ROMATOİD ARTRİTİN KLİNİK TEDAVİSİNDE KULLANILAN DİYET YAKLAŞIMLARININ DEĞERLENDİRİLMESİ

Öz

Romatoid Artit (RA), populasyonun %0.5-1.0’ini etkileyen sistemik inflamasyon, kalıcı sinovit ve diğer komorbiditelerle karakterize bir kronik, otoimmün bozukluktur. Uzun süreli aktif RA şiddetli eklem hasarı, ağrının engellenememesi, yaşam kalitesinde düşüşe neden olmaktadır. RA’nın etiyolojisi tam olarak anlaşılamamıştır ancak doğuştan gelen ve edinilmiş bağışıklık sistemlerinin tepkileri arasındaki etkileşimden kaynaklandığı düşünülmektedir. RA, kan dolaşımında Romatoid Faktör ve antisitrüline peptit antikotlarının varlığı ile karakterize edilmektedir. Ayrıca Romatoid artrit ile ilişkili immünitede bağırsak mikrobiyomunun önemi olduğu vurgulanmaktadır. Mikrobiyotadaki değişikliklerin, hastalığın riski ve şiddeti ile ilgili olduğu düşünülmektedir. Başta akciğerler, ağız mukozası ve gastrointestinal sistem olmak üzere üç bölge, mikrobiyotada görülen değişiklikler ile ilişkilendirilmiştir. RA'nın farmasötik tedavisi genellikle; ağrıyı ve inflamasyonu yönetmek için kullanılan steroidal olmayan anti-inflamatuar ilaçları (NSAID's) ve hastalığı yavaşlatarak ağrıyı azaltan anti-romatizmal ilaçları içerir. Ne yazık ki birçok hastada remisyon olasılığı düşük olmakla birlikte, ilaçlarla ilgili yaygın yan etkiler rapor edilmektedir. Hastalarda bazı çevresel ve yaşamsal değişikliklerin semptomları şiddetlendirdiği ve dolayısıyla RA’nın şiddetini etkilediği düşünülmektedir. Örneğin RA hastaları, kırmızı et, alkollü ve alkolsüz içecek tüketiminin semptomlarını kötüleştirdiğini; balık ve yaban mersini gibi besinlerin ise semptomlarını hafifletmeye yardımcı olduğunu ifade etmektedir. RA’nın semptomlarını yönetmek amacıyla; inflamasyonu azaltmada, antioksidan seviyelerini artırmada ve lipid profillerini iyileştirmede potansiyel diyet değişiklikleri önerilmektedir. Romatoid Artritin hem başlangıcında hem de hastalığın şiddetinde, diyetle ilgili meydana gelen antijenik yük ve gıda sensivitesinin rol oynadığı düşünülmektedir. Bunun yanında RA hastalarında kullanılan NSAID ilaçlar ile hastaların bağırsak mukozasının alerjenlere karşı daha geçirgen olduğu gösterilmektedir. Bu anlamda Eliminasyon diyeti, Akdeniz Diyeti, Vegan/vejetaryen Diyet yaklaşımı; Omega-3 yağ asidi, D vitamin ve probiyotik takviyesinin hastalık aktivitesini azalttığı düşünülmektedir. Bu derlemenin amacı, RA ile ilişkili semptomları azaltmak için kullanılan belirli diyet yaklaşımlarının ve besin takviyelerinin etkinliğini, literatürde bilimsel kanıtlara dayanarak değerlendirmektir.

Anahtar Kelimeler

• Artrit Romatoid
• Diyet yönetimi
• Diyet
• Akdeniz
• Vejetaryen

AN EVALUATION OF DIETARY APPROACHES USED IN THE CLINICAL MANAGEMENT OF RHEUMATOID ARTHRITIS

Öz

Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by systemic inflammation, persistent synovitis, and other comorbidities, that affects 0.5-1.0% of the overall population. Long-term active RA causes severe joint damage, disabling pain and diminished life quality. The etiology of RA is not accurately understood, but it is thought to be due to an interaction between the responses of the innate and acquired immune systems. RA is characterized by the presence of Rheumatoid Factor (RF) and anti citrullinated peptide antibodies in the blood circulation. Also the composition of intestinal the gut microbiome is claimed to be critical in immune responses associated with RA. Changes in the microbiota are thought to be related to the risk and severity of the disease. Three regions; primarily the lungs, oral mucosa and gastrointestinal tract have been associated with changes in the microbiota. Commonly, the pharmaceutical treatment of RA includes non-steroidal anti-inflammatory drugs (NSAIDs) that are used to manage the pain and inflammation associated with RA and disease-modifying anti-rheumatic drugs that reduces pain by slowing down the disease. Unfortunately, remission is not likely in many patients. Moreover, side effects related to drugs are commonly reported. Some alterations in the patients’ life and environment are thought to aggravate symptoms, thus influencing severity of RA. For example RA patients, the participants asserted that consumption of red meat, alcoholic and non-alcoholic beverages worsen their symptoms, while nutrients such as fish and blueberries help alleviate the symptoms. To manage the adverse effects of RA, particular dietary alterations are suggested to be effective in reducing inflammation, increasing antioxidant levels, and improving lipid profiles. Antigenic load and food intolerance are thought to play a role in both the onset of Rheumatoid Arthritis. Besides, it has been shown that the intestinal mucosa of the patients would have become more permeable to allergens due to long term NSAIDs use. In this sense, Elimination Diet, Mediterranean Diet, Vegan/Vegetarian Diet approach, Omega-3 Fatty acids, Vitamin D and probiotic supplementation is thought to reduce disease activity. The purpose of this review is to evaluate the efficiency of certain dietary approaches and supplements used for lessening the RA related symptoms, based on the scientific evidence found in the literature.

Anahtar Kelimeler

• Dietary Management
• Diet
• Mediterranean
• Vegaterian
• Artrit Romatoid
• Diyet yönetimi
• Diyet
• Akdeniz
• Vejetaryen

Kaynakça

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