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Volume 35, Issue 1, March 2024



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Mediterr J Rheumatol 2023;34(1):30-6
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Fly Me to the Immune: Immunonutrition in Rheumatic Diseases
Maria G. Grammatikopoulou1, Georgios Marakis2, Konstantinos Gkiouras1, Dorothea Athanatou1, Maria I. Maraki3, Dimitrios P. Bogdanos1
Authors Information

1Immunonutrition Unit, Department of Rheumatology and Clinical immunology, General University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece

2Nutrition and Food Standards Unit, Directorate of Risk Assessment and Nutrition, Hellenic Food Authority, Athens, Greece

3Department of Nutrition and Dietetics, School of Health Sciences, Hellenic Mediterranean University, Crete, Greece

Keywords: vitamin D, dysbiosis, microbiota, anti-inflammatory diet, rheumatoid arthritis, lupus, psoriasis
References
  1. Scrimshaw NS, Taylor CE, Gordon JE. Interactions of nutrition and infection - PubMed. Monograms Ser World Heal Organ 1968;57:3–329.
  2. Zapatera B, Prados A, Gómez-Martínez S, Marcos A. Immunonutrition: methodology and applications. Nutr Hosp 2015;31:145–4.
  3. Gredel S. Nutrition and Immunity in man. 2nd ed. Brussels: ILSI Europe Monograph Series, 2011.
  4. Calder PC. Immunonutrition: May have beneficial effects in surgical patients. BMJ Br Med J 2003;327:117.
  5. Makrides M, Ochoa JB, Szajewska H (eds). The importance of immunonutrition. Vevey, Switzerland: Nestlé Nutrition Institute Workshop Series, 2013.
  6. Forget P, Echeverria G, Giglioli S, Bertrand B, Nikis S, Lechat JP, et al. Biomarkers in immunonutrition programme, is there still a need for new ones? A brief review. Ecancermedicalscience 2015 Jun 18;9:546.
  7. Grimble RF. Basics in clinical nutrition: Immunonutrition – Nutrients which influence immunity: Effect and mechanism of action. Eur e-Journal Clin Nutr Metab 2009;4:e10–e13.
  8. Olsen MN, Tangvik RJ, Halse AK. Evaluation of Nutritional Status and Methods to Identify Nutritional Risk in Rheumatoid Arthritis and Spondyloarthritis. Nutr 2020;12:3571.
  9. Santo RC, Silva JM, Lora PS, Moro ALD, Freitas EC, Bartikoski BJ, et al. Cachexia in patients with rheumatoid arthritis: a cohort study. Clin Rheumatol 2020 Dec;39(12):3603-13.
  10. Efthymiou E, Grammatikopoulou MG, Gkiouras K, Efthymiou G, Zafiriou E, Goulis DG, et al. Time to Deal with Rheumatoid Cachexia: Prevalence, Diagnostic Criteria, Treatment Effects and Evidence for Management. Mediterr J Rheumatol 2022;33:271–290.
  11. Meza-Meza MR, Vizmanos-Lamotte B, Muñoz-Valle JF, Parra-Rojas I, Garaulet M, Campos-López B, et al. Relationship of Excess Weight with Clinical Activity and Dietary Intake Deficiencies in Systemic Lupus Erythematosus Patients. Nutr 2019, Vol 11, Page 2683 2019; 11: 2683.
  12. Markaki AG, Gkiouras K, Papakitsos C, Grammatikopoulou MG, Papatsaraki A, Ioannou R, et al. Disease Activity, Functional Ability and Nutritional Status in Patients with Rheumatoid Arthritis: An Observational Study in Greece. Mediterr J Rheumatol 2020;31:406.
  13. Silvestre MP, Rodrigues AM, Canhão H, Marques C, Teixeira D, Calhau C, et al. Cross-Talk between Diet-Associated Dysbiosis and Hand Osteoarthritis. Nutr 2020;12:3469.
  14. Vieira JRP, Rezende AT de O, Fernandes MR, da Silva NA. Intestinal microbiota and active systemic lupus erythematosus: a systematic review. Adv Rheumatol 2021;61:1–8.
