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• Heterogeneity in clinical presentation and variability in disease course of rheumatic diseases pose a significant problem in describing the epidemiology of these conditions. • Despite these limitations, our understanding of the epidemiology of rheumatic diseases has dramatically improved in the past several decades. • Rapid advances in genomic technology and lowered cost of genotyping are leading to exciting new knowledge of the genetics underlying rheumatic disease. • These exciting findings may help identify subphenotypes, predict drug response, as well as clarify the role of genetic and environmental disease risk factors. • Hopefully, in the near future, these findings may result in promising new prevention strategies and treatments to reduce the suffering from rheumatic disease. [ABSTRACT FROM AUTHOR]

• There are numerous mechanisms by which micronutrients might be expected to influence the development or progression of osteoarthritis, but there has been insufficient research to draw definitive conclusions • One observational study suggested a protective effect of vitamin C for progression of osteoarthritis of the knee. Intake of vitamin E and β-carotene bore no relationship to osteoarthritis incidence or progression in that study, suggesting that the mechanism of benefit of vitamin C may be mediated through nonantioxidant properties • Clinical trials of vitamins E, C, and A and selenium have produced negative or inconsistent results • Epidemiological data for vitamin D in the treatment of symptoms and structural progression of osteoarthritis are conflicting. A randomized controlled trial is currently underway to address the efficacy of vitamin D in both the treatment of symptoms and structural progression in osteoarthritis. • Epidemiological data for vitamin K as a disease modifying micronutrient in osteoarthritis are conflicting. Randomized controlled trials are currently underway to address the efficacy of vitamin K in both the treatment of symptoms and structural progression in osteoarthritis. • There have been numerous positive clinical trials of glucosamine and chondroitin products for OA that have shown them to be well tolerated; however, interpretation of these trials is clouded by issues of biological plausibility, heterogeneity, publication bias, inconsistent results and methodological problems. [ABSTRACT FROM AUTHOR]

• The juvenile idiopathic arthritides are a group of heterogeneous disorders characterized by chronic arthritis with frequent extra-articular manifestations. • Differences in nomenclature and terminology require care in the interpretation of the medical literature. • Nutritional impairment is common in children with rheumatic diseases and assessment of nutritional status is a pivotal part of each child's evaluation. • Growth delay occurs in patients with juvenile idiopathic arthritis as a result of several factors such as early epiphyseal fusion, chronic steroid use, increased energy expenditure, and malnutrition. • Restriction of salt intake or supplemental vitamins such as vitamin D and folic acid are often required in patients who are receiving certain medications such as corticosteroids and methotrexate. [ABSTRACT FROM AUTHOR]

• Sjögren's syndrome is a chronic autoimmune disorder, most common in adult women. • There is no known etiology or cure for Sjögren's syndrome. • Sjögren's syndrome is characterized by debilitating ocular and oral manifestations. • Early diagnosis and palliation are critical. • Nutrition implications are similar to those for patients undergoing oral cancer and head and neck radiation. • Omega-3 fatty acids have been implicated as a potential therapeutic agent. [ABSTRACT FROM AUTHOR]

• Gastrointestinal involvement is common in systemic vasculitis. • Chronic systemic inflammation is common in vasculitis and frequently leads to weight loss and cachexia. • Immunosuppressive medications can cause gastrointestinal toxicity. • There is little evidence of any dietary manipulations or supplementations having any impact on the course of vasculitis. [ABSTRACT FROM AUTHOR]

• Chronic muscle inflammation in polymyositis or dermatomyositis causes muscle weakness and fatigue. • The chronic inflammation could lead to a catabolic state and additional loss of muscle mass. • The chronic muscle inflammation could induce a metabolic myopathy. • Body weight may not be reliable to measure muscle loss, rather measurement of body composition is recommended. •For patients with polymyositis or dermatomyositis it is important to provide the body with the right amount of macronutrients and trace elements for maintenance and improvement of body functions. • One recommendation is supplementation with calcium and vitamin D. • Another recommendation is regular physical exercise that during limited periods can be combined with supplements such as creatine, if done under the care of a physician. [ABSTRACT FROM AUTHOR]

The pathophysiology of fibromyalgia is not known. Its prevalence is approx 3 to 5%. Females are affected more often than males. • The most pathogenomic features are multiple bilateral tender points. The other symptoms include chronic pain, sleep disturbances, and fatigue, which may lead to psychological distress. • Fibromyalgia symptoms and time course are individually variable. • Gastrointestinal symptoms may also occur, and circulatory disturbances in the brain have been described. • There is no special therapeutic diet for this disease. All patients with rheumatoid diseases may have nutritional deficiencies. Vegan diets may be helpful for pain relief and modification in fibromyalgia. Physical activity helps maintain proper food intake and rest. [ABSTRACT FROM AUTHOR]

