The Role of Dietary Fiber in Rheumatoid Arthritis Patients: A Feasibility Study

Nutrients. 2019 Oct 7;11(10):2392. doi: 10.3390/nu11102392.


Short-chain fatty acids are microbial metabolites that have been shown to be key regulators of the gut-joint axis in animal models. In humans, microbial dysbiosis was observed in rheumatoid arthritis (RA) patients as well as in those at-risk to develop RA, and is thought to be an environmental trigger for the development of clinical disease. At the same time, diet has a proven impact on maintaining intestinal microbial homeostasis. Given this association, we performed a feasibility study in RA patients using high-fiber dietary supplementation with the objective to restore microbial homeostasis and promote the secretion of beneficial immunomodulatory microbial metabolites. RA patients (n = 36) under routine care received daily high-fiber bars or cereals for 28 days. Clinical assessments and laboratory analysis of immune parameters in blood and stool samples from RA patients were done before and after the high-fiber dietary supplementation. We observed an increase in circulating regulatory T cell numbers, favorable Th1/Th17 ratios, as well as decreased markers of bone erosion in RA patients after 28 days of dietary intervention. Furthermore, patient-related outcomes of RA improved. Based on these results, we conclude that controlled clinical studies of high-fiber dietary interventions could be a viable approach to supplement or complement current pharmacological treatment strategies.

Keywords: gut–joint axis; high-fiber diet (HFD); microbiota; rheumatoid arthritis (RA); short chain fatty acids (SCFA).

MeSH terms

  • Arthritis, Rheumatoid / diagnosis
  • Arthritis, Rheumatoid / diet therapy*
  • Arthritis, Rheumatoid / immunology
  • Arthritis, Rheumatoid / microbiology
  • Bacteria / growth & development
  • Bacteria / immunology
  • Bacteria / metabolism*
  • Bone Resorption
  • Dietary Fiber / administration & dosage*
  • Dietary Fiber / adverse effects
  • Dietary Fiber / metabolism
  • Dietary Supplements* / adverse effects
  • Feasibility Studies
  • Female
  • Gastrointestinal Microbiome*
  • Host-Pathogen Interactions
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • T-Lymphocytes, Regulatory / immunology
  • Th1 Cells / immunology
  • Th17 Cells / immunology
  • Time Factors
  • Treatment Outcome


  • Dietary Fiber