Vol. 20 No. 1 (2026): Revista Reumatología al Día
Artículos de Revisión

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

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  • juan sebastian theran leon
juan sebastian theran leon
servimed
DOI: https://doi.org/10.62484/rad.v20i1.11906

Published 2026-04-14

Keywords

  • enfermedades reumáticas,
  • dieta antiinflamatoria,
  • patrones dietéticos,
  • dieta mediterránea,
  • ácidos grasos omega-3,
  • inflamación
    • ...More
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How to Cite

theran leon, juan sebastian. (2026). 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. Reumatología Al Día, 20(1), 10. https://doi.org/10.62484/rad.v20i1.11906

Copyright (c) 2026 Reumatología al Día

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Abstract

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

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References

  1. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388(10055):2023-38. https://doi.org/10.1016/S0140-6736(16)30173-8 DOI: https://doi.org/10.1016/S0140-6736(16)30173-8
  2. 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 DOI: https://doi.org/10.1136/annrheumdis-2013-204627
  3. 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 DOI: https://doi.org/10.1016/S0140-6736(20)32340-0
  4. 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 DOI: https://doi.org/10.1016/S0140-6736(17)31472-1
  5. 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 DOI: https://doi.org/10.1016/j.autrev.2018.05.009
  6. 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 DOI: https://doi.org/10.1177/0884533617700353
  7. 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 DOI: https://doi.org/10.1016/j.immuni.2019.09.020
  8. 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 DOI: https://doi.org/10.2174/1871530314666140922153350
  9. 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 DOI: https://doi.org/10.1053/j.gastro.2014.12.036
  10. 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 DOI: https://doi.org/10.1038/s41575-018-0061-2
  11. 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 DOI: https://doi.org/10.1136/ard-2022-223356corr1
  12. 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 DOI: https://doi.org/10.1002/acr.24596
  13. 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 DOI: https://doi.org/10.3899/jrheum.100951
  14. 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 DOI: https://doi.org/10.1007/s00296-020-04731-0
  15. 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 DOI: https://doi.org/10.1136/ard.62.3.208
  16. 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 DOI: https://doi.org/10.3390/nu13103506
  17. 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 DOI: https://doi.org/10.3390/nu12123601
  18. 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 DOI: https://doi.org/10.1016/j.nut.2017.06.023
  19. 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 DOI: https://doi.org/10.1042/BST20160474
  20. 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 DOI: https://doi.org/10.3899/jrheum.190795
  21. 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 DOI: https://doi.org/10.1097/MD.0000000000007024
  22. 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 DOI: https://doi.org/10.1002/ptr.4639
  23. 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 DOI: https://doi.org/10.1111/ijcp.14280
  24. 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 DOI: https://doi.org/10.1038/nrdp.2016.39
  25. 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 DOI: https://doi.org/10.1016/j.endinu.2018.05.009
  26. 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 DOI: https://doi.org/10.1186/s12937-015-0068-2
  27. 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 DOI: https://doi.org/10.1177/0961203314540966
  28. 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 DOI: https://doi.org/10.1136/annrheumdis-2018-214856
  29. 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 DOI: https://doi.org/10.1038/srep24072
  30. 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 DOI: https://doi.org/10.1038/s41584-020-0441-1
  31. 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 DOI: https://doi.org/10.1002/acr.24375
  32. 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 DOI: https://doi.org/10.1136/annrheumdis-2016-209707
  33. 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 DOI: https://doi.org/10.1056/NEJMoa035700
  34. 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 DOI: https://doi.org/10.1002/art.39813
  35. 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 DOI: https://doi.org/10.1016/j.autrev.2018.05.008
  36. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745-59. https://doi.org/10.1016/S0140-6736(19)30417-9 DOI: https://doi.org/10.1016/S0140-6736(19)30417-9
  37. 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 DOI: https://doi.org/10.1038/nrrheum.2016.136
  38. 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 DOI: https://doi.org/10.1136/ard.2006.065904
  39. 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 DOI: https://doi.org/10.1001/jama.2013.277669
  40. 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 DOI: https://doi.org/10.1002/art.21735
  41. 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 DOI: https://doi.org/10.1093/rheumatology/key011
  42. 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 DOI: https://doi.org/10.1016/j.joca.2019.06.011
  43. Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311(15):1547-55. https://doi.org/10.1001/jama.2014.3266 DOI: https://doi.org/10.1001/jama.2014.3266
  44. 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 DOI: https://doi.org/10.1111/1756-185X.13419
  45. 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 DOI: https://doi.org/10.1016/j.sjpain.2016.07.004
  46. 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 DOI: https://doi.org/10.3344/kjp.2017.30.4.250
  47. 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 DOI: https://doi.org/10.1089/ars.2013.5260
  48. 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 DOI: https://doi.org/10.1002/art.39259
  49. 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 DOI: https://doi.org/10.7554/eLife.01202
  50. 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 DOI: https://doi.org/10.1128/mBio.01548-14
  51. 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 DOI: https://doi.org/10.1038/srep20602
  52. 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 DOI: https://doi.org/10.1016/j.cell.2016.05.041
  53. 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 DOI: https://doi.org/10.2337/db07-1403
  54. 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 DOI: https://doi.org/10.1056/NEJMoa1800389
  55. 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 DOI: https://doi.org/10.1017/S0029665112003011
  56. 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 DOI: https://doi.org/10.1186/s12992-015-0109-9
  57. 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 DOI: https://doi.org/10.4060/cc3859en
  58. 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
  59. 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 DOI: https://doi.org/10.3945/jn.115.219634
  60. 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 DOI: https://doi.org/10.1093/ajcn/nqaa019