關節炎是指關節痛﹑腫和破壞的情況。香港常見的兩種關節炎分別為痛風和類風濕性關節炎 (風濕)。前者與進食過多普林或身體把尿酸排進尿液的能力下降有關；而後者則因不明原因導致關節受到自身免疫系統攻擊。

現時，主流的治療風濕方法是依靠藥物，或者加上含豐富奧米加-3脂肪酸和其他營養素的飲食。一些早期研究發現，比起正常的控制組別，一部分風濕病人體內有較高對抗小麥成份的G免疫球蛋白抗體。Kjeldsen-Kragh領導的研究小組也發現，風濕病人體內有較高對抗某幾種食物的抗體，而他們轉食素食後亦得到改善。這些研究為治療或控制風濕迎來了新方向。

一個近期的研究為這個新方向解開了更多謎題。一組風濕病人被隨機分為兩組為期一年，素食(不包括小麥)和非素食。最後根據ACR20條件，40.5%素食病人有明顯改善；而非素食組只有4%。於實驗開始及最後階段中，研究人員檢驗病人體內對抗牛奶和小麥的G免疫球蛋白水平。比較非素食組後發現，素食組的G免疫球蛋白水平於實驗之後明顯下降；再詳細分析數據發現，原來素食組的G免疫球蛋白水平下降主要來自40.5%實驗後有明顯改善的素食病人，而不是其他參與者。研究人員強調，減少身體受到食物刺激並不一定可以令G免疫球蛋白水平下降。反而，是次實驗中素食對一部分風濕病人的正面功效可能真的由於對抗外來食物致敏原的免疫反應降低。加上其他支持這項結論的研究，所有證據都支持一個概念，就是腸道免疫系統的改變可以影響風濕病人關節發炎的情況。

以上的故事得出一個較清晰的新方向，除了藥物，可用於治療或控制風濕，就是根據血液中抗食物的G免疫球蛋白水平而進行排除飲食。

Arthritis is a collective term used to describe the condition of joint pain, swelling and destruction. The two commonly heard types of arthritis in Hong Kong are Gout and Rheumatoid Arthritis (RA). The former one is associated with excessive ingestion of purine or compromised excretion of uric acid into urine while the latter one is of unknown reason causing attack to the joints by own immune system.

The current main stream treatment of RA relies on medication and/or diet rich in omega-3 fatty acid and possibly some other nutrients. In some earlier studies, subgroups of RA patients have been found to have elevated levels of IgG antibodies against wheat ingredients compared with control. Increased antibody levels to several dietary antigens have also been demonstrated by Kjeldsen-Kragh et al in RA patients who subsequently responded favorably to a vegetarian diet. All these provide a light into new direction in treating RA.


In a more recent study, more details in the story are revealed. A group of patients are randomized into two groups, vegan diet and non-vegan diet group for a year. Turnout, 40.5% patients in vegan diet group have significant improvements according to ACR20 criteria while only 4% in non-vegan diet group. The IgG levels against gluten and milk before and after the treatment are measured. It is found that IgG levels of vegan diet group have the significant drop after the treatment, as compared to the non-vegan diet group. When the data of vegan diet group are subdivided, the decrease of IgG levels mainly come from the positively responder group, but not from other subgroups. The researchers emphasized that this decrease did not always occur as a result of a lack of exposure to the antigens. It rather suggests that a positive effect of a vegan diet in a subgroup of RA patients may indeed be due to diminished immune response tot exogenous food antigens. Taken together other supporting studies, these studies thus provide additional support to the concept that changes in the gut immune system can influence the course of joint inflammation in RA.

This above story gives a clear view of new way to treat or manage RA with elimination diet based on food-specific IgG levels in blood, beside medication.



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