence for future nutrition and microbial therapies.<\/jats:p>","DOI":"10.3390\/nu18091325","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T14:29:03Z","timestamp":1776868143000},"page":"1325","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Role of Microbiome and Diet on Disease Activity and Immune\u2013Inflammatory Status in Rheumatoid Arthritis"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1591-8343","authenticated-orcid":false,"given":"Aleksandra","family":"Rodziewicz","sequence":"first","affiliation":[{"name":"Laboratory of Photobiology and Molecular Diagnostics, University of Gda\u0144sk, 80-309 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1410-4287","authenticated-orcid":false,"given":"Ewa","family":"Bryl","sequence":"additional","affiliation":[{"name":"Department of Physiopathology, Medical University of Gda\u0144sk, 80-210 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1016\/S0140-6736(10)60826-4","article-title":"Rheumatoid arthritis","volume":"376","author":"Scott","year":"2010","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1002\/art.24385","article-title":"Quantitative heritability of anti-citrullinated protein antibody-positive and anti-citrullinated protein antibody-negative rheumatoid arthritis","volume":"60","author":"Toes","year":"2009","journal-title":"Arthritis Rheumatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1002\/art.23255","article-title":"Physical inactivity in patients with rheumatoid arthritis: Data from twenty-one countries in a cross-sectional, international study","volume":"59","author":"Sokka","year":"2008","journal-title":"Arthritis Rheumatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1002\/acr.21710","article-title":"Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: A long-term followup from disease onset","volume":"65","author":"Ajeganova","year":"2013","journal-title":"Arthritis Care Res."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kupczyk, D., Bilski, R., Szeleszczuk, \u0141., M\u0105dra-Gackowska, K., and Studzi\u0144ska, R. (2025). The Role of Diet in Modulating Inflammation and Oxidative Stress in Rheumatoid Arthritis, Ankylosing Spondylitis, and Psoriatic Arthritis. Nutrients, 17.","DOI":"10.3390\/nu17091603"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1136\/ard.2007.069831","article-title":"Vitamin D and autoimmunity: New aetiological and therapeutic considerations","volume":"66","author":"Arnson","year":"2007","journal-title":"Ann. Rheum. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1007\/s10067-012-2080-7","article-title":"Association between vitamin D intake and the risk of rheumatoid arthritis: A meta-analysis","volume":"31","author":"Song","year":"2012","journal-title":"Clin. Rheumatol."},{"key":"ref_8","first-page":"827","article-title":"Vitamin D level in rheumatoid arthritis and its correlation with the disease activity: A meta-analysis","volume":"34","author":"Lee","year":"2016","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Lin, J., Liu, J., Davies, M.L., and Chen, W. (2016). Serum Vitamin D Level and Rheumatoid Arthritis Disease Activity: Review and Meta-Analysis. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0146351"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"275","DOI":"10.3899\/jrheum.090705","article-title":"Vitamin D status and its associations with disease activity and severity in African Americans with recent-onset rheumatoid arthritis","volume":"37","author":"Craig","year":"2010","journal-title":"J. Rheumatol."},{"key":"ref_11","first-page":"658","article-title":"Associations between vitamin D, disease activity, and clinical response to therapy in rheumatoid arthritis","volume":"30","author":"Baker","year":"2012","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"246","DOI":"10.3109\/14397595.2014.952487","article-title":"Relationships between serum 25-hydroxycalciferol, vitamin D intake and disease activity in patients with rheumatoid arthritis\u2014TOMORROW study","volume":"25","author":"Matsumoto","year":"2015","journal-title":"Mod. Rheumatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"667","DOI":"10.18388\/abp.2017_1636","article-title":"Vitamin D status in patients with rheumatoid arthritis: A correlation analysis with disease activity and progression, as well as serum IL-6 levels","volume":"64","author":"Polasik","year":"2017","journal-title":"Acta Biochim. Pol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e034935","DOI":"10.1136\/bmjopen-2019-034935","article-title":"Association between Vitamin D and fatigue in patients with rheumatoid arthritis: A cross-sectional study","volume":"10","author":"Haugen","year":"2020","journal-title":"BMJ Open."