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Are dietary vitamin D, omega-3 fatty acids and folate associated with treatment results in patients with early rheumatoid arthritis? Data from a Swedish population-based prospective study
  1. Cecilia Lourdudoss1,
  2. Alicja Wolk2,
  3. Lena Nise2,
  4. Lars Alfredsson2,
  5. Ronald van Vollenhoven1
  1. 1 Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
  2. 2 Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Cecilia Lourdudoss; cecilia.lourdudoss{at}


Background Dietary intake of vitamin D and omega-3 fatty acids (FA) may be associated with superior response to antirheumatic treatments. In addition, dietary folate intake may be associated with worse response to methotrexate (MTX). The aim of this study was to investigate the association between dietary vitamin D, omega-3 FA, folate and treatment results of disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA).

Methods This prospective study was based on data from the Epidemiological Investigation of Rheumatoid Arthritis (EIRA) study, and included 727 patients with early RA from 10 hospitals in Sweden. Data on dietary vitamin D, omega-3 FA and folate intake based on food frequency questionnaires were linked with data on European League Against Rheumatism (EULAR) response after 3 months of DMARD treatment. Associations between vitamin D, omega-3 FA, folate and EULAR response were analysed with logistic regression adjusted for potential confounders.

Results The majority of patients (89.9%) were initially treated with MTX monotherapy and more than half (56.9%) with glucocorticoids. Vitamin D and omega-3 FA were associated with good EULAR response (OR 1.80 (95% CI 1.14 to 2.83) and OR 1.60 (95% CI 1.02 to 2.53), respectively). Folate was not significantly associated with EULAR response (OR 1.20 (95% CI 0.75 to 1.91)). Similar results were seen in a subgroup of patients who were initially treated with MTX monotherapy at baseline.

Conclusions Higher intake of dietary vitamin D and omega-3 FA during the year preceding DMARD initiation may be associated with better treatment results in patients with early RA. Dietary folate intake was not associated with worse or better response to treatment, especially to MTX. Our results suggest that some nutrients may be associated with enhanced treatment results of DMARDs.

  • Rheumatology
  • Epidemiology
  • Nutrition & Dietetics

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  • Contributors LA was instrumental in establishing the Epidemiological Investigation of RheumatoidArthritis (EIRA) study. LN provided data from the EIRA master file. RVV played a major role in the study design and drafting the manuscript together with CL. CL performed all the statistical analyses. RVV, AW and LA contributed to the interpretation of the results from a clinical, nutritional and epidemiological aspect, respectively. All authors approved the final manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained from patients.

  • Ethics approval Regional Ethical Review Board at Karolinska Institutet.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.