Adjunct role of potassium-rich vegetarian diet and a novel potassium food supplement to improve pain in chronic rheumatoid arthritis on supervised standard care: a randomised controlled study
Authors
Toktam Kianifard
Rheumatology, Center for Rheumatic Diseases, Pune, Maharashtra, India
Manjit Saluja
Rheumatology, Center for Rheumatic Diseases, Pune, Maharashtra, India
Sanjeev Sarmukaddam
Biostatistics, Center for Rheumatic Diseases, Pune, Maharashtra, India
Anuradha Venugopalan
Laboratory, Center for Rheumatic Diseases, Pune, Maharashtra, India
Arvind Chopra
Center for Rheumatic Diseases, Pune, Maharashtra, India
Introduction
An earlier food survey showed dietary potassium deficiency in rheumatoid arthritis (RA).
Objective
To evaluate an adjunct role of oral potassium to reduce joint pain in RA.
Methods
172 consenting eligible symptomatic patients (median duration 6.5 years) on standard care were randomised into an assessor blind, parallel efficacy, controlled, prospective, multiarm single-centre study (80% power, drug trial design) of 16 weeks duration—arm A (potassium-rich vegetarian diet), arm B (arm A plus novel potassium food supplement) and arm C (control, regular diet). Standard efficacy (American College of Rheumatology recommendation) and safety and diet intake (3-day recall) were assessed at monthly intervals (protocol). Standard soft-ware package (SPSS V.20) was used for statistical analysis; analysis of variance), Mann-Whitney statistic and χ2 test.; significant p<0.05, two sided). Study arms were found matched at baseline. Background RA medication remained stable. Preset target for increased potassium intake (India standards) were mostly achieved and participants remained normokalemic.
Results
155 patients (90.1%) completed the study and several showed improvement (maximum improved measures in arm B). Potassium intervention was safe and well tolerated. Adverse events were mild; none caused patient withdrawal. On comparison, the mean change in pain visual analogue scale (−2.23, 95% CI −2.99 to −1.48) at week 16 (primary efficacy) from baseline was significantly superior in arm B (per protocol analysis). A high daily potassium intake (5–7.5 g, arm B) was significantly associated with low pain (study completion); OR 2.5 (univariate analysis), likelihood ratio 2.9 (logistic regression). Compliance (intervention), diet record and analysis, RA medication and absence of placebo were potential confounders.
Conclusion
High oral potassium intake, based on a suitable vegetarian diet and food supplement, reduced joint pain and improved RA. It was a safe adjunct to standard care, Further validation studies are required.
Trial registration
CTRI/2022/03/040726; Clinical Trial Registry of India.
Keywords: Musculo-skeletal health, Nutrient deficiencies, Nutritional treatment, Precision nutrition
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