Objective: To demonstrate the effects of a very low-fat, vegan diet on patients with rheumatoid arthritis (RA).Design: Single-blind dietary intervention study. Subjects and study interventions:This study evaluated the influence of a 4-week, very lowfat (,10%), vegan diet on 24 free-living subjects with RA, average age, 56 6 11 years old.Outcome measurements: Prestudy and poststudy assessment of RA symptomatology was performed by a rheumatologist blind to the study design. Biochemical measures and 4-day diet data were also collected. Subjects met weekly for diet instruction, compliance monitoring, and progress assessments.Results: There were significant (p , 0.001) decreases in fat (69%), protein (24%), and energy (22%), and a significant increase in carbohydrate (55%) intake. All measures of RA symptomatology decreased significantly (p , 0.05), except for duration of morning stiffness (p . 0.05). Weight also decreased significantly (p