Long-term Effectiveness of a Lifestyle Program for Rheumatoid Arthritis: One-year Follow-up of the “Plants for Joints” Randomized Clinical Trial

Carlijn Wagenaar¹, Wendy Walrabenstein¹, Marike Van der Leeden², Franktien Turkstra², Jos W.R. Twisk¹, Maarten Boers¹, Henriët van Middendorp³, Peter Weijs⁴ and Dirkjan van Schaardenburg⁵, ¹Amsterdam University Medical Centers, Amsterdam, Netherlands, ²Reade Rheumatology Center, Amsterdam, Netherlands, ³Leiden University, Leiden, Netherlands, ⁴Amsterdam University of Applied Sciences, Amsterdam, Netherlands, ⁵Reade, Amsterdam, Netherlands

Meeting: ACR Convergence 2023

Keywords: diet, health behaviors, Intervention, nutrition, rheumatoid arthritis

Session Information

Date: Monday, November 13, 2023

Title: (1308–1344) RA – Treatments Poster II

Session Type: Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: The 16-week Plants for Joints (PFJ) multidisciplinary lifestyle program, based on a whole-food plant-based diet, physical activity, and stress management, significantly reduced 28-joint Disease Activity Score (DAS28) compared to usual care in people with rheumatoid arthritis (RA).^1,2The objective was to determine the long-term effectiveness of the PFJ lifestyle program on disease activity in people with RA.

Methods: In the PFJ assessor-blind randomized clinical trial, people with RA (DAS28 ≥ 2.6 and ≤ 5.1) were randomized to receive the PFJ program in addition to usual care, or the control group which received usual care. After this 16-week period the control group also received the program. After completion of the program all participants were followed-up for one year with biannual visits and six adherence-promoting webinars. Participants with a DAS28 < 2.6 were instructed to taper antirheumatic medication following a pre-specified protocol. Medication changes were assessed at one year as an “increase,” “stable,” or “decrease” compared to baseline by an independent committee. Secondary outcomes included anthropometric and metabolic markers. An intention-to-treat analysis with a linear mixed model was used to analyze within-group differences.

Results: 65 (84%) of the 77 participants, who completed the initial 16-week clinical trial, completed the one-year follow-up. 92% of participants were female with a mean (SD) age of 55 (12) and body mass index of 26 (4) kg/m². In the year after the PFJ program the DAS28 continued to improve slightly whereby a within-group difference of –0.9 points was observed after one year compared to baseline (p < 0.0001) (Figure 1). All components of the DAS28 improved significantly compared to baseline (Table 1). Of the 56 participants who completed the follow-up and used disease modifying anti-rheumatic medication, 27 (48%) decreased or stopped, 16 had stable, and 13 had increased medication. 45 participants (58%) improved DAS28 scores (20 with DAS28 < 2.6) with stable or less medication compared to baseline. After the 1-year follow-up period waist circumference, LDL cholesterol, and CRP remained significantly lower than baseline values, although there was no longer a significant difference in weight or HbA1c.

Conclusion: The PFJ lifestyle program significantly decreased disease activity in people with RA and its effects were sustained till one year after program completion with on average slightly less antirheumatic medication. Metabolic benefits found after the lifestyle intervention were only partially sustained, possibly indicating attenuated adherence to the program in the follow-up.

References 1. Walrabenstein, Trials 2021 2. Walrabenstein, Rheumatology 2023

Figure 1. Mean change in DAS28 (a) during the randomized controlled trial phase and one-year follow-up period per trial arm and (b) for the whole cohort before and after completing the lifestyle intervention and one year follow-up.

Table 1. Plants for Joints cohort at start and end of the 16-week intervention period as well as during the one year extension study (6 and 12 months after completing the intervention). Continuous variables reported as mean (SD) when normally distributed or as median [IQR] when skewed. Within-group difference shown between start of the lifestyle intervention and end of the 12-month follow-up determined using the linear-mixed model when model assumptions were met. For variables in which model assumptions were not met (†) a linear-mixed model was performed after log transformation and within group differences were reported as median difference of complete paired values determined using a Wilcoxon test (p-values from the linear mixed model are shown, all were similar to the Wilcoxon test). ESR = Erythrocyte sedimentation rate.

Disclosures: C. Wagenaar: The Netherlands Organisation for Health Research and Development (ZonMw), 5; W. Walrabenstein: None; M. Van der Leeden: None; F. Turkstra: None; J. Twisk: None; M. Boers: None; H. van Middendorp: None; P. Weijs: None; D. van Schaardenburg: None.

To cite this abstract in AMA style:

Wagenaar C, Walrabenstein W, Van der Leeden M, Turkstra F, Twisk J, Boers M, van Middendorp H, Weijs P, van Schaardenburg D. Long-term Effectiveness of a Lifestyle Program for Rheumatoid Arthritis: One-year Follow-up of the “Plants for Joints” Randomized Clinical Trial [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/long-term-effectiveness-of-a-lifestyle-program-for-rheumatoid-arthritis-one-year-follow-up-of-the-plants-for-joints-randomized-clinical-trial/. Accessed .

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