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Testing the specific carbohydrate diet in children with juvenile idiopathic arthritis

Background

Juvenile idiopathic arthritis (JIA) is an overarching term for a variety of rheumatological diseases. This condition has been linked to cesarean delivery and early weaning from breastfeeding — factors that potentially affect the gut microbiome. Diet is one tool for improving the gut microbiome, and the specific carbohydrate diet (SCD) focuses on reducing gut inflammation by increasing beneficial bacteria. The SCD eliminates added sugars, grains, some legumes, starchy tubers, cow's milk, sweets, and foods that contain fructo-oligosaccharides. The SCD has been used to decrease inflammation in children with inflammatory bowel disease; will it also benefit children with JIA?

The study

This 4-week open-label exploratory study enrolled 22 children (ages 6–17) with varied categories of idiopathic arthritis (7 with active arthritis at the time of enrollment) involving ≤2 inflamed joints and an erythrocyte sedimentation rate of <30 mm/hour. The children adhered to the SCD (their families were instructed on how to implement the diet) for the duration of the trial.

Standard laboratory tests, an analysis of 92 inflammatory proteins, and measurements of short-chain fatty acids in fecal samples were conducted at baseline and the end of the intervention. The primary outcomes were changes in the number of inflamed joints, score on the child health assessment questionnaire (CHAQ), overall well-being, pain, and morning stiffness. The secondary outcomes were changes in the microbiota and fecal short-chain fatty acids.

The results

Fifteen children completed the intervention. The diet resulted in improvements in several primary outcomes, namely, morning stiffness, pain, physical function, and CHAQ scores. Arthritis severity improved in five of the seven children with active arthritis. All of the children showed a decrease in nine inflammatory proteins. Butyrate (a short-chain fatty acid produced in the gut) increased in all of the participants.

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