• Dietary trends, increasing obesity and metabolic syndrome prevalence, are contributing to the increasing worldwide prevalence of hyperuricemia and gout. • There is a strong association of metabolic syndrome with hyperuricemia. • Dietary intervention is strongly recommended in patients with metabolic syndrome and hyperuricemia. Consumption of meat, seafood, and alcoholic beverages in moderation is useful. • Controlled weight management has the potential to lower serum urate levels. • Dairy products may have clinically meaningful antihyperuricaemic effects. • Further education and studies are needed to improve our understanding of dietary factors and hyperuricemia. [ABSTRACT FROM AUTHOR]

• There are interesting data on nutritional supplementation in the treatment of systemic lupus erythematous. However, at this time, there is little convincing human data to support dietary modifications or nutritional supplementation. • Future research may be helpful to identify potentially beneficial nutritional supplementation therapies in systemic lupus erythematous. [ABSTRACT FROM AUTHOR]

• Rheumatoid cachexia is nearly universal in patients with established rheumatoid arthritis. • Treatment that suppresses inflammation in rheumatoid arthritis does not reverse cachexia, although it will stop progressing. Reversal requires specific anabolic treatment, which is best done using resistance exercise. • Micronutrient deficiencies—especially vitamin B6 and antioxidants—are common in rheumatoid arthritis and should be treated judiciously. [ABSTRACT FROM AUTHOR]

• Complementary and alternative medicine encompasses a wide array of interventions, including diets, dietary supplements, and herbal products. • Scientific evidence does not support a substantial role of special diets in the treatment of the majority of patients with rheumatic disease, but various dietary manipulations may be beneficial when combined with standard medical therapy. • Long-term safety of dietary and herbal supplements is a legitimate concern and patients should always be cautioned about their use of these products. • Observed benefits in disease activity owing to short-term trials may be more reflective of the natural history of rheumatic disease rather than true differences in long-term outcome. [ABSTRACT FROM AUTHOR]

• Physical activity and exercise are safe and beneficial or the vast majority of people, including those with rheumatic disease. • Exercise aids in the prevention and management of chronic ill health, including rheumatic conditions, coronary heart disease, diabetes, strokes, certain cancers, and improves psychological well-being. • People should aim to do 30 minutes of moderate activity at least five times per week to gain health benefits. • Prior to beginning an exercise regimen, patients should establish current physical abilities and activity levels, and then set realistic, appropriate goals that "nudge the boundaries" and can be monitored regularly. • Within reason, the more exercise a person can do, the better, but only within the boundaries of maintaining safety and comfort. [ABSTRACT FROM AUTHOR]

• Timing of medication in relation to mealtime influences absorption and bioavailability of drugs. • Fish-oil supplementation can reduce prostaglandin production and proinflammatory cytokines. • Nonsteroidal anti-inflammatory drug use can be modulated by fish-oil supplements. • Folate status is important for prevention of methotrexate toxicity. • Side effects of medication, pathological process of the disease, low appetite, and low mobility from active disease can contribute to poor nutritional status of patients with rheumatic disease. • Optimal nutritional status should be maintained to achieve a positive treatment outcome and to reduce the risk for developing concurrent diseases. [ABSTRACT FROM AUTHOR]

• Nutritional status consists of more than dietary intake. • Six key aspects of nutritional status assessment are ABCDEFs: anthropometry, biochemical tests, clinical indices, dietary status, environmental influences, and functional indices. • Nutritional status assessment includes the ABCDEFs, but may require special adoptions for some of the arthritis and rheumatic diseases. [ABSTRACT FROM AUTHOR]

• The immune system is centrally involved in the pathogenesis of many rheumatic diseases, although the precise mechanisms by which the immune system becomes diseased remain undefined for most illnesses. • central theory governing autoimmunity is that disease results when a genetically susceptible individual is exposed to either a self-antigen or foreign antigen, resulting in an aberrant immune response. • Autoantibody formation is characteristic of many rheumatic illnesses but many of these autoantibodies are not directly pathogenic. • This chapter provides an overview of immunology and the rheumatic illnesses discussed in this volume, with a focus on autoimmunity. [ABSTRACT FROM AUTHOR]