Team: ADIRA, aka the “Tendon Ticklers”

Base Article: Vadell AKE, Bärebring L, Hulander E, Gjertsson I, Lindqvist HM, Winkvist A. Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA)-a randomized, controlled crossover trial indicating effects on disease activity. Am J Clin Nutr. 2020;111(6):1203-1213. doi:10.1093/ajcn/nqaa019

Authors: The Allegheny Health Network Rheumatology Fellowship Program

1. Saloni Goyal, DO, first year rheumatology fellow, Allegheny Health Network
2. Conor O’Donnell, MD, first year rheumatology fellow, Allegheny Health Network
3. Zaina Shahid, MD, second year rheumatology fellow, Allegheny Health Network
4. Sara Shahid, MD, second year rheumatology fellow, Allegheny Health Network
5. Michael Lucke MD, Rheumatologist, Allegheny Health Network

Team Overview

Imagine a team huddle between you and your poorly controlled rheumatoid arthritis patient. You just completed a long discussion to optimize their medications when they throw you a curve ball, “doc what about my diet?”  A setback? I think not! You have your one shining moment when you think back to the ADIRA trial. ADIRA hit a homerun in demonstrating the importance of an anti-inflammatory diet. In this trial, a mediterranean diet with probiotics squared off against a predominantly carnivorous diet and proved to be a heavy hitter in reducing DAS 28 scores. Randomized crossover study design, high compliance to assigned diet due to home deliveries of meals, and stable weights throughout the study minimized confounding throughout the clinical trial.  This remarkable trial has changed clinical practice by putting the ball in the patient’s court, empowering them to seize victory in the clash against rheumatoid arthritis.

Though this study looked at a homogenous Swedish population and the clinical importance of a mildly reduced DAS may not be of great significance to scientific minds, this is of paramount importance to the patient. The patient is finally taken off the bench and steps onto the court to have their Christian Laettner moment to hit a buzzer beater.  Finally, you have created a patient doctor relationship where you can see them hit repeated game winners. When they happily come back to see you, both you and the patient will bask in the glory of victory.

Want to learn more?

See the Q&A on theMednet.org about the following question: How do you counsel patients who ask if there are any dietary modifications they can make to help control their autoimmune disease?

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