  15. Tsigalou C, Stavropoulou E, Bezirtzoglou E. Current Insights in Microbiome Shifts in Sjogren’s Syndrome and Possible Therapeutic Interventions. Front Immunol 2018 May 24;9:1106.
  16. Todberg T, Kaiser H, Zachariae C, C, Egeberg A, Halling AS, Skov L. Characterization of the oral and gut microbiota in patients with psoriatic diseases: A systematic review. Acta Derm Venereol 2021 Jul 30;101(7):adv00512.
  17. 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 y Nutr 2018;65:533–9.
  18. Hassanalilou T, Khalili L, Ghavamzadeh S, Shokri A, Payahoo L, Bishak YK. Role of vitamin D deficiency in systemic lupus erythematosus incidence and aggravation. Autoimmun Highlights 2018;9:1–10.
  19. Heidari B, Tajian-Tilaki K, Babaei M. Vitamin D Deficiency and Rheumatoid Arthritis: Epidemiological, Immunological, Clinical and Therapeutic Aspects. Mediterr J Rheumatol 2019; 30: 94–102.
  20. Ali OME. Prevalence of Vitamin D Deficiency and Its Relationship with Clinical Outcomes in Patients with Fibromyalgia: a Systematic Review of the Literature. SN Compr Clin Med 2022 41 2022; 4: 1–8.
  21. Lightfoot YL, Blanco LP, Kaplan MJ. Metabolic Abnormalities and Oxidative Stress in Lupus. Curr Opin Rheumatol 2017;29:442.
  22. Hedar AM, Stradner MH, Roessler A, Goswami N. Autoimmune Rheumatic Diseases and Vascular Function: The Concept of Autoimmune Atherosclerosis. J Clin Med 2021 Sep 27;10(19):4427.
  23. Sakkas LI. Regulatory B cells in autoimmune rheumatic diseases. Mediterr J Rheumatol 2017;28:75–9.
  24. Badii M, Gaal O, Popp RA, Crișan TO, Joosten LAB. Trained immunity and inflammation in rheumatic diseases. Jt Bone Spine 2022;89:105364.
  25. Padula SJ, Clark RB, Korn JH. Cell-mediated immunity in rheumatic disease. Hum Pathol 1986;17:254–63.
  26. Rhoads JP, Major AS, Rathmell JC. Fine tuning of immunometabolism for the treatment of rheumatic diseases. Nat Rev Rheumatol 2017;13:313–20.
  27. Ahn SS, Han M, Yoo J, Park YB, Jung I, Lee SW. Incidence of Tuberculosis in Systemic Necrotizing Vasculitides: A Population-Based Study From an Intermediate-Burden Country. Front Med 2020;7:686.
  28. Calabrese LH, Calabrese C, Lenfant T, Kirchner E, Strand V. Infections in the Era of Targeted Therapies: Mapping the Road Ahead. Front Med 2020;7:336.
  29. Sakkas LI, Bogdanos DP. Infections as a cause of autoimmune rheumatic diseases. Auto-Immunity Highlights;2016 Dec;7(1):13.
  30. Sakkas LI, Bogdanos DP. Multiple hit infection and autoimmunity: The dysbiotic microbiota-ACPA connection in rheumatoid arthritis. Curr Opin Rheumatol 2018;30:403–9.
  31. Bogdanos DP, Smyk DS, Invernizzi P, Rigopoulou EI, Blank M, Pouria S, et al. Infectome: a platform to trace infectious triggers of autoimmunity. Autoimmun Rev 2013;12:726–40.
  32. Bogdanos DP, Smyk DS, Rigopoulou EI, Sakkas LI, Shoenfeld Y. Infectomics and autoinfectomics: A tool to study infectious-induced autoimmunity. Lupus 2015;24:364–73.
  33. Hsu CY, Ko CH, Wang JL, Hsu TC, Lin CY. Comparing the burdens of opportunistic infections among patients with systemic rheumatic diseases: A nationally representative cohort study. Arthritis Res Ther 2019;21:1–10.
  34. Bogdanos DP, Sakkas LI. Infections: Viruses and Bacteria. In: Perricone C, Shoenfeld Y (eds) Mosaic of Autoimmunity: The Novel Factors of Autoimmune Diseases. Saint-Petersburg: Academic Press, 2019, pp. 201–211.