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1111\/1756-185X.12770","article-title":"Role of vitamin D supplementation in improving disease activity in rheumatoid arthritis: An exploratory study","volume":"20","author":"Chandrashekara","year":"2017","journal-title":"Int. J. Rheum. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1080\/1744666X.2020.1805317","article-title":"Vitamin D: Does it help Tregs in active rheumatoid arthritis patients","volume":"16","author":"Gado","year":"2020","journal-title":"Expert Rev. Clin. Immunol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Buondonno, I., Rovera, G., Sassi, F., Rigoni, M.M., Lomater, C., Parisi, S., Pellerito, R., Isaia, G.C., and D\u2019Amelio, P. (2017). Vitamin D and immunomodulation in early rheumatoid arthritis: A randomized doubleblind placebo-controlled study. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0178463"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1002\/biof.1096","article-title":"Mediterranean diet and health","volume":"39","author":"Sofi","year":"2013","journal-title":"Biofactors"},{"key":"ref_19","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_20","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1136\/ard.2006.065151","article-title":"A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow","volume":"66","author":"McKellar","year":"2007","journal-title":"Ann. Rheum. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Papandreou, P., Gioxari, A., Daskalou, E., Grammatikopoulou, M.G., Skouroliakou, M., and Bogdanos, D.P. (2023). Mediterranean Diet and Physical Activity Nudges versus Usual Care in Women with Rheumatoid Arthritis: Results from the MADEIRA Randomized Controlled Trial. Nutrients, 15.","DOI":"10.3390\/nu15030676"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S116","DOI":"10.1097\/RHU.0000000000001064","article-title":"Effect of a Dynamic Exercise Program in Combination with Mediterranean Diet on Quality of Life in Women with Rheumatoid Arthritis","volume":"26","author":"Llorente","year":"2020","journal-title":"J. Clin. Rheumatol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Raad, T., George, E., Griffin, A., Larkin, L., Fraser, A., Kennedy, N., and Tierney, A. (2024). Effects of a telehealth-delivered Mediterranean diet intervention in adults with Rheumatoid Arthritis (MEDRA): A randomised controlled trial. BMC Musculoskelet. Disord., 25.","DOI":"10.1186\/s12891-024-07742-1"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"6004916","DOI":"10.1155\/2022\/6004916","article-title":"Dietary Pattern or Weight Loss: Which One Is More Important to Reduce Disease Activity Score in Patients with Rheumatoid Arthritis? A Randomized Feeding Trial","volume":"2022","author":"Sadeghi","year":"2022","journal-title":"Int. J. Clin. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1002\/acr.22481","article-title":"Mediterranean diet and incidence of rheumatoid arthritis in women","volume":"67","author":"Hu","year":"2015","journal-title":"Arthritis Care Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s00296-014-3185-x","article-title":"Diet and alcohol as risk factors for rheumatoid arthritis: A nested case-control study","volume":"35","author":"Sundstrom","year":"2015","journal-title":"Rheumatol. Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1002\/art.41487","article-title":"Mediterranean Diet and Risk of Rheumatoid Arthritis: Findings from the French E3N-EPIC Cohort Study","volume":"73","author":"Nguyen","year":"2021","journal-title":"Arthritis Rheumatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/j.clnu.2017.02.011","article-title":"Monounsaturated fatty acids might be key factors in the Mediterranean diet that suppress rheumatoid arthritis disease activity: The TOMORROW study","volume":"37","author":"Matsumoto","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Barbalace, M.C., Talotta, R., Rapisarda, F., D\u2019Amico, V., Lagan\u00e0, M., Malaguti, M., Campenn\u00ec, A., Cannav\u00f2, S., Hrelia, S., and Ruggeri, R.M. (2025). Unlocking the Power of the Mediterranean Diet: Two in One\u2014Dual Benefits for Rheumatic and Thyroid Autoimmune Diseases. Nutrients, 17.","DOI":"10.3390\/nu17081383"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/1475-2891-13-31","article-title":"U.S. adults are not meeting recommended levels for fish and omega-3 fatty acid intake: Results of an analysis using observational data from NHANES 2003\u20132008","volume":"13","author":"Papanikolaou","year":"2014","journal-title":"Nutr. