Alimentación y enfermedades reumáticas: Una revisión narrativa sobre el papel de los patrones dietéticos en la modulación de la inflamación y la actividad de la enfermedad
Publicado 14-04-2026
Palabras clave
- enfermedades reumáticas,
- dieta antiinflamatoria,
- patrones dietéticos,
- dieta mediterránea,
- ácidos grasos omega-3
- inflamación ...Más
Cómo citar
Derechos de autor 2026 Reumatología al Día

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Resumen
Introducción: Las enfermedades reumáticas constituyen un grupo heterogéneo de patologías caracterizadas por inflamación crónica con importante morbilidad. La evidencia científica reciente ha identificado la alimentación como factor modulador de la respuesta inflamatoria y la actividad de la enfermedad. El objetivo de esta revisión fue sintetizar la evidencia disponible sobre el papel de los patrones y componentes dietéticos en la modulación de la inflamación y la actividad clínica de las principales enfermedades reumáticas.
Metodología: Se realizó una búsqueda bibliográfica en PubMed, Scopus y Web of Science, sin restricción temporal, con énfasis en publicaciones de los últimos diez años. Se seleccionaron artículos originales, revisiones sistemáticas, metaanálisis y guías de práctica clínica, priorizando estudios con diseño analítico y nivel de evidencia moderado-alto.
Resultados: La dieta mediterránea demostró beneficios consistentes en la reducción de marcadores inflamatorios y actividad de la enfermedad en artritis reumatoide y lupus. Los ácidos grasos omega-3, los polifenoles y la vitamina D mostraron efectos antiinflamatorios relevantes. La restricción de purinas y fructosa resultó eficaz en el manejo de la gota, mientras que la pérdida de peso redujo significativamente la carga articular en osteoartritis.
Conclusión: La evidencia respalda la integración de estrategias nutricionales como complemento terapéutico en las enfermedades reumáticas, aunque se requieren ensayos clínicos aleatorizados con mayor tamaño muestral y seguimiento
Citas
- Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388(10055):2023-38. https://doi.org/10.1016/S0140-6736(16)30173-8
- Cross M, Smith E, Hoy D, Carmona L, Wolfe F, Vos T, et al. The global burden of rheumatoid arthritis: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(7):1316-22. https://doi.org/10.1136/annrheumdis-2013-204627
- Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019. Lancet. 2021;396(10267):2006-17. https://doi.org/10.1016/S0140-6736(20)32340-0
- McInnes IB, Schett G. Pathogenetic insights from the treatment of rheumatoid arthritis. Lancet. 2017;389(10086):2328-37. https://doi.org/10.1016/S0140-6736(17)31472-1
- Philippou E, Nikiphorou E. Are we really what we eat? Nutrition and its role in the onset of rheumatoid arthritis. Autoimmun Rev. 2018;17(11):1074-7. https://doi.org/10.1016/j.autrev.2018.05.009
- Ricker MA, Haas WC. Anti-inflammatory diet in clinical practice: a review. Nutr Clin Pract. 2017;32(3):318-25. https://doi.org/10.1177/0884533617700353
- Christ A, Lauterbach M, Latz E. Western diet and the immune system: an inflammatory connection. Immunity. 2019;51(5):794-811. https://doi.org/10.1016/j.immuni.2019.09.020
- Casas R, Sacanella E, Estruch R. The immune protective effect of the Mediterranean diet against chronic low-grade inflammatory diseases. Endocr Metab Immune Disord Drug Targets. 2014;14(4):245-54. https://doi.org/10.2174/1871530314666140922153350
- Tilg H, Moschen AR. Food, immunity, and the microbiome. Gastroenterology. 2015;148(6):1107-19. https://doi.org/10.1053/j.gastro.2014.12.036