  35. Gelber AC, Levine SM, Darrah E. Inflammatory Rheumatic Diseases. In: Hammer GD, McPhee SJ (eds) Pathophysiology of Disease: An Introduction to Clinical Medicine. China: McGraw-Hill Education, 2019.
  36. Deane KD, El-Gabalawy H. Pathogenesis and prevention of rheumatic disease: focus on preclinical RA and SLE. Nat Rev Rheumatol 2014;10:212–28.
  37. Jennings F, Lambert E, Fredericson M. Rheumatic diseases presenting as sports-related injuries. Sports Med 2008;38:917–30.
  38. Guevara-Pacheco S, Feicán-Alvarado A, Sanín LH, Vintimilla-Ugalde J, Vintimilla-Moscoso F, Delgado-Pauta J, et al. Prevalence of musculoskeletal disorders and rheumatic diseases in Cuenca, Ecuador: a WHO-ILAR COPCORD study. Rheumatol Int 2016;36:1195–204.
  39. Gilheaney Ó, Béchet S, Walshe M. Modified diet use in adults with temporomandibular disorders related to rheumatoid arthritis: A systematic review. Mediterr J Rheumatol 2020;31:183–9.
  40. Fricton JR. Temporomandibular Disorders. In: Aminoff MJ, Daroff RB (eds) Encyclopedia of the Neurological Sciences. Academic Press, 2014, pp. 409–413.
  41. Branco JC, Rodrigues AM, Gouveia N, Eusébio M, Ramiro S, Machado PM, et al. Prevalence of rheumatic and musculoskeletal diseases and their impact on health-related quality of life, physical function and mental health in Portugal: results from EpiReumaPt– a national health survey. RMD Open 2016;2:e000166.
  42. Fletcher J, Bishop EL, Harrison SR, Swift A, Cooper SC, Dimeloe SK, et al. Autoimmune disease and interconnections with vitamin D. Endocr Connect 2022 Mar 31;11(3):e210554.
  43. Islam MA, Khandker SS, Alam SS, Kotyla P, Hassan R. Vitamin D status in patients with systemic lupus erythematosus (SLE): A systematic review and meta-analysis. Autoimmun Rev 2019 Nov;18(11):102392.
  44. An L, Sun MH, Chen F, Li JR. Vitamin D levels in systemic sclerosis patients: a meta-analysis. Drug Des Devel Ther 2017;11:3119.
  45. Schneider L, Hax V, Monticielo O, Macedo TF, Barreto RKM, Marcondes NA, et al. Dualities of the vitamin D in systemic sclerosis: a systematic literature review. Adv Rheumatol 2021;61:1–10.
  46. Zhao S, Duffield SJ, Moots RJ, Goodson NJ. Systematic review of association between vitamin D levels and susceptibility and disease activity of ankylosing spondylitis. Rheumatology 2014;53:1595–603.
  47. Kuo CY, Huang YC, Lin KJ, Tsai TY. Vitamin D Deficiency Is Associated with Severity of Dry Eye Symptoms and Primary Sjögren’s Syndrome: A Systematic Review and Meta-Analysis. J Nutr Sci Vitaminol (Tokyo) 2020;66:386–8.
  48. Pitukweerakul S, Thavaraputta S, Prachuapthunyachart S, Karnchanasorn R. Hypovitaminosis D is Associated with Psoriasis: A Systematic Review and Meta-Analysis. Kansas J Med 2019;12:103–8.
  49. Buckley L, Guyatt G, Fink HA, Cannon M, Grossman J, Hansen KE, et al. 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis Rheumatol (Hoboken, NJ) 2017;69:1521–37.
  50. Yong WC, Sanguankeo A, Upala S. Effect of vitamin D supplementation in chronic widespread pain: a systematic review and meta-analysis. Clin Rheumatol 2017;36:2825–33.
  51. Wu Z, Malihi Z, Stewart AW, Lawes CM, Scragg R. The association between vitamin D concentration and pain: a systematic review and meta-analysis. Public Health Nutr 2018;21:2022–37.
  52. Charoenngam N, Holick MF. Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients 2020;12:1–28.
  53. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266–81.
