Naima Hagström: Exploring the Specific Carbohydrate Diet as an Adjunctive Treatment Option in Children with Juvenile Idiopathic Arthritis

Abstract

Advances in pharmacological treatments have improved the overall outcomes for patients with Juvenile Idiopathic Arthritis (JIA) in recent decades. However, many patients still struggle to achieve remission and suffer from debilitating symptoms, such as pain and fatigue, even when inflammation is controlled. The Specific Carbohydrate Diet (SCD) has shown promise as an adjunctive treatment in a small cohort of children with JIA. This thesis further explored the impacts of SCD as an adjunctive treatment option in children with JIA.

Paper I indicated sustained clinical benefits for several months post-intervention in the follow-up group. While no statistically significant differences were found in long-term medication requirements between the intervention group and matched controls, six patients who were candidates for treatment escalation did not require changes in their regimens post-intervention, suggesting clinically meaningful effects for some individuals.

Paper II enhanced our understanding of the multifaceted challenges faced by children and families navigating dietary interventions. Despite practical, financial, and social challenges, dietary treatments were highly appreciated and considered worthwhile by both children and parents, particularly for their perceived ability to improve symptoms that persist despite pharmacological treatment.

Paper III revealed high intakes of beneficial foods and a low probability of inadequate intakes. However, findings also uncovered potential nutritional risks, such as elevated intakes of saturated fats and red meat. This may be a disadvantage for children with JIA, who are already at increased risk of cardiovascular disease and metabolic syndrome. Additionally, low calcium intake poses a concern given children with JIA’s susceptibility to reduced bone density.

Paper IV demonstrated significant increases in plasma short-chain fatty acids, known for positive immunological effects, after four weeks of SCD. Several metabolomic changes correlated with changes in clinical outcomes, providing guidance towards potential mechanisms underlying the dietary effects of SCD.

This thesis represents an initial, exploratory contribution to the largely uncharted field of dietary interventions for JIA. While the results indicate beneficial effects, the SCD may not be the optimal dietary approach. These promising findings should be viewed as a foundation for further, more comprehensive research in larger cohorts.