- Zmora N, Suez J, Elinav E. You are what you eat: diet, health and the gut microbiota. Nat Rev Gastroenterol Hepatol. 2019;16(1):35-56. https://doi.org/10.1038/s41575-018-0061-2
- Smolen JS, Landewé RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3-18. https://doi.org/10.1136/ard-2022-223356
- Fraenkel L, Bathon JM, England BR, St Clair EW, Arayssi T, Carandang K, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2021;73(7):924-39. https://doi.org/10.1002/acr.24596
- Pelaez-Ballestas I, Sanin LH, Moreno-Montoya J, Alvarez-Nemegyei J, Burgos-Vargas R, Garza-Elizondo M, et al. Epidemiology of the rheumatic diseases in Mexico. A study of 5 regions based on the COPCORD methodology. J Rheumatol Suppl. 2011;86:3-8. https://doi.org/10.3899/jrheum.100951
- Almutairi K, Nossent J, Preen D, Keen H, Inderjeeth C. The global prevalence of rheumatoid arthritis: a meta-analysis based on a systematic review. Rheumatol Int. 2021;41(5):863-77. https://doi.org/10.1007/s00296-020-04731-0
- Skoldstam L, Hagfors L, Johansson G. An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Ann Rheum Dis. 2003;62(3):208-14. https://doi.org/10.1136/ard.62.3.208
- Raad T, Griffin A, George ES, Larkin L, Fraser A, Kennedy N, et al. Dietary interventions with or without omega-3 supplementation for the management of rheumatoid arthritis: a systematic review. Nutrients. 2021;13(10):3506. https://doi.org/10.3390/nu13103506
- Johansson K, Wasén C, Erlandsson MC, Bilberg A, Mannerkorpi K, Enman Y, et al. Anti-inflammatory diet and disease activity in rheumatoid arthritis: a randomized controlled trial. Nutrients. 2020;12(12):3601. https://doi.org/10.3390/nu12123601
- Gioxari A, Kaliora AC, Marantidou F, Panagiotakos DP. Intake of ω-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: a systematic review and meta-analysis. Nutrition. 2018;45:114-24. https://doi.org/10.1016/j.nut.2017.06.023
- Calder PC. Omega-3 fatty acids and inflammatory processes: from molecules to man. Biochem Soc Trans. 2017;45(5):1105-15. https://doi.org/10.1042/BST20160474
- Mouterde G, Gamon E, Rincheval N, Lukas C, Seror R, Dariot-Brethes P, et al. Association between vitamin D deficiency and disease activity, disability, and radiographic progression in early rheumatoid arthritis: the ESPOIR cohort. J Rheumatol. 2020;47(11):1624-8. https://doi.org/10.3899/jrheum.190795
- Franco AS, Freitas TQ, Bernardo WM, Pereira RMR. Vitamin D supplementation and disease activity in patients with immune-mediated rheumatic diseases: a systematic review and meta-analysis. Medicine (Baltimore). 2017;96(23):e7024. https://doi.org/10.1097/MD.0000000000007024
- Chandran B, Goel A. A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis. Phytother Res. 2012;26(11):1719-25. https://doi.org/10.1002/ptr.4639
- Pourhabibi-Zarandi F, Rafraf M, Zare Javid A, Asghari-Jafarabadi M, Parvizi Dalir S. Curcumin and rheumatoid arthritis: a systematic review of literature. Int J Clin Pract. 2021;75(10):e14280. https://doi.org/10.1111/ijcp.14280
- Kaul A, Gordon C, Crow MK, Touma Z, Urowitz MB, van Vollenhoven R, et al. Systemic lupus erythematosus. Nat Rev Dis Primers. 2016;2:16039. https://doi.org/10.1038/nrdp.2016.39
- Pocovi-Gerardino G, Correa-Rodríguez M, Callejas-Rubio JL, Ríos-Fernández R, Ortego-Centeno N, Rueda-Medina B. Dietary intake and nutritional status in patients with systemic lupus erythematosus. Endocrinol Diabetes Nutr. 2018;65(9):533-9. https://doi.org/10.1016/j.endinu.2018.05.009
