Rheumatoid Arthritis Guidelines Require Dietary Recommendations: An Overlooked Opportunity

Clinical guidelines for rheumatoid arthritis (RA), including those from the American College of Rheumatology (ACR) and the European Alliance of Associations for Rheumatology (EULAR), predominantly emphasize pharmacotherapy while largely omitting dietary recommendations. This omission persists despite accumulating clinical evidence and strong patient interest in nutrition. Recent cohort studies and randomized trials have demonstrated that anti-inflammatory dietary patterns, such as the Mediterranean diet, improve RA clinical outcomes; yet international guidelines remain silent on nutrition. This critical gap is especially pronounced in low-resource settings, where dietary modifications could serve as accessible, cost-effective adjuncts to pharmacotherapy. Although several national associations (including those in Germany, France, Australia, the UK, and New Zealand) have begun incorporating whole-food and plant-based recommendations, these frameworks often fail to personalize based on age, sex, ethnicity, and body composition. This opinion paper calls on the ACR and EULAR to integrate evidence-based, culturally sensitive, and individualized dietary recommendations into future RA guidelines. Addressing this gap is essential to align clinical practice with emerging scientific evidence and support equitable, patient-centered care.