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1051\/rnd:2005047","article-title":"Conversion of alpha-linolenic acid to longer-chain polyunsaturated fatty acids in human adults","volume":"45","author":"Burdge","year":"2005","journal-title":"Reprod. Nutr. Dev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s00296-002-0234-7","article-title":"Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis","volume":"23","author":"Adam","year":"2003","journal-title":"Rheumatol. Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1111\/j.1365-2362.1992.tb01431.x","article-title":"The effects of dietary supplementation with n-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: A randomized, double blind trial","volume":"22","author":"Nielsen","year":"1992","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"178","DOI":"10.3109\/03009749209099218","article-title":"Effect of six months of fish oil supplementation in stable rheumatoid arthritis. A double-blind, controlled study","volume":"21","author":"Skoldstam","year":"1992","journal-title":"Scand. J. Rheumatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1093\/rheumatology\/32.11.982","article-title":"Effects of fish oil supplementation on non-steroidal anti-inflammatory drug requirement in patients with mild rheumatoid arthritis\u2014A double-blind placebo controlled study","volume":"32","author":"Lau","year":"1993","journal-title":"Br. J. Rheumatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1136\/annrheumdis-2013-204145","article-title":"Fish oil in recent onset rheumatoid arthritis: A randomised, double-blind controlled trial within algorithm-based drug use","volume":"74","author":"Proudman","year":"2015","journal-title":"Ann. Rheum. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.pain.2007.01.020","article-title":"A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain","volume":"129","author":"Goldberg","year":"2007","journal-title":"Pain"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.arcmed.2012.06.011","article-title":"Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: A meta-analysis","volume":"43","author":"Lee","year":"2012","journal-title":"Arch. Med. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.nut.2017.06.023","article-title":"Intake of omega-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: A systematic review and meta-analysis","volume":"45","author":"Gioxari","year":"2018","journal-title":"Nutrition"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1007\/s00394-021-02707-9","article-title":"The effect of flaxseed with or without anti-inflammatory diet in patients with rheumatoid arthritis, a randomized controlled trial","volume":"61","author":"Nazarinia","year":"2022","journal-title":"Eur. J. Nutr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1002\/acr.23295","article-title":"Relationship Between Fish Consumption and Disease Activity in Rheumatoid Arthritis","volume":"70","author":"Tedeschi","year":"2018","journal-title":"Arthritis Care Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2631","DOI":"10.1007\/s00394-024-03451-6","article-title":"A randomized controlled cross-over trial investigating the acute inflammatory and metabolic response after meals based on red meat, fatty fish, or soy protein: The postprandial inflammation in rheumatoid arthritis (PIRA) trial","volume":"63","author":"Hulander","year":"2024","journal-title":"Eur. J. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s00394-025-03710-0","article-title":"A randomized controlled cross-over trial of differences in acute effects on serum metabolites from isocaloric meals based on red meat, fatty fish, or soy protein","volume":"64","author":"Lindqvist","year":"2025","journal-title":"Eur. J. Nutr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1186\/s13075-014-0446-8","article-title":"Fish consumption and risk of rheumatoid arthritis: A dose-response meta-analysis","volume":"16","author":"Crippa","year":"2014","journal-title":"Arthritis Res. Ther."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1289\/ehp.9887","article-title":"Positive associations of serum concentration of polychlorinated biphenyls or organochlorine pesticides with self-reported arthritis, especially rheumatoid type, in women","volume":"115","author":"Lee","year":"2007","journal-title":"Environ. Health Perspect."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1136\/annrheumdis-2013-203338","article-title":"Long-term intake of dietary long-chain n-3 polyunsaturated fatty acids and risk of rheumatoid arthritis: A prospective cohort study of women","volume":"73","author":"Wallin","year":"2014","journal-title":"Ann. Rheum. