(P30-012-23) Fasting Leads to Disease Activity Suppression and Sustained Weight Loss in Rheumatoid Arthritis

Objectives: Rheumatoid Arthritis (RA) is a chronic autoimmune disease that affects about 1% of the global population with women being at higher risk. Prolonged fasting (PF) has been associated with improvements in RA, but the mechanism behind the decrease in inflammatory processes remains unclear. Also, the so achieved improvements can typically only be maintained for a limited period and are reverted after reintroduction of a standard diet. PF as well as intermittent fasting (IF) have been shown to have a modulatory effect on the gut microbiome and a decreased diversity in the latter is correlated with RA.

The aim of this project is to identify specific mechanistic factors between nutrition and the immune system that may help to sustain the beneficial effects of fasting on RA by tracking common and disease-specific molecular signature.

Methods: The RA patients have been recruited as part of an open-label, multi-center, controlled clinical trial consisting of a cross-sectional and a longitudinal study. A total of 60 RA patients and 60 healthy controls were recruited. The longitudinal arm (30 RA patients) followed a 5–7-day PF. The PF was followed by a time-restricted eating (TRE) diet, a form of IF, for a period of 12 months according to the 16:8 pattern. The patients attended 11 visits, on which several samples have been collected, allowing us to analyze clinical and anthropometric data, routine and molecular methodologies and meta-omics data.

Results: Preliminary results after the PF show a significant improvement in RA symptoms (DAS28, HAQ). This observation is accompanied by a significant weight loss and significant decreases in several clinical parameters such as CRP amongst others. Patients report a beneficial effect of PF up to 6 months and show a maintained significant weight loss of an average of 4.4 kg after 12 months while following TRE without caloric restriction.

Conclusions: The preliminary results of the study show that fasting has a beneficial effect on RA which might be partly due to the sustained weight loss. Subsequent analysis of the collected nutritional and immunological data will further elucidate the beneficial effect of fasting on the immune system, while meta-omics data might allow us to link these findings to possible changes in the gut microbiome function.

Funding Sources: European Research Council, European Union’s Horizon 2020 research and innovation program