Why should rheumatologists care? Because one of the most common questions patients ask us (after What is it? Why? Why me? What will happen to me? How will you treat it? and What can I do?) is what should I eat? What diet should I follow to make it go away or get better? Who among us has not had a patient who thought their symptoms were related to something ingested and, if so, reasoned that avoiding that food would ameliorate disease? Rheumatology was long intrigued by the seductive notion that the right diet or eliminating offending foodstuffs could moderate rheumatic symptoms. There was the notion of “delayed-onset” food allergies, or non–immunoglobulin-E–mediated food allergic syndromes (like migraine, gastrointestinal, or rheumatologic symptoms).
I came to study this fairly early in my career. As a young academician, food and diet and/or food and arthritis was the furthest topic from my mind; it was not something someone trying to do serious scholarship would even remotely consider. One afternoon in the late 1970s I received a call from my dean. He said there was a wealthy individual in his office willing to donate to the university if we would study diet therapy for arthritis. Would I do it? I responded that I was too busy in my laboratory finding the cause and cure for rheumatoid arthritis (RA) to waste time studying diet; besides, no respectable rheumatologist would want to be identified with such a study. A few years later my dean called again offering that same invitation. He explained that the person requesting the study was again in his office but now with a blank check and that it would be very important for my career to do this. By now the project had piqued my intellectual curiosity, and so I came to examine diet (and learn about complementary and alternative medicine).
We did this rather rigorously, using our clinical research unit and carrying out placebo-controlled diet therapy and food challenges. We found elimination diet therapy ineffective for RA (and osteoarthritis) and could not document food-sensitive or food-related rheumatic symptoms in most patients who thought they had them (just as was reported in the JAMA review). However, we did describe several individuals with such symptoms, notably a lady with clinical and immunological sensitivity to milk. We concluded that food/diet therapy had no general important role in managing rheumatic disease. The occasional patient with clear food-related disease merited formal study. Nothing in the many subsequent reports on this topic has changed these impressions.
