Skip to main content

Advertisement

SpringerLink
Log in

Impact of Ramadan diurnal intermittent fasting on rheumatic diseases

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Introduction

Ramadan intermittent fasting is observed by Muslims from sunrise to sunset and alternated with moments of re-feeding. The aims of this study were to assess the impact of Ramadan fasting on rheumatoid arthritis (RA) and spondyloarthritis (SpA) activity and to assess its impact on chronic medications intake in patients with rheumatic diseases.

Methods

This prospective monocentric study included patients with RA or SpA who fasted during Ramadan of 2019. The disease activity and the managing of chronic medications were assessed and compared between two visits: the first one 6 months before starting Ramadan fasting and the second after fasting at least 7 days.

Results

Fifty-six patients were included: 36 with RA (average age 57.5 ± 10.9 years) and 20 with SpA (average age 47 ± 12.6 years). In the RA group, the Disease Activity Scores (DAS) 28 ESR, and DAS 28 CRP decreased after fasting respectively from 4.3 ± 1.3 to 3.5 ± 1.4 (p < 0.001) and from 3.4 ± 1.2 to 2.9 ± 1.3 (p = 0.001). In the SpA group, Ankylosing Spondylitis Disease Activity Scores (ASDAS) ESR and ASDAS CRP decreased respectively from 2.3 ± 0.5 to 1.9 ± 0.7 (p = 0.039) and from 1.9 ± 0.5 to 1.8 ± 0.8 (p = 0.388). Fasting did not affect significantly either compliance with chronic medications or tolerance.

Conclusions

Fasting can be a possible way to induce rapid improvement of rheumatic diseases activity. In addition, patients with a specific fear of drug intake during this period can be reassured, which will enhance the adherence to treatment.

Key Points

• Fasting during Ramadan, the ninth month of the Islamic calendar, consists of intermittent fasting observed from sunrise to sunset.

• In this set of patients, beneficial effects of intermittent fasting were demonstrated on RA activity, but were less evident in patients with SpA despite a general trend towards improvement.

• Fasting did not affect significantly either compliance with chronic medications or tolerance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Adawi M, Damiani G, Bragazzi NL et al (2019) The impact of intermittent fasting (Ramadan fasting) on psoriatic arthritis disease activity, enthesitis, and dactylitis: a multicentre study. Nutrients 11. https://doi.org/10.3390/nu11030601

  2. Adawi M, Watad A, Brown S, Aazza K, Aazza H, Zouhir M, Sharif K, Ghanayem K, Farah R, Mahagna H, Fiordoro S, Sukkar SG, Bragazzi NL, Mahroum N (2017) Ramadan fasting exerts immunomodulatory effects: insights from a systematic review. Front Immunol 8:1144. https://doi.org/10.3389/fimmu.2017.01144

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Hafström I, Ringertz B, Gyllenhammar H et al (1988) Effects of fasting on disease activity, neutrophil function, fatty acid composition, and leukotriene biosynthesis in patients with rheumatoid arthritis. Arthritis Rheum 31:585–592. https://doi.org/10.1002/art.1780310502

    Article  PubMed  Google Scholar 

  4. Bragazzi NL, Watad A (2017) The impact of fasting on rheumatic diseases. Isr Med Assoc J IMAJ 19:378–379

    PubMed  Google Scholar 

  5. Rouhani MH, Azadbakht L (2014) Is Ramadan fasting related to health outcomes? A review on the related evidence. J Res Med Sci Off J Isfahan Univ Med Sci 19:987–992

    Google Scholar 

  6. Boukhris O, Trabelsi K, Shephard RJ et al (2019) Sleep patterns, alertness, dietary intake, muscle soreness, fatigue, and mental stress recorded before, during and after Ramadan observance. Sports Basel Switz 7. https://doi.org/10.3390/sports7050118

