INTERMITTENT fasting notably reduces disease activity in patients with rheumatic disease, but current evidence remains conflicting. In a new systematic review and meta-analysis synthesizing seven independent clinical studies and nine datasets, researchers evaluated the therapeutic potential of structured fasting regimens. The pooled analysis encompassed 471 individuals with rheumatoid arthritis and 85 patients diagnosed with spondyloarthritis. Investigated fasting modalities included 16:8 time-restricted eating, Ramadan diurnal intermittent fasting, and supervised low-calorie fasts lasting seven to ten days.
Pooled outcomes revealed distinct benefits for clinical composite indices. Observational datasets demonstrated significant reductions in the 28-joint Disease Activity Score (DAS28) alongside substantial improvements in patient-reported pain measured by the Visual Analog Scale. In the randomized controlled trial cohort, intermittent fasting maintained a statistically significant reduction in DAS28 scores (mean difference: -0.55, 95% confidence interval: -1.09 to -0.02, P = 0.04). However, other clinical parameters exhibited less definitive trajectories; changes in the Clinical Disease Activity Index and morning stiffness duration failed to reach statistical significance.
Objective inflammatory markers showed notable divergence from clinical symptom improvements. While erythrocyte sedimentation rate displayed an encouraging downward trend across randomized trials, the confidence intervals crossed the null value. Similarly, high-sensitivity C-reactive protein levels showed no statistically significant reduction and exhibited marked statistical heterogeneity. Study authors attributed this variability to diverse fasting protocols, varying disease durations, and disparate baseline immunosuppressive therapies across the small number of available trials.
Despite these limitations, intermittent fasting demonstrated a favorable safety profile with predominantly mild, transient adverse effects. Investigators emphasized that fasting protocols should not replace standard disease-modifying antirheumatic drugs. Instead, time-restricted feeding may represent a viable nonpharmacological adjunctive strategy, particularly for patients managing metabolic comorbidities or seeking structured lifestyle modifications. Rheumatologists encountering patient inquiries regarding dietary interventions must emphasize that rigorously standardized, large-scale trials remain necessary before clinical guidelines incorporate fasting into routine practice.
Reference
Liu R et al. Intermittent fasting for rheumatic diseases: a systematic review and meta-analysis of conflicting evidence from observational studies and randomized controlled trials. PeerJ. 2026;14:e21185.
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