Women who consume increased amounts of antioxidants from fruits and vegetables as part of a healthy diet may reduce their risk of developing rheumatoid arthritis (RA). A 2017 prospective study by Hu Y, et al and published in the Annals of Rheumatic Diseases reviewed data from the Nurses’ Health Studies to evaluate the association between long-term dietary quality and risk of RA in women.
The primary outcomes for this study were RA diagnosis with two subtypes of the disease (seropositive and seronegative) and the dietary quality score as measured by the 2010 Alternative Healthy Eating Index (AHEI-2010). The AHEI-2010 is a dietary scoring tool based on the US Dietary Guidelines for Americans where the highest score possible is a 110. Items classified in the healthy dietary category by the AHEI-2010 include fruits, vegetables, whole grains, nuts, long-chain omega-3 fatty acids, polyunsaturated fat and moderate alcohol consumption. Conversely, sugar-sweetened beverages including fruit juice, red and processed meats, trans-fat and excess sodium are classified as unhealthy food choices. Past studies have shown that higher scores on the AHEI-2010 correlate to a lower risk for several chronic diseases. 
In Dr. Hu’s study, 76,597 women from the Nurses’ Health Study aged 30-55 years and 93,392 women from the Nurses’ Health Study II aged 25-42 were followed for up to 21.6 years with greater than 90% compliance in both groups. At baseline the subjects were free of RA and other connective tissue diseases and follow up information was gathered biennially including lifestyle, environmental exposure and anthropometric information.
Results showed that among women aged 55 years and younger, a better quality diet was associated with a 33% lower RA risk with the strongest association in the seropositive RA group. No significant association was found in the women over 55 years of age in relationship to diet quality and RA risk. The investigators surmised that the risk of RA was not lowered by a healthy diet in the over 55 years of age group potentially because of genetics and hormonal changes related to menopause. Additional data showed a decrease in early-onset RA and moderate alcohol consumption and lower intake of red meat.
An evaluation conducted in 2015 by Wang D, et al. reviewed changes in AHEI-2010 scores from 1999-2012 and found that although total dietary quality had increased on the index from 39.9 to 48.2 (highest score is 110) it was still a long way from perfect. One of the best ways to improve AHEI-2010 scores is to increase consumption of antioxidants which can be found in a wide array of colorful fruits and vegetables. Evidence is emerging that these antioxidants reduce inflammation and oxidative stress, two major underlying causative factors for degenerative disease processes including RA.
In summary, improving dietary quality, particularly through increased intake of fruits and vegetables high in antioxidants, will reduce incidence of chronic disease, including RA in women 55 years and younger. Further programs and education are needed to support an awareness and implementation of higher dietary quality among the general population.
Why is this clinically relevant?
- Better quality diet is linked to reduced risk of developing RA in women 55 years and younger and reduced risk of developing a variety of chronic disease processes in both men and women including CVD, T2D and certain forms of cancers.
- Quality of diet can be improved by increased consumption of high antioxidant fruits and vegetables, whole grains, nuts, long-chain omega-3 fatty acids, polyunsaturated fat and moderate alcohol consumption and reduced intake of sugar-sweetened beverages including fruit juice, red and processed meats, trans-fat and excess sodium.
- Healthcare providers should discuss ways to implement a high quality diet in patients, particularly those at risk for or suffering from chronic disease.
- Healthcare providers should consider recommending high quality nutritional supplement recommendation in those patients unable to make dietary changes.
 Chiuve S, et al. Alternative Dietary Indices Both Strongly Predict Risk of Chronic Disease. J. Nutr. June 1, 2012 vol. 142 no. 6 1009-1018
 Wang D, et al. Improvements In US Diet Helped Reduce Disease Burden And Lower Premature Deaths, 1999–2012; But Overall Diet Remains Poor. Health Aff (Millwood). 2015 Nov; 34(11): 1916–1922. doi: 10.1377/hlthaff.2015.0640
 Islam MA, et al. Dietary Phytochemicals: Natural Swords Combating Inflammation and Oxidation-Mediated Degenerative Diseases. Oxid Med Cell Longev. 2016;2016:5137431.