  54. Smyk DS, Orfanidou T, Invernizzi P, Bogdanos DP, Lenzi M. Vitamin D in autoimmune liver disease. Clin Res Hepatol Gastroenterol 2013;37:535–45.
  55. Guan Y, Hao Y, Guan Y, Bu H, Wang H. The Effect of Vitamin D Supplementation on Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2020 Oct 30;7:596007.
  56. Franco AS, Freitas TQ, Bernardo WM, Pereira RMR. Vitamin D supplementation and disease activity in patients with immune-mediated rheumatic diseases. Medicine (Baltimore) 2017;96: e7024.
  57. Theodoridis X, Grammatikopoulou MG, Stamouli EM, Talimtzi P, Pagkalidou E, Zafiriou E, et al. Effectiveness of oral vitamin D supplementation in lessening disease severity among patients with psoriasis: A systematic review and meta-analysis of randomized controlled trials. Nutrition 2021;82:111024.
  58. Hahn J, Cook NR, Alexander EK, Friedman S, Walter J, Bubes V, et al. Vitamin D and marine omega 3 fatty acid supplementation and incident autoimmune disease: VITAL randomized controlled trial. BMJ; 376. Epub ahead of print 26 January 2022. DOI: 10.1136/BMJ-2021-066452.
  59. Liu XX, Wang XX, Cui LL. Association between Oral vitamin C supplementation and serum uric acid: A meta-analysis of randomized controlled trials. Complement Ther Med 2021;60:102761.
  60. Gholizadeh M, Ghafour Saeedy SA, Abdi A, Khademi F, Lorian K, Clark CCT, et al. Vitamin C reduces interleukin-6 plasma concentration: a systematic review and meta-analysis of randomized clinical trials. Clin Nutr Open Sci 2021;40:1–14.
  61. El-Zayat SR, Sibaii H, Mannaa FA. Micronutrients and many important factors that affect the physiological functions of toll-like receptors. Bull Natl Res Cent 2019;43:1–15.
  62. Serapinas D, Boreikaite E, Bartkeviciute A, Bandzeviciene R, Silkunas M, Bartkeviciene D. The importance of folate, vitamins B6 and B12 for the lowering of homocysteine concentrations for patients with recurrent pregnancy loss and MTHFR mutations. Reprod Toxicol 2017;72:159–63.
  63. Deller DJ, Urban E, Ibbotson RN, Horwood J, Milazzo S, Robson HN. Folic-acid deficiency in rheumatoid arthritis: relation of levels of serum folic-acid activity to treatment with phenylbutazone. Br Med J 1966;1:765–7.
  64. Bramley D. What dose of folic acid to use with methotrexate in rheumatoid arthritis? Drug Ther Bull 2021;59:103–6.
  65. Liu L, Liu S, Wang C, Guan W, Zhang Y, Hu W, et al. Folate Supplementation for Methotrexate Therapy in Patients With Rheumatoid Arthritis: A Systematic Review. J Clin Rheumatol 2019;25:197–202.
  66. Hayta E, Hizmetli S, Atalar MH, Çinar Z. Association of Plasma Homocysteine Level and Carotid Intima-Media Thickness in Rheumatoid Arthritis Patients Receiving Methotrexate. Arch Rheumatol 2015;30:214–20.
  67. Głuszek J, Wierzowiecka M, Niklas K, Niklas A. The importance of homocysteine in the development of cardiovascular complications in patients with rheumatoid arthritis. Reumatologia 2020;58:282.
  68. Ruiz-León AM, Lapuente M, Estruch R, Casas R. Clinical advances in immunonutrition and atherosclerosis: A review. Front Immunol 2019;10:837.
  69. Sonawane K, Zhu Y, Chan W, Aguilar D, Deshmukh AA, Suarez-Almazor ME. Association of Serum Folate Levels With Cardiovascular Mortality Among Adults With Rheumatoid Arthritis. JAMA Netw Open. 2020 Feb 5;3(2):e200100.
  70. Saboori S, Shab-Bidar S, Speakman JR, Yousefi Rad E, Djafarian K. Effect of vitamin E supplementation on serum C-reactive protein level: a meta-analysis of randomized controlled trials. Eur J Clin Nutr 2015;69:867–73.