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1097\/00001648-199605000-00007","article-title":"Diet and rheumatoid arthritis in women: A possible protective effect of fish consumption","volume":"7","author":"Shapiro","year":"1996","journal-title":"Epidemiology"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Sparks, J.A., O\u2019Reilly, \u00c9.J., Barbhaiya, M., Tedeschi, S.K., Malspeis, S., Lu, B., Willett, W.C., Costenbader, K.H., and Karlson, E.W. (2019). Association of fish intake and smoking with risk of rheumatoid arthritis and age of onset: A prospective cohort study. BMC Musculoskelet. Disord., 20.","DOI":"10.1186\/s12891-018-2381-3"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1089\/107555302753507195","article-title":"Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis","volume":"8","author":"McDougall","year":"2002","journal-title":"J. Altern. Complement. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2683","DOI":"10.1093\/rheumatology\/keac693","article-title":"A multidisciplinary lifestyle program for rheumatoid arthritis: The \u2018Plants for Joints\u2019 randomized controlled trial","volume":"62","author":"Walrabenstein","year":"2023","journal-title":"Rheumatology"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S0300-483X(00)00276-6","article-title":"Antioxidants in vegan diet and rheumatic disorders","volume":"155","author":"Hanninen","year":"2000","journal-title":"Toxicology"},{"key":"ref_52","first-page":"747","article-title":"Effect of a strict vegan diet on energy and nutrient intakes by Finnish rheumatoid patients","volume":"47","author":"Rauma","year":"1993","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1093\/rheumatology\/40.10.1175","article-title":"A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: The effects on arthritis correlate with a reduction in antibodies to food antigens","volume":"40","author":"Hafstrom","year":"2001","journal-title":"Rheumatology"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"R34","DOI":"10.1186\/ar2388","article-title":"Gluten-free vegan diet induces decreased LDL and oxidized LDL levels and raised atheroprotective natural antibodies against phosphorylcholine in patients with rheumatoid arthritis: A randomized study","volume":"10","author":"Elkan","year":"2008","journal-title":"Arthritis Res. Ther."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e13409","DOI":"10.1111\/sji.13409","article-title":"Impact of gluten intake on clinical outcomes in patients with chronic inflammatory diseases initiating biologics: Secondary analysis of the prospective multicentre BELIEVE cohort study","volume":"100","author":"Gregersen","year":"2024","journal-title":"Scand. J. Immunol."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Khanna, S., Jaiswal, K.S., and Gupta, B. (2017). Managing Rheumatoid Arthritis with Dietary Interventions. Front. Nutr., 4.","DOI":"10.3389\/fnut.2017.00052"},{"key":"ref_57","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_58","first-page":"357","article-title":"Serum levels of interleukin-6 and dehydroepiandrosterone sulphate in response to either fasting or a ketogenic diet in rheumatoid arthritis patients","volume":"18","author":"Fraser","year":"2000","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Hartmann, A.M., D\u2019Urso, M., Dell\u2019Oro, M., Koppold, D.A., Steckhan, N., Michalsen, A., Kandil, F.I., and Kessler, C.S. (2023). Post Hoc Analysis of a Randomized Controlled Trial on Fasting and Plant-Based Diet in Rheumatoid Arthritis (NutriFast): Nutritional Supply and Impact on Dietary Behavior. Nutrients, 15.","DOI":"10.3390\/nu15040851"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2357","DOI":"10.1038\/s41598-025-86734-0","article-title":"The effects of intermittent fasting on antioxidant and inflammatory markers and liver enzymes in postmenopausal, overweight and obese women with rheumatoid arthritis: A randomized controlled trial","volume":"15","author":"Tavakoli","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"103189","DOI":"10.1016\/j.ctim.2025.103189","article-title":"Effects of intermittent fasting diet in overweight and obese postmenopausal women with rheumatoid arthritis: A randomized controlled clinical trial","volume":"91","author":"Ranjbar","year":"2025","journal-title":"Complement. Ther. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1080\/030097401316909549","article-title":"Selenium supplementation in rheumatoid arthritis investigated in a double blind, placebo-controlled trial","volume":"30","author":"Peretz","year":"2001","journal-title":"Scand. J. Rheumatol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1007\/s12291-009-0053-7","article-title":"Effect of green tea extract and vitamin C on oxidant or antioxidant status of rheumatoid arthritis rat model","volume":"24","author":"Meki","year":"2009","journal-title":"Indian J. Clin. Biochem."