- Arriens C, Hynan LS, Engel RM, Olsen N, Garg N, Gourley M, et al. Placebo-controlled randomized clinical trial of fish oil's impact on fatigue, quality of life, and disease activity in systemic lupus erythematosus. Nutr J. 2015;14:82. https://doi.org/10.1186/s12937-015-0068-2
- Sahebari M, Nabavi N, Salehi M. Vitamin D serum level in patients with systemic lupus erythematosus and its association with disease activity: a meta-analysis. Lupus. 2014;23(14):1417-25. https://doi.org/10.1177/0961203314541689
- Azzouz D, Omarbekova A, Heguy A, Schwudke D, Gisch N, Piber TR, et al. Lupus nephritis is linked to disease-activity associated expansions and immunity to a gut commensal. Ann Rheum Dis. 2019;78(7):947-56. https://doi.org/10.1136/annrheumdis-2018-214856
- Lopez P, de Paz B, Rodriguez-Carrio J, Hevia A, Sanchez B, Margolles A, et al. Th17 responses and natural IgM antibodies are related to gut microbiota composition in systemic lupus erythematosus patients. Sci Rep. 2016;6:24072. https://doi.org/10.1038/srep24072
- Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol. 2020;16(7):380-90. https://doi.org/10.1038/s41584-020-0441-1
- FitzGerald JD, Dalbeth N, Mikuls T, Brignardello-Petersen R, Guyatt G, Abeles AM, et al. 2020 American College of Rheumatology guideline for management of gout. Arthritis Care Res (Hoboken). 2020;72(6):744-60. https://doi.org/10.1002/acr.24180
- Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castañeda-Sanabria J, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017;76(1):29-42. https://doi.org/10.1136/annrheumdis-2016-209707
- Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004;350(11):1093-103. https://doi.org/10.1056/NEJMoa035700
- Juraschek SP, Gelber AC, Choi HK, Appel LJ, Miller ER 3rd. Effects of the Dietary Approaches to Stop Hypertension (DASH) diet and sodium intake on serum uric acid. Arthritis Rheumatol. 2016;68(12):3002-9. https://doi.org/10.1002/art.39813
- Nielsen SM, Zobbe K, Engstrom A, Ellegaard K, Bliddal H, Christensen R. Nutritional recommendations for gout: an update from clinical epidemiology. Autoimmun Rev. 2018;17(11):1090-6. https://doi.org/10.1016/j.autrev.2018.05.008
- Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745-59. https://doi.org/10.1016/S0140-6736(19)30417-9
- Robinson WH, Lepus CM, Wang Q, Raghu H, Mao R, Lindstrom TM, et al. Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nat Rev Rheumatol. 2016;12(10):580-92. https://doi.org/10.1038/nrrheum.2016.136
- Christensen R, Bartels EM, Astrup A, Bliddal H. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2007;66(4):433-9. https://doi.org/10.1136/ard.2006.065904
- Messier SP, Mihalko SL, Legault C, Miller GD, Nicklas BJ, DeVita P, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA. 2013;310(12):1263-73. https://doi.org/10.1001/jama.2013.277669
- Neogi T, Booth SL, Zhang YQ, Jacques PF, Terkeltaub R, Aliabadi P, et al. Low vitamin K status is associated with osteoarthritis in the hand and knee. Arthritis Rheum. 2006;54(4):1255-61. https://doi.org/10.1002/art.21735
- Thomas S, Browne H, Mobasheri A, Rayman MP. What is the evidence for a role for diet and nutrition in osteoarthritis? Rheumatology (Oxford). 2018;57(suppl_4):iv61-iv74. https://doi.org/10.1093/rheumatology/key011
- Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578-89. https://doi.org/10.1016/j.joca.2019.06.011
- Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311(15):1547-55. https://doi.org/10.1001/jama.2014.3266
- Silva AR, Bernardo A, Cardoso J, Cruz D, Favero G, Rezzani R, et al. Diet and fibromyalgia: a systematic review. Int J Rheum Dis. 2019;22(1):40-6. https://doi.org/10.1111/1756-185X.13419
