Nutritional guidance in spondyloarthritis: confronting the evidence gap

Purpose of review: to summarize current evidence on the role of specific dietary patterns in spondyloarthritis (SpA) management. Recent findings: dietary interventions may offer a novel, complementary strategy to manage symptoms and enhance overall quality of life in many rheumatic diseases, including SpA. Evidence suggests that the Mediterranean diet may have beneficial effects on inflammation and SpA symptoms. Although there is growing interest in the ketogenic diet with some promising results, data is scarce. Some SpA patients may have sensitivities or intolerances to certain foods containing gluten, which can trigger or worsen their symptoms, especially when associated with intestinal inflammation. Hypocaloric diets and weight loss can provide significant benefit in overweight and obese patients with SpA, potentially reducing systemic inflammation. Finally, while the efficacy of probiotics remains a matter of debate, periods of fasting have proven effective in reducing disease activity indices. Summary: the importance of a healthy dietary lifestyle and its potential benefits in symptom management is acknowledged by the majority of the patients. There is an increased need and demand from patients to receive nutritional counseling that should be integrated into routine SpA management to enhance patient outcomes.