  71. Asbaghi O, Sadeghian M, Nazarian B, Sarreshtedari M, Mozaffari-Khosravi H, Maleki V, et al. The effect of vitamin E supplementation on selected inflammatory biomarkers in adults: a systematic review and meta-analysis of randomized clinical trials. Sci Reports 2020;10:1–17.
  72. Singh U, Devaraj S, Jialal I. Vitamin E, oxidative stress, and inflammation. Annu Rev Nutr 2005;25:151–74.
  73. Liu X, Yang G, Luo M, Yang CH, Li LY, Wu S, et al. Serum vitamin E levels and chronic inflammatory skin diseases: A systematic review and meta-analysis. PLoS One 2021;16:e0261259.
  74. Ma Y, Zhang X, Fan D, Xia Q, Wang M, Pan F. Common trace metals in rheumatoid arthritis: A systematic review and meta-analysis. J Trace Elem Med Biol 2019;56:81–9.
  75. Gad SS, Fayez AM, Abdelaziz M, Abou El-Ezz D. Amelioration of autoimmunity and inflammation by zinc oxide nanoparticles in experimental rheumatoid arthritis. Naunyn Schmiedebergs Arch Pharmacol 2021;394:1975–81.
  76. Frangos T, Maret W. Zinc and Cadmium in the Aetiology and Pathogenesis of Osteoarthritis and Rheumatoid Arthritis. Nutrients 2020;13:1–22.
  77. Lv J, Ai P, Lei S, Zhou F, Chen S, Zhang Y. Selenium levels and skin diseases: systematic review and meta-analysis. J Trace Elem Med Biol 2020 Dec;62:126548.
  78. Hughes M, Cooper GJS, Wilkinson J, New P, Guy JM, Herrick AL. Abnormalities of selenium but not of copper homeostasis may drive tissue fibrosis in patients with systemic sclerosis. Rheumatology 2015;54:747–8.
  79. Lundberg AC, Akesson A, Akesson B. Dietary intake and nutritional status in patients with systemic sclerosis. Ann Rheum Dis 1992;51:1143–8.
  80. Deyab G, Hokstad I, Aaseth J, Småstuen MC, Whist JE, Agewall S, et al. Effect of anti-rheumatic treatment on selenium levels in inflammatory arthritis. J Trace Elem Med Biol 2018;49:91–7.
  81. Qamar N, John P, Bhatti A. Emerging role of selenium in treatment of rheumatoid arthritis: An insight on its antioxidant properties. J Trace Elem Med Biol 2021 Jul;66:126737.
  82. Rosenkranz E, Maywald M, Hilgers RD, Brieger A, Clarner T, Kipp M, et al. Induction of regulatory T cells in Th1-/Th17-driven experimental autoimmune encephalomyelitis by zinc administration. J Nutr Biochem 2016;29:116–23.
  83. Straubel D, Thielitz A, Reinhold A, Grüngreiff K, Reinhold D. Combined Treatment with Zinc Aspartate and Intravenous Immunoglobulins (IVIGs) Ameliorates Experimental Autoimmune Encephalomyelitis (EAE). J Immunol Res 2018 Sep 26;2018:5982169.
  84. Salari S, Khomand P, Arasteh M, Yousefzamani B, Hassanzadeh K. Zinc sulphate: A reasonable choice for depression management in patients with multiple sclerosis: A randomized, double-blind, placebo-controlled clinical trial. Pharmacol Rep 2015;67:606–9.
  85. Gkiouras K, Grammatikopoulou MG, Myrogiannis I, , Papamitsou T, Rigopoulou EI, Sakkas LI, et al. Efficacy of n-3 fatty acid supplementation on rheumatoid arthritis’ disease activity indicators: a systematic review and meta-analysis of randomized placebo-controlled trials. Crit Rev Food Sci Nutr. Epub ahead of print 2022. DOI: 10.1080/10408398.2022.2104210.
  86. Kostoglou-Athanassiou I, Athanassiou L, Athanassiou P. The effect of omega-3 fatty acids on rheumatoid arthritis. Mediterr J Rheumatol 2020; 31: 190–194.