  7. Abendroth A, Michalsen A, Lüdtke R et al (2010) Changes of intestinal microflora in patients with rheumatoid arthritis during fasting or a Mediterranean diet. Forsch Komplementmed 2006 17:307–313. https://doi.org/10.1159/000322313

    Article  Google Scholar 

  8. Kjeldsen-Kragh J, Haugen M, Borchgrevink CF et al (1991) Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet Lond Engl 338:899–902. https://doi.org/10.1016/0140-6736(91)91770-u

    Article  CAS  Google Scholar 

  9. Sköldstam L, Larsson L, Lindström FD (1979) Effect of fasting and lactovegetarian diet on rheumatoid arthritis. Scand J Rheumatol 8:249–255. https://doi.org/10.3109/03009747909114631

    Article  PubMed  Google Scholar 

  10. Sköldstam L (1986) Fasting and vegan diet in rheumatoid arthritis. Scand J Rheumatol 15:219–221. https://doi.org/10.3109/03009748609102091

    Article  PubMed  Google Scholar 

  11. Müller H, de Toledo FW, Resch KL (2001) Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scand J Rheumatol 30:1–10

    PubMed  Google Scholar 

  12. Kjeldsen-Kragh J, Sumar N, Bodman-Smith K, Brostoff J (1996) Changes in glycosylation of IgG during fasting in patients with rheumatoid arthritis. Br J Rheumatol 35:117–119. https://doi.org/10.1093/rheumatology/35.2.117

    Article  CAS  PubMed  Google Scholar 

  13. The effects of Ramadan fasting on body composition, blood pressure, glucose metabolism, and markers of inflammation in NAFLD patients: an observati... - PubMed - NCBI. https://www.ncbi.nlm.nih.gov/pubmed/28922096. Accessed 6 Feb 2020

  14. Meo SA, Hassan A (2015) Physiological changes during fasting in Ramadan. JPMA J Pak Med Assoc 65:S6–S14

    PubMed  Google Scholar 

  15. Effect of fasting with two meals on BMI and inflammatory markers of metabolic syndrome. - PubMed - NCBI. https://www.ncbi.nlm.nih.gov/pubmed/24199461. Accessed 6 Feb 2020

  16. Aksungar FB, Topkaya AE, Akyildiz M (2007) Interleukin-6, C-reactive protein and biochemical parameters during prolonged intermittent fasting. Ann Nutr Metab 51:88–95. https://doi.org/10.1159/000100954

    Article  CAS  PubMed  Google Scholar 

  17. Ebrahimi S, Rahmani F, Avan A et al (2016) Effects of Ramadan fasting on the regulation of inflammation. J Fasting Health 4:32–37

    Google Scholar 

  18. Damiani G, Watad A, Bridgewood C et al (2019) The impact of Ramadan fasting on the reduction of PASI score, in moderate-to-severe psoriatic patients: a real-life multicenter study. Nutrients 11. https://doi.org/10.3390/nu11020277

Download references

Author information

Authors and Affiliations

  1. Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia

    Dorra Ben Nessib, Kaouther Maatallah, Hanene Ferjani, Dhia Kaffel & Wafa Hamdi

  2. Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia

    Dorra Ben Nessib, Kaouther Maatallah, Hanene Ferjani, Dhia Kaffel & Wafa Hamdi

  3. Research Unit UR17SP04, 2010, Ksar Said, Tunis, Tunisia

    Dorra Ben Nessib, Kaouther Maatallah, Hanene Ferjani, Dhia Kaffel & Wafa Hamdi

Authors
  1. Dorra Ben Nessib
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kaouther Maatallah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hanene Ferjani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dhia Kaffel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wafa Hamdi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dorra Ben Nessib.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Informed consent was obtained from the patients.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ben Nessib, D., Maatallah, K., Ferjani, H. et al. Impact of Ramadan diurnal intermittent fasting on rheumatic diseases. Clin Rheumatol 39, 2433–2440 (2020). https://doi.org/10.1007/s10067-020-05007-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-020-05007-5

Keywords

Search

Navigation