Postprandial Inflammation in Rheumatoid Arthritis (PIRA)

Patients with RA will be studied to see whether meals of different content will affect inflammation and metabolic variables in the postprandial state. Healthy controls will also be invited to examine potentially different responses to patients with RA.

The PIRA study aims to evaluate the metabolic and inflammatory effects after a vegan meal or a meal containing red meat or fish in patients with RA and matched controls. The study have a cross-over design and each participant will have one of three meals every week and then be compared to themselves. In addition healthy individuals will be included for the red meat meal so that the response from this meal could be compared between patients with RA and their matched controls. Blood samples will be collected before the meal (fasting) and every hour until 5h. Primary outcome will be high sensitive IL-6. Secondary outcomes will be additional inflammation markers such as area under curve for hs-CRP and gene expression in PBMC:s regarding genes related to inflammation and, glucose, blood lipids and metabolomics-profile in serum and urine.

All data will be given a new code Before statistical analysis to mask treatment (study meal or Control) to the outcome assessor

Matched Controls will be served only one meal of meat to compare response between (non-RA) matched controls and patients with RA

Changes in gene expressions related to inflammation and disease activity in peripheral blood mononuclear cells

Patterns of nuclear magnetic resonance (NMR) analysis of metabolites, analysis of several timepoints separately

Patterns of nuclear magnetic resonance (NMR) analysis of metabolites,analysis of several timepoints separately

Measured by questionnaire about socioeconomic status and changes in dietary habits related to perceived health

Inclusion Criteria for patients with RA: Diagnosed with rheumatoid arthritis BMI 18.5-30.0 kg/m2 2 years or more since diagnosis No DMARD changes during the last 3 months Inclusion Criteria for healthy controls: Absence of diagnosis of RA BMI 18.5-30.0 kg/m2 Self-assessed as healthy Exclusion Criteria: Diagnosis of cancer, inflammatory bowel disease, celiac disease, diabetes Allergy or intolerance to any of the foods in the study Pregnancy or breastfeeding Use of any blood lipid lowering medication, glucocorticoids or IL-6-inhibitor during the last 4 weeks prior to enrolment Smoking Hemoglobin < 100 g/L

Data cannot be shared publicly because of Swedish law. The datasets analysed could be made available from the corresponding author on reasonable request.

Lindqvist HM, Wallengren O, Eriksson A, Hulander E, Winkvist A, Barebring L. Validity of bioimpedance for assessment of fat-free mass in women with Rheumatoid Arthritis compared to non-rheumatic controls. Clin Nutr ESPEN. 2022 Feb;47:333-338. doi: 10.1016/j.clnesp.2021.11.016. Epub 2021 Nov 14.