Mechanisms and clinical evidence of dietary patterns in axial spondyloarthritis

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that significantly impairs quality of life. Despite pharmacological advances, there is increasing interest in adjunctive nutritional interventions. This review evaluates the efficacy, mechanisms, and safety of dietary models-including low-starch, gluten-free, dairy-free, vegan/vegetarian, and Mediterranean diets-for axSpA management. A comprehensive literature search was conducted across Medline/PubMed, EMBASE, Scopus, Web of Science, and the Directory of Open Access Journals (DOAJ) databases for peer-reviewed articles published up to June 1, 2026. The search strategy utilized Boolean operators (AND, OR) to combine Medical Subject Heading (MeSH) terms and free-text keywords encompassing concepts of 'axial spondyloarthritis' and various dietary interventions (e.g., Mediterranean, gluten-free, and low-starch diets). Studies focusing on isolated nutrient supplementations without a broader dietary framework were excluded. Restrictive diets (e.g., low-starch or gluten-free) offer theoretical anti-inflammatory benefits via gut microbiota modulation but pose risks for unsupervised micronutrient deficiencies. While the Mediterranean diet is a feasible and safe option for general health, evidence for specific dietary interventions in axSpA remains limited and predominantly observational, with few randomized controlled trials available. Integrating personalized nutritional counseling into the multidisciplinary management of axSpA may help safely prevent deficiencies, optimize body weight, and improve patient well-being. However, current evidence remains insufficient to universally recommend a specific dietary model for axSpA.