{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T19:22:08Z","timestamp":1787858528293,"version":"build-2784847793"},"reference-count":33,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82574970"],"award-info":[{"award-number":["82574970"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Clinical Medical Research Transformation Special Project of Anhui Province","award":["202304295107020114, 202304295107020115"],"award-info":[{"award-number":["202304295107020114, 202304295107020115"]}]},{"name":"Xin\u2019 an Institute of Medicine and Traditional Chinese Medicine Modernization","award":["2023CXMMTCM004, 2023CXMMTCM015"],"award-info":[{"award-number":["2023CXMMTCM004, 2023CXMMTCM015"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>Intermittent fasting (IF) has emerged as a dietary approach with potential therapeutic effects that is gaining recognition. Although several studies have explored the impact of IF on clinical symptoms in patients with rheumatic diseases, a quantitative synthesis of the existing evidence is lacking. This study aims to systematically evaluate the overall effects of IF on disease activity and inflammatory markers in patients with rheumatic diseases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search was conducted in PubMed, Web of Science, Embase, and The Cochrane Library for clinical studies examining intermittent fasting interventions in rheumatic diseases, with a search deadline of March 15, 2026. RevMan 5.4 software was utilized to perform a meta-analysis on the studies that met the inclusion criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of seven independent studies (yielding nine datasets) were included in the analysis, comprising 471 patients with rheumatoid arthritis (RA) and 85 patients with spondyloarthritis (SpA). The results indicated that observational studies, which provide a lower level of evidence, demonstrated significant improvements in disease activity scores associated with intermittent fasting (\n                      <jats:italic>e.g<\/jats:italic>\n                      ., Visual Analog Scale (VAS),\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.05; Disease Activity Score in 28 joints (DAS28),\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.05). Additionally, an analysis of three randomized controlled trials (RCTs) revealed that (IF) significantly reduced DAS28 scores (MD = \u22120.55, 95% CI [\u22121.09 to \u22120.02],\n                      <jats:italic>P<\/jats:italic>\n                      = 0.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings suggest a positive effect of intermittent fasting on disease activity, as indicated by both observational studies and RCTs. However, the reliability of the conclusions drawn from RCTs is limited due to the small number of studies and considerable heterogeneity in the interventions. There is an urgent need for more rigorously designed RCTs to further validate these results.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.21185","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T08:47:30Z","timestamp":1777279650000},"page":"e21185","source":"Crossref","is-referenced-by-count":1,"title":["Intermittent fasting for rheumatic diseases: a systematic review and meta-analysis of conflicting evidence from observational studies and randomized controlled trials"],"prefix":"10.7717","volume":"14","author":[{"given":"Ruofan","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanwei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunfei","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanbing","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4443","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"issue":"3","key":"10.7717\/peerj.21185\/ref-1","doi-asserted-by":"publisher","first-page":"601","DOI":"10.3390\/nu11030601","article-title":"The impact of intermittent fasting (Ramadan fasting) on psoriatic arthritis disease activity, enthesitis, and dactylitis: a multicentre study","volume":"11","author":"Adawi","year":"2019","journal-title":"Nutrients"},{"issue":"1","key":"10.7717\/peerj.21185\/ref-2","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1007\/s00393-016-0251-7","article-title":"Rheumatoid arthritis","volume":"76","author":"Aletaha","year":"2017","journal-title":"Zeitschrift f\u00fcr Rheumatologie"},{"key":"10.7717\/peerj.21185\/ref-3","doi-asserted-by":"publisher","first-page":"368","DOI":"10.5114\/ada.2021.107098","article-title":"Clinical implications of intermittent Ramadan fasting on stable plaque psoriasis: a prospective observational study","volume":"39","author":"Almutairi","year":"2022","journal-title":"Advances in Dermatology and Allergology"},{"issue":"8","key":"10.7717\/peerj.21185\/ref-4","doi-asserted-by":"publisher","first-page":"2433","DOI":"10.1007\/s10067-020-05007-5","article-title":"Impact of Ramadan diurnal intermittent fasting on rheumatic diseases","volume":"39","author":"Ben Nessib","year":"2020","journal-title":"Clinical Rheumatology"},{"issue":"2","key":"10.7717\/peerj.21185\/ref-5","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1007\/s10067-021-05892-4","article-title":"Sustainable positive effects of Ramadan intermittent fasting in rheumatoid arthritis","volume":"41","author":"Ben Nessib","year":"2022","journal-title":"Clinical Rheumatology"},{"issue":"7","key":"10.7717\/peerj.21185\/ref-6","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1038\/nrrheum.2017.95","article-title":"Managing rheumatic and musculoskeletal diseases-past, present and future","volume":"13","author":"Burmester","year":"2017","journal-title":"Nature Reviews Rheumatology"},{"issue":"2","key":"10.7717\/peerj.21185\/ref-7","doi-asserted-by":"publisher","first-page":"277","DOI":"10.3390\/nu11020277","article-title":"The impact of ramadan fasting on the reduction of PASI score, in moderate-to-severe psoriatic patients: a real-life multicenter study","volume":"11","author":"Damiani","year":"2019","journal-title":"Nutrients"},{"issue":"12","key":"10.7717\/peerj.21185\/ref-8","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1016\/j.medcli.2023.07.014","article-title":"Rheumatoid arthritis","volume":"161","author":"Diaz-Gonzalez","year":"2023","journal-title":"Medicina Cl\u00ednica"},{"key":"10.7717\/peerj.21185\/ref-9","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1136\/annrheumdis-2014-eular.5567","article-title":"AB0358 impact of morning stiffness duration in rheumatoid arthritis activity\u2019s evaluation\/study data QUEST-RA morocco","volume":"73","author":"Fanta","year":"2014","journal-title":"Annals of the Rheumatic Diseases"},{"issue":"6","key":"10.7717\/peerj.21185\/ref-10","doi-asserted-by":"publisher","first-page":"105790","DOI":"10.1016\/j.jbspin.2024.105790","article-title":"2024 update of the recommendations of the French Society of Rheumatology for the diagnosis and management of patients with rheumatoid arthritis","volume":"91","author":"Fautrel","year":"2024","journal-title":"Joint Bone Spine"},{"issue":"1","key":"10.7717\/peerj.21185\/ref-11","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/s12906-018-2136-6","article-title":"Is fasting safe? 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