- Marum AP, Moreira C, Saraiva F, Tomas-Carus P, Sousa-Guerreiro C. A low fermentable oligo-di-mono saccharides and polyols (FODMAP) diet reduced pain and improved daily living in fibromyalgia patients. Scand J Pain. 2016;13:166-72. https://doi.org/10.1016/j.sjpain.2016.07.004
- Makrani AH, Afshari M, Ghajar M, Forooghi Z, Moosazadeh M. Vitamin D and fibromyalgia: a meta-analysis. Korean J Pain. 2017;30(4):250-7. https://doi.org/10.3344/kjp.2017.30.4.250
- Cordero MD, Alcocer-Gómez E, de Miguel M, Culic O, Carrión AM, Alvarez-Suarez JM, et al. Can coenzyme Q10 improve clinical and molecular parameters in fibromyalgia? Antioxid Redox Signal. 2013;19(12):1356-61. https://doi.org/10.1089/ars.2013.5260
- Scher JU, Littman DR, Abramson SB. Microbiome in inflammatory arthritis and human rheumatic diseases. Arthritis Rheumatol. 2016;68(1):35-45. https://doi.org/10.1002/art.39259
- Scher JU, Sczesnak A, Longman RS, Segata N, Ubeda C, Bielski C, et al. Expansion of intestinal Prevotella copri correlates with enhanced susceptibility to arthritis. Elife. 2013;2:e01202. https://doi.org/10.7554/eLife.01202
- Hevia A, Milani C, López P, Cuervo A, Arboleya S, Duranti S, et al. Intestinal dysbiosis associated with systemic lupus erythematosus. mBio. 2014;5(5):e01548-14. https://doi.org/10.1128/mBio.01548-14
- Guo Z, Zhang J, Wang Z, Ang KY, Huang S, Hou Q, et al. Intestinal microbiota distinguish gout patients from healthy humans. Sci Rep. 2016;6:20602. https://doi.org/10.1038/srep20602
- Koh A, De Vadder F, Kovatcheva-Datchary P, Bäckhed F. From dietary fiber to host physiology: short-chain fatty acids as key bacterial metabolites. Cell. 2016;165(6):1332-45. https://doi.org/10.1016/j.cell.2016.05.041
- Cani PD, Bibiloni R, Knauf C, Waget A, Neyrinck AM, Delzenne NM, et al. Changes in gut microbiota control metabolic endotoxemia-induced inflammation in high-fat diet-induced obesity and diabetes in mice. Diabetes. 2008;57(6):1470-81. https://doi.org/10.2337/db07-1403
- Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378(25):e34. https://doi.org/10.1056/NEJMoa1800389
- Jacobs DR Jr, Tapsell LC. Food synergy: the key to a healthy diet. Proc Nutr Soc. 2013;72(2):200-6. https://doi.org/10.1017/S0029665112003011
- Mattei J, Malik V, Wedick NM, Hu FB, Spiegelman D, Willett WC, et al. Reducing the global burden of type 2 diabetes by improving the quality of staple foods: The Global Nutrition and Epidemiologic Transition Initiative. Global Health. 2015;11:23. https://doi.org/10.1186/s12992-015-0109-9
- FAO, IFAD, PAHO, UNICEF, WFP. Latin America and the Caribbean – Regional overview of food security and nutrition 2023. Santiago: FAO; 2023. https://doi.org/10.4060/cc3859en
- Galarza-Maldonado C, Cardiel MH, Benegas M, Massardo L, Soriano ER, Pineda C, et al. PANLAR consensus on the challenges and opportunities of rheumatology practice in Latin America. Clin Rheumatol. 2022;41(9):2583-92. https://doi.org/10.1007/s10067-022-06215-z
- Subar AF, Freedman LS, Tooze JA, Kirkpatrick SI, Boushey C, Neuhouser ML, et al. Addressing current criticism regarding the value of self-report dietary data. J Nutr. 2015;145(12):2639-45. https://doi.org/10.3945/jn.115.219634
- Vadell AKE, Bärebring L, Hulander E, Gjertsson I, Lindqvist HM, Winkvist A. Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA)—a randomized, controlled crossover trial indicating effects on disease activity. Am J Clin Nutr. 2020;111(6):1203-1213. https://doi.org/10.1093/ajcn/nqaa019
