Rheumatoid Arthritis, Alergi Makanan dan Reaksi Simpang Makanan

Widodo Judarwanto

Children Allergy Center – Bunda Jakarta Hospital, Indonesia

 

Pasien dengan rheumatoid arthritis (RA) sering merasa bahwa ada hubungan antara asupan makanan dan aktivitas penyakit mereka, tetapi bukti untuk mendukung koneksi tersebut telah bertentangan. Laporan biasanya didasarkan pada percobaan diet dengan protokol yang cukup berbeda, diikuti oleh semacam tantangan makanan.


Pengaruh hipotetis negatif dari makanan pada aktivitas klinis artritis reumatoid seropositif dipelajari menggunakan dua jenis makanan dasar buatan. Salah satu diet adalah alergen gratis, alergen lainnya dibatasi, hanya berisi lactoproteins dan pewarna kuning. Sembilan puluh empat pasien memasuki studi, yang berlangsung 12 minggu. Selama periode empat minggu kedua mereka secara acak ditugaskan untuk salah satu dari dua makanan buatan. Perbandingan antara baseline dan periode berikutnya menunjukkan perbaikan hanya subjektif. Tidak ada perbedaan yang terlihat antara efek klinis dari dua diet diuji. Sembilan pasien (tiga pada kelompok terbatas alergen, enam dalam kelompok bebas alergen) menunjukkan respon yang menguntungkan, diikuti oleh ditandai eksaserbasi penyakit selama rechallenge. manipulasi diet juga membawa perubahan dalam parameter aktivitas penyakit objektif pada pasien ini. Keberadaan subkelompok pasien yang intoleransi makanan mempengaruhi aktivitas faktor rheumatoid arthritis seropositif arthritis layak pertimbangan serius.


Alergi makanan adalah mekanisme kekebalan tubuh yang kompleks yang terjadi di banyak bagian tubuh dengan hasil yang beragam. Hal ini sangat penting untuk mengidentifikasi orang-orang yang memiliki alergi makanan karena asosiasi alergi dengan gangguan kronis. Diagnosis alergi makanan didasarkan pada sejarah yang cermat, pemeriksaan fisik, tes khusus untuk imunoglobulin E (IgE), seperti tes tusuk kulit (SPT), tes radioallergosorbent dan foodchallenges oral. alergi makanan dapat ditentukan dengan SPT, yang merupakan metode yang mudah dan murah. Namun, percobaan eliminasi makanan / tantangan adalah cara yang baik dan dapat diandalkan untuk mengkonfirmasi alergi makanan yang disarankan oleh alergi SPT .Makanan tercatat pada tahun 1953 sebagai faktor penyebab dalam beberapa kasus arthritis. studi terbaru melaporkan bahwa banyak tanda-tanda dan gejala rheumatoid arthritis (RA) mungkin berhubungan dengan alergi makanan. Dalam banyak studi, beberapa manipulasi diet bebas alergi atau hypoallergenic telah terbukti untuk memperbaiki manifestasi klinis RA, tetapi mekanisme yang ini terjadi tidak diketahui.


Di sisi lain, penelitian terbaru telah menemukan pentingnya peran sitokin yang mempromosikan peradangan, seperti tumor necrosis factor- (TNF-) dan interleukin-1ß (IL-1ß). Juga, TNF- dan IL-1 yang dianggap sebagai sitokin kunci dalam pengembangan RA. Bukti yang mendukung korelasi tingkat aktivitas penyakit pada RA dan perkembangan jointdamage dengan tingkat TNF- dan IL-1. Dalam RA, TNF-appears menjadi terutama bertanggung jawab untuk mengemudi peradangan, sedangkan IL-1 memainkan peran penting dalam kerusakan tulang rawan dan tulang. IL-1 ada dalam dua bentuk, IL-1 dan IL-1ß, yang ditranskripsi dari gen terkait erat namun berbeda. IL-1 terutama terikat pada membran sel sementara IL-1ß adalah bentuk ekstraseluler dominan dari IL-1.


Dalam meninjau literatur, menjadi jelas bahwa ada beberapa studi menyelidiki mekanisme hubungan antara diet dan TNF- dan IL-1ß. Dilaporkan bahwa minyak ikan dapat menekan produksi sitokin proinflamasi pada pasien RA. Beberapa studi telah menunjukkan bahwa suplementasi asam lemak n-3 dapat mengurangi produksi IL-1 dan TNF-, dan hasil dalam pengurangan penting dalam durasi kekakuan pagi dan lembut count sendi pada pasien dengan RA.


Namun, hubungan antara alergi makanan dan sitokin proinflamasi di RA masih belum diketahui. Oleh karena itu, peneliti meneliti efek dari tantangan diet individual yang terdiri dari makanan alergi pada tingkat IL-1ß TNF-and pada pasien dengan RA.


Makanan hipersensitivitas di RA tidak mencerminkan IgE dimediasi alergi, dan kebanyakan studi telah menyimpulkan bahwa makanan tidak mungkin memiliki efek patogen di RA. Dengan demikian, Panush dilakukan dibutakan tantangan dikemas, dan tidak lebih dari 5% dari pasien RA yang dianggap menunjukkan sensitivitas makanan imunologi. Namun demikian, studi epidemiologi besar Eropa baru-baru ini, menentukan odds ratio (OR) setelah disesuaikan dengan variabel, disarankan bahwa ada hubungan yang signifikan antara poliartritis inflamasi dan asupan tinggi daging merah (OR = 1.9), daging dan daging produk gabungan (OR = 2.3), dan jumlah protein (OR = 2.9).


Beberapa laporan sebelumnya telah menganggap bahwa efek diet patogen pada RA bisa bergantung pada asupan terus-menerus dari makanan; tes tantangan singkat dengan dosis yang relatif kecil mungkin tidak mengendap gejala klinis. Studi mempertimbangkan variabel kuantitatif sebenarnya telah cenderung untuk menyarankan makanan yang tidak memiliki patogen penting, setidaknya di sebagian kecil yang signifikan (20-40%) dari pasien.


Upaya untuk mengidentifikasi sensitif pasien makanan RA dengan mengukur antibodi spesifik makanan atau kompleks imun dalam serum telah gagal. Penyelidikan kami sebelumnya juga menyimpulkan bahwa pengukuran antibodi serum jarang memprediksi atau mengkonfirmasi hipersensitivitas makanan pada pasien RA. Meskipun peningkatan kegiatan IgM ditemukan, tidak ada hubungan yang meyakinkan dengan variabel klinis atau manfaat diet. Mengangkat kegiatan IgA serum untuk gliadin telah dilaporkan pada pasien RA, namun tingkat yang rendah dibandingkan dengan IgG dan IgM ditujukan terhadap antigen yang sama pada pasien serta kegiatan controls.Raised IgG untuk gliadin ditemukan pada 47% dari 93 pasien RA, dan 41% secara bersamaan memiliki faktor rheumatoid IgA (RF) dan ada beberapa hubungan dengan atrophy.However vili duodenum, sebuah penelitian berikutnya adalah bertentangan.


Secara keseluruhan, antibodi serum tidak muncul untuk memberikan link imunologi antara diet dan RA. Alasannya mungkin bahwa aktivasi sistem kekebalan usus tidak andal tercermin dalam serum, dan fakta bahwa beredar IgA RF didominasi polimer mendukung origin.Moreover mukosa, pasien RA mungkin memiliki peradangan usus kecil gaib dan peningkatan permeabilitas mukosa independen penggunaan non-steroid anti-inflammatory (NSAID).

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