Treatment for Rheumatoid Arthritis in Patients Following a Vegan Diet

Dietary Recommendations

The American College of Rheumatology conditionally recommends a Mediterranean-style diet over a vegan diet for patients with rheumatoid arthritis, as it has better evidence for improving RA symptoms 1, 2, 3
The Mediterranean diet includes vegetables, fruits, whole grains, nuts, seeds, olive oil, moderate amounts of low-fat dairy and fish, with limited intake of processed foods and saturated fats 4
The American College of Rheumatology conditionally recommends against adherence to other formally defined diets, including vegan diets, due to very low to moderate certainty evidence showing no consistent, clinically meaningful benefit for RA symptoms 5, 6
A "food first" approach is recommended over dietary supplements, emphasizing high-quality foods to obtain necessary nutrients 2, 3

Exercise is strongly recommended for all RA patients regardless of diet choice 1, 2, 6
Rehabilitation interventions including occupational therapy and physical therapy are conditionally recommended for benefits on pain, physical function, and independence 1, 2, 3
Maintaining a healthy body weight is unanimously supported for optimizing RA outcomes, as obesity is associated with higher disease activity and poorer treatment response 4, 5
Additional conditionally recommended interventions include standardized self-management programs 3, 6, cognitive behavioral therapy and mind-body approaches 6, 7, and acupuncture, massage therapy, and thermal modalities 6, 7
Tobacco cessation is important for patients with RA who use tobacco 2, 3, 4

Rheumatology clinicians should consider involving registered dieticians to assist RA patients who wish to modify their diet 1, 2, 4
Early referral to occupational and physical therapists is recommended to help patients learn proper techniques for exercise and self-management 2, 3
The American College of Rheumatology emphasizes the importance of assembling an interprofessional healthcare team to support individuals with RA 3, 6

When transitioning from a vegan diet to a Mediterranean-style diet, focus on incorporating plant-based components and optional addition of fish and low-fat dairy if acceptable to the patient 4
The burden and costs of adhering to any formally defined diet should be considered, and patient preferences are expected to differ 5
Dietary modifications should be considered as complementary to, not replacements for, standard pharmacological treatments for RA 1, 3