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1002\/art.24194","article-title":"Vitamin E in the primary prevention of rheumatoid arthritis: The Women\u2019s Health Study","volume":"59","author":"Karlson","year":"2008","journal-title":"Arthritis Rheumatol."},{"key":"ref_65","first-page":"293","article-title":"Antioxidants as adjuvant therapy in rheumatoid disease. A preliminary study","volume":"51","author":"Helmy","year":"2001","journal-title":"Arzneimittelforschung"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1007\/s10067-008-0848-6","article-title":"Antioxidant intervention in rheumatoid arthritis: Results of an open pilot study","volume":"27","author":"Rijken","year":"2008","journal-title":"Clin. Rheumatol."},{"key":"ref_67","first-page":"835","article-title":"Beneficial role of antioxidants on clinical outcomes and erythrocyte antioxidant parameters in rheumatoid arthritis patients","volume":"5","author":"Jalili","year":"2014","journal-title":"Int. J. Prev. Med."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.nut.2018.10.010","article-title":"Cranberry juice decreases disease activity in women with rheumatoid arthritis","volume":"60","author":"Thimoteo","year":"2019","journal-title":"Nutrition"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"111183","DOI":"10.1016\/j.nut.2021.111183","article-title":"Beneficial effects of fish oil and cranberry juice on disease activity and inflammatory biomarkers in people with rheumatoid arthritis","volume":"86","author":"Fatel","year":"2021","journal-title":"Nutrition"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.1002\/ptr.4639","article-title":"A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis","volume":"26","author":"Chandran","year":"2012","journal-title":"Phytother. Res."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1089\/jmf.2017.3930","article-title":"A Novel Highly Bioavailable Curcumin Formulation Improves Symptoms and Diagnostic Indicators in Rheumatoid Arthritis Patients: A Randomized, Double-Blind, Placebo-Controlled, Two-Dose, Three-Arm, and Parallel-Group Study","volume":"20","author":"Amalraj","year":"2017","journal-title":"J. Med. Food"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1186\/s13075-021-02583-y","article-title":"Is tea consumption associated with reduction of risk of rheumatoid arthritis? A Swedish case-control study","volume":"23","author":"Westerlind","year":"2021","journal-title":"Arthritis Res. Ther."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1093\/ajcn\/nqaa019","article-title":"Anti-inflammatory Diet in Rheumatoid Arthritis (ADIRA)\u2014A randomized, controlled crossover trial indicating effects on disease activity","volume":"111","author":"Vadell","year":"2020","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1186\/s13075-021-02478-y","article-title":"Change in dietary inflammatory index score is associated with control of long-term rheumatoid arthritis disease activity in a Japanese cohort: The TOMORROW study","volume":"23","author":"Matsumoto","year":"2021","journal-title":"Arthritis Res. Ther."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1038\/nature11868","article-title":"Sodium chloride drives autoimmune disease by the induction of pathogenic TH17 cells","volume":"496","author":"Kleinewietfeld","year":"2013","journal-title":"Nature"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1038\/nature11984","article-title":"Induction of pathogenic TH17 cells by inducible salt-sensing kinase SGK1","volume":"496","author":"Wu","year":"2013","journal-title":"Nature"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1093\/rheumatology\/keu330","article-title":"Interaction between dietary sodium and smoking increases the risk for rheumatoid arthritis: Results from a nested case-control study","volume":"54","author":"Sundstrom","year":"2015","journal-title":"Rheumatology"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"e924","DOI":"10.1097\/MD.0000000000000924","article-title":"High Sodium Intake Is Associated with Self-Reported Rheumatoid Arthritis: A Cross Sectional and Case Control Analysis Within the SUN Cohort","volume":"94","author":"Salgado","year":"2015","journal-title":"Medicine"},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Marouen, S., du Cailar, G., Audo, R., Lukas, C., Vial, G., Tournadre, A., Barrat, E., Ribstein, J., Combe, B., and Morel, J. (2017). Sodium excretion is higher in patients with rheumatoid arthritis than in matched controls. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0186157"},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Scrivo, R., Massaro, L., Barbati, C., Vomero, M., Ceccarelli, F., Spinelli, F.R., Riccieri, V., Spagnoli, A., Alessandri, C., and Desideri, G. (2017). The role of dietary sodium intake on the modulation of T helper 17 cells and regulatory T cells in patients with rheumatoid arthritis and systemic lupus erythematosus. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0184449"},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Mortier, C., Govindarajan, S., Venken, K., and Elewaut, D. (2018). It Takes \u2018Guts\u2019 to Cause Joint Inflammation: Role of Innate-like T Cells. Front. Immunol., 9.","DOI":"10.3389\/fimmu.2018.01489"},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Guerreiro, C.S., Calado, A., Sousa, J., and Fonseca, J.E. (2018). Diet, Microbiota, and Gut Permeability\u2014The Unknown Triad in Rheumatoid Arthritis. Front. Med., 5.","DOI":"10.3389\/fmed.2018.00349"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1038\/nm.3914","article-title":"The oral and gut microbiomes are perturbed in rheumatoid arthritis and partly normalized after treatment","volume":"21","author":"Zhang","year":"2015","journal-title":"Nat. Med."},{"key":"ref_84","first-page":"1500","article-title":"Fecal microbiota in early rheumatoid arthritis","volume":"35","author":"Vaahtovuo","year":"2008","journal-title":"J. Rheumatol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13073-016-0299-7","article-title":"An expansion of rare lineage intestinal microbes characterizes rheumatoid arthritis","volume":"8","author":"Chen","year":"2016","journal-title":"Genome Med."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"113518","DOI":"10.1016\/j.biopha.2022.113518","article-title":"Collinsella is associated with cumulative inflammatory burden in an established rheumatoid arthritis cohort","volume":"153","author":"Tinahones","year":"2022","journal-title":"Biomed. Pharmacother."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"6665563","DOI":"10.1155\/2021\/6665563","article-title":"The Gut Microbiota and Its Relevance to Peripheral Lymphocyte Subpopulations and Cytokines in Patients with Rheumatoid Arthritis","volume":"2021","author":"Li","year":"2021","journal-title":"J. Immunol. Res."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"6839356","DOI":"10.1155\/2022\/6839356","article-title":"Oral and Intestinal Bacterial Substances Associated with Disease Activities in Patients with Rheumatoid Arthritis: A Cross-Sectional Clinical Study","volume":"2022","author":"Kitamura","year":"2022","journal-title":"J. Immunol. Res."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s13075-023-03013-x","article-title":"Factors associated with the composition of the gut microbiome in patients with established rheumatoid arthritis and its value for predicting treatment responses","volume":"25","author":"Koh","year":"2023","journal-title":"Arthritis Res. Ther."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"3486","DOI":"10.1093\/rheumatology\/keae045","article-title":"Treatment response in rheumatoid arthritis is predicted by the microbiome: A large observational study in UK DMARD-naive patients","volume":"63","author":"Danckert","year":"2024","journal-title":"Rheumatology"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"4014","DOI":"10.1093\/rheumatology\/keae706","article-title":"A predictive model based on the gut microbiota improves the diagnostic effect in patients with rheumatoid arthritis","volume":"64","author":"Wang","year":"2025","journal-title":"Rheumatology"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.34133\/research.1097","article-title":"The Gut Microbiota: Emerging Evidence in Autoimmune and Inflammatory Diseases","volume":"9","author":"Zeng","year":"2025","journal-title":"Research"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"4315","DOI":"10.1111\/bph.15852","article-title":"Short-chain fatty acids regulate B cells differentiation via the FFA2 receptor to alleviate rheumatoid arthritis","volume":"179","author":"Yao","year":"2022","journal-title":"Br. J. Pharmacol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1016\/j.cmet.2020.03.003","article-title":"Microbiota-Derived Metabolites Suppress Arthritis by Amplifying Aryl-Hydrocarbon Receptor Activation in Regulatory B Cells","volume":"31","author":"Rosser","year":"2020","journal-title":"Cell. Metab."