News in brief: Plant based diet reduces inflammation; Has deprescribing of opioids been forgotten?; Oral versus subcut MTX

Reminder to beef up the veggies

New research investigating 173 dietary factors and the gut microbiome of 1,425 people has provided further support for a largely plant-based diet to reduce the intestinal inflammation underlying many chronic diseases.

The study found higher intake of animal foods, processed foods, alcohol and sugar were associated with a microbial environment characteristic of inflammation, and higher levels of intestinal inflammatory markers.

In contrast, food such as nuts, oily fish, fruits, vegetables, cereals and red wine were associated with commensal microbiota known to be anti-inflammatory such as Roseburia sp.

“We identified significant associations that replicate across patients with Crohn’s disease, ulcerative colitis, irritable bowel syndrome and the general population, implying a potential for microbiome-targeted dietary strategies to alleviate and prevent intestinal inflammation,” the Dutch researchers said.

“We provide support for the idea that the diet can be a significant complementary therapeutic strategy through the modulation of the gut microbiome.”


Opioid deprescribing may be missing in practice

There has been a concerning rise in the prevalence rate of long-term opioid prescription in Australia despite the recognised harmful effects.

A study of more than 800,000 adults with a musculoskeletal diagnosis from 402 general practices found prevalence rates of long-term opioid prescriptions increased from 5.5% in 2012 to 9.1% in 2018.

However the incidence rate dropped slightly from about 3.6% in 2012 to 3.0% in 2018.

The findings suggest there has been “insufficient pro-active opioid deprescribing” and that many patients have become dependent or possibly addicted to opioids.

The most common conditions attracting opioids were spondyloarthritis (13.8%) and fibromyalgia (13.3%) in 2012, and Paget disease (22.2%) and fibromyalgia (21.4%) in 2018.

Rural patients or those in areas of socioeconomic disadvantage were particularly at risk.


Oral methotrexate tops subcut

Researchers from The Netherlands have recommended oral over subcutaneous methotrexate as a starting point in patients with rheumatoid arthritis.

A retrospective study of 640 adult patients with RA found an oral strategy was similarly effective to subcutaneous methotrexate on the basis of DAS-28-CRP at 3-6 months.

However the mean methotrexate dose was lower using an oral strategy (18.0 v 19.9 mg; p= 0.002) and there were fewer adverse events (41% v 52%; p=0.005).

“Starting with oral MTX in RA in a real-life setting is non inferior to a subcutaneous MTX treatment with regard to disease activity control, at least when used in dosages up to 25 mg and on a background of HCQ cotreatment and a treat-to-target approach,” they said.

“In addition, tolerability was better. This supports the strategy of starting with oral MTX.”


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