  87. Navarini L, Afeltra A, Gallo Afflitto G, Margiotta DPE. Polyunsaturated fatty acids: any role in rheumatoid arthritis? Lipids Health Dis 2017; 16: 197.
  88. Serhan CN, Chiang N. Endogenous pro-resolving and anti-inflammatory lipid mediators: a new pharmacologic genus. Br J Pharmacol; 153 Suppl 1. Epub ahead of print March 2008. DOI: 10.1038/SJ.BJP.0707489.
  89. 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: 114-124.e4.
  90. Petersson S, Philippou E, Rodomar C, Nikiphorou E. The Mediterranean diet, fish oil supplements and Rheumatoid arthritis outcomes: evidence from clinical trials. Autoimmun Rev 2018;17:1105–14.
  91. Esmaeili SA, Mahmoudi M, Momtazi AA, Sahebkar A, Doulabi H, Rastin M. Tolerogenic probiotics: potential immunoregulators in Systemic Lupus Erythematosus. J Cell Physiol 2017;232:1994–2007.
  92. Zhong D, Wu C, Zeng X, Wang Q. The role of gut microbiota in the pathogenesis of rheumatic diseases. Clin Rheumatol 2018;37:25–34.
  93. Yu D, Du J, Pu X, Zheng L, Chen S, Wang N, et al. The Gut Microbiome and Metabolites Are Altered and Interrelated in Patients With Rheumatoid Arthritis. Front Cell Infect Microbiol; 11. Epub ahead of print 25 January 2022. DOI: 10.3389/FCIMB.2021.763507.
  94. Cutolo M, Nikiphorou E. Don’t neglect nutrition in rheumatoid arthritis! RMD Open 2018;4:e000591.
  95. Feng J, Zhao F, Sun J, Lin B, Zhao L, Liu Y, et al. Alterations in the gut microbiota and metabolite profiles of thyroid carcinoma patients. Int J Cancer 2019;144:2728–45.
  96. Manasson J, Blank RB, Scher JU. The microbiome in rheumatology: Where are we and where should we go? Ann Rheum Dis 2020;79:727–33.
  97. Sanchez P, Letarouilly JG, Nguyen Y, Sigaux J, Barnetche T, Czernichow S, et al. Efficacy of Probiotics in Rheumatoid Arthritis and Spondyloarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutr 2022;14:354.
  98. Lowe JR, Briggs AM, Whittle S, Stephenson MD. A systematic review of the effects of probiotic administration in inflammatory arthritis. Complement Ther Clin Pract; 40. Epub ahead of print 1 August 2020. DOI: 10.1016/J.CTCP.2020.101207.
  99. Zeng L, Yu G, Wu Y, Hao W Chen H. The Effectiveness and Safety of Probiotic Supplements for Psoriasis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Preclinical Trials. J Immunol Res; 2021. Epub ahead of print 2021. DOI: 10.1155/2021/7552546.
  100. Grammatikopoulou M, Gkiouras K, Theodoridis X, Asteriou E, Forbes A, Bogdanos DP. Oral Adjuvant Curcumin Therapy for Attaining Clinical Remission in Ulcerative Colitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2018;10:1737.
  101. Jakubczyk K, Drużga A, Katarzyna J, Skonieczna-Żydecka K. Antioxidant Potential of Curcumin—A Meta-Analysis of Randomized Clinical Trials. Antioxidants 2020;9:1–13.
  102. Athanassiou P, Athanassiou L, Kostoglou-Athanassiou I. Nutritional Pearls: Diet and Rheumatoid Arthritis. Mediterr J Rheumatol 2020;31:319–24.
  103. Ebrahimzadeh A, Abbasi F, Ebrahimzadeh A, Jibril AT, Milajerdi A. Effects of curcumin supplementation on inflammatory biomarkers in patients with Rheumatoid Arthritis and Ulcerative colitis: A systematic review and meta-analysis. Complement Ther Med 2021;61:102773.
  104. Jones VA, Patel PM, Wilson C, Wang H, Ashack KA. Complementary and alternative medicine treatments for common skin diseases: A systematic review and meta-analysis. JAAD Int 2021;2:76–93.