},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"H\u00e4ger, J., Bang, H., Hagen, M., Frech, M., Tr\u00e4ger, P., Sokolova, M., 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_96","doi-asserted-by":"crossref","unstructured":"Wang, Z., Yu, Y., Liao, J., Hu, W., Bian, X., Wu, J., and Zhu, Y.Z. (2021). S-Propargyl-Cysteine Remodels the Gut Microbiota to Alleviate Rheumatoid Arthritis by Regulating Bile Acid Metabolism. Front. Cell. Infect. Microbiol., 11.","DOI":"10.3389\/fcimb.2021.670593"},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Yu, D., Du, J., Pu, X., Zheng, L., Chen, S., Wang, N., Li, J., Chen, S., Pan, S., and Shen, B. (2022). The Gut Microbiome and Metabolites Are Altered and Interrelated in Patients with Rheumatoid Arthritis. Front. Cell. Infect. Microbiol., 11.","DOI":"10.3389\/fcimb.2021.763507"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1002\/fbe2.70016","article-title":"Extraction, Characterization, and Impact of Polysaccharides from Zhonghuang No. 1 Etiolated-Green Tea on Human Fecal Microbiota","volume":"4","author":"Tian","year":"2025","journal-title":"Food Bioeng."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"106949","DOI":"10.1016\/j.fitote.2025.106949","article-title":"Digestion characteristics of Changyanning formula and its regulatory effect on fecal microbiota and metabolites during in vitro fermentation","volume":"187","author":"Huang","year":"2025","journal-title":"Fitoterapia"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1258\/002367793780810441","article-title":"Intestinal, segmented, filamentous bacteria in a wide range of vertebrate species","volume":"27","author":"Klaasen","year":"1993","journal-title":"Lab. Anim."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.cell.2009.09.033","article-title":"Induction of intestinal Th17 cells by segmented filamentous bacteria","volume":"139","author":"Ivanov","year":"2009","journal-title":"Cell"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1016\/j.immuni.2010.06.001","article-title":"Gut-residing segmented filamentous bacteria drive autoimmune arthritis via T helper 17 cells","volume":"32","author":"Wu","year":"2010","journal-title":"Immunity"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1016\/j.immuni.2016.03.013","article-title":"Gut Microbiota Drive Autoimmune Arthritis by Promoting Differentiation and Migration of Peyer\u2019s Patch T Follicular Helper Cells","volume":"44","author":"Teng","year":"2016","journal-title":"Immunity"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1111\/imm.12760","article-title":"The immune response to Prevotella bacteria in chronic inflammatory disease","volume":"151","author":"Larsen","year":"2017","journal-title":"Immunology"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"e01202","DOI":"10.7554\/eLife.01202","article-title":"Expansion of intestinal Prevotella copri correlates with enhanced susceptibility to arthritis","volume":"2","author":"Scher","year":"2013","journal-title":"eLife"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1136\/annrheumdis-2018-214514","article-title":"Prevotella copri in individuals at risk for rheumatoid arthritis","volume":"78","author":"Lesker","year":"2019","journal-title":"Ann. Rheum. Dis."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1002\/art.40003","article-title":"Evidence of the Immune Relevance of Prevotella copri, a Gut Microbe, in Patients with Rheumatoid Arthritis","volume":"69","author":"Pianta","year":"2017","journal-title":"Arthritis Rheumatol."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"2878","DOI":"10.1002\/art.39785","article-title":"Suppression of Inflammatory Arthritis by Human Gut-Derived Prevotella histicola in Humanized Mice","volume":"68","author":"Marietta","year":"2016","journal-title":"Arthritis Rheumatol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"eabn5166","DOI":"10.1126\/scitranslmed.abn5166","article-title":"Clonal IgA and IgG autoantibodies from individuals at risk for rheumatoid arthritis identify an arthritogenic strain of Subdoligranulum","volume":"14","author":"Chriswell","year":"2022","journal-title":"Sci. Transl. Med."},{"key":"ref_110","doi-asserted-by":"crossref","unstructured":"Li, H., Dai, J., Zhao, C., Hu, T., Zhao, G., Wang, Q., and Zhang, L. (2024). Gut Subdoligranulum variabile ameliorates rheumatoid arthritis by promoting TSG-6 synthesis from joint cells. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1418717"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1016\/j.chom.2023.03.018","article-title":"Fusobacterium nucleatum aggravates rheumatoid arthritis through FadA-containing outer membrane vesicles","volume":"31","author":"Hong","year":"2023","journal-title":"Cell Host Microbe"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1080\/03009740310003695","article-title":"Effects of probiotic therapy on the activity and activation of mild rheumatoid arthritis\u2014A pilot study","volume":"32","author":"Hatakka","year":"2003","journal-title":"Scand. J. Rheumatol."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1111\/1756-185X.12333","article-title":"Effects of Lactobacillus casei supplementation on disease activity and inflammatory cytokines in rheumatoid arthritis patients: A randomized double-blind clinical trial","volume":"17","author":"Alipour","year":"2014","journal-title":"Int. J. Rheum. Dis."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.nut.2013.09.007","article-title":"Probiotic supplementation improves inflammatory status in patients with rheumatoid arthritis","volume":"30","author":"Alipour","year":"2014","journal-title":"Nutrition"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1111\/1756-185X.12888","article-title":"Clinical and metabolic response to probiotic supplementation in patients with rheumatoid arthritis: A randomized, double-blind, placebo-controlled trial","volume":"19","author":"Zamani","year":"2016","journal-title":"Int. J. Rheum. Dis."},{"key":"ref_116","first-page":"CR347","article-title":"A randomized, double-blinded, placebo-controlled pilot study of probiotics in active rheumatoid arthritis","volume":"17","author":"Pineda","year":"2011","journal-title":"Med. Sci. Monit."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"111282","DOI":"10.1016\/j.nut.2021.111282","article-title":"Mixture of probiotics reduces inflammatory biomarkers and improves the oxidative\/nitrosative profile in people with rheumatoid arthritis","volume":"89","author":"Cannarella","year":"2021","journal-title":"Nutrition"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.3855\/jidc.21182","article-title":"Therapeutical efficacy of immunobiotics in patients with newly diagnosed rheumatoid arthritis","volume":"19","author":"Barac","year":"2025","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1017\/S000711451700085X","article-title":"Synbiotic supplementation and the effects on clinical and metabolic responses in patients with rheumatoid arthritis: A randomised, double-blind, placebo-controlled trial","volume":"117","author":"Zamani","year":"2017","journal-title":"Br. J. Nutr."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"30732","DOI":"10.1038\/s41598-025-16611-3","article-title":"Inulin supplementation improves some inflammatory indices, clinical outcomes, and quality of life in rheumatoid arthritis patients","volume":"15","author":"Tabatabaeyan","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1017\/S0007114517001593","article-title":"Adherence to the Mediterranean diet is associated with the gut microbiota pattern and gastrointestinal characteristics in an adult population","volume":"117","author":"Mitsou","year":"2017","journal-title":"Br. J. Nutr."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1136\/gutjnl-2015-309957","article-title":"High-level adherence to a Mediterranean diet beneficially impacts the gut microbiota and associated metabolome","volume":"65","author":"Pellegrini","year":"2016","journal-title":"Gut"},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1093\/rheumatology\/33.7.638","article-title":"Changes of faecal flora in rheumatoid arthritis during fasting and one-year vegetarian diet","volume":"33","author":"Peltonen","year":"1994","journal-title":"Br. J. Rheumatol."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1093\/rheumatology\/36.1.64","article-title":"Faecal microbial flora and disease activity in rheumatoid arthritis during a vegan diet","volume":"36","author":"Peltonen","year":"1997","journal-title":"Br. J. Rheumatol."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1017\/S0007114509371767","article-title":"Effects of a gluten-free diet on gut microbiota and immune function in healthy adult human subjects","volume":"102","author":"Nadal","year":"2009","journal-title":"Br. J. Nutr."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s13073-016-0295-y","article-title":"The influence of a short-term gluten-free diet on the human gut microbiome","volume":"8","author":"Bonder","year":"2016","journal-title":"Genome Med."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1016\/j.cmet.2024.08.007","article-title":"Dietary-timing-induced gut microbiota diurnal oscillations modulate inflammatory rhythms in rheumatoid arthritis","volume":"36","author":"Ma","year":"2024","journal-title":"Cell Metab."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/9\/1325\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T04:14:49Z","timestamp":1778213689000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/9\/1325"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,22]]},"references-count":127,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["nu18091325"],"URL":"https:\/\/doi.org\/10.3390\/nu18091325","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,22]]}}}