Impact of the specific carbohydrate diet on juvenile idiopathic arthritis in an Egyptian cohort

Abstract

Objective
The specific carbohydrate diet (SCD) has demonstrated a beneficial effect in pediatric inflammatory bowel disease. This study aimed to determine the potential effect of a minimum 4-week SCD intervention on children with juvenile idiopathic arthritis (JIA).


Methods
This prospective, single-arm, interventional pilot study encompassed 40 patients with JIA exhibiting mild to moderate disease activity as per juvenile arthritis disease activity score-27(JADAS27), with ≤ 2 active joints, and an erythrocyte sedimentation rate (ESR) of < 30 mm/h at inclusion. Participants were required to have maintained stable medical treatment without any modifications for a minimum of 12 weeks prior to enrollment, with no anticipated alterations in medication during the study duration. Patients adhered to the SCD for at least 4- week duration under the guidance of a pediatric dietitian. Of the 40 JIA patients incorporated into the study, only 27 patients aged 9–16 years with disease duration of 1-11years completed a minimum 4 weeks adherence to the SCD. Evaluation of morning stiffness duration, pain visual analogue scale (VAS), JADAS27 and physical functional evaluation using child health assessment questionnaire (CHAQ) were determined. Laboratory assessments, including ESR and C-reactive protein (CRP) were analyzed. Furthermore, Faecal Short-Chain Fatty Acids (SCFAs) including butyrate, propionate, acetate, and valerate, were measured. All evaluations were conducted at baseline and subsequent to a minimum of four weeks of adherence to the SCD.


Results

Regarding the evaluation of SCFAs, butyrate levels demonstrated a significant increase (
p
 < 0.001) following the SCD intervention. Propionate and acetate, while also elevated (
p
 = 0.004 and 0.01 respectively), displayed a less substantial increase in comparison to butyrate. Valerate likewise showed a significant increase (
p
 = 0.048). These elevations in SCFAs coincided with a significant improvement in morning stiffness duration (
p
 = 0.016), pain VAS, JADAS27, and CHAQ (
p
 < 0.001 for all), which was further corroborated by a significant decrease in laboratory markers of inflammation, including ESR (
p
 = 0.009) and CRP (
p
 = 0.006).



Conclusion
Specific carbohydrate diet, as a prospective adjunctive therapeutic option, could potentially improve clinical outcomes in JIA patients. While the positive preliminary findings, it is essential to conduct more rigorous and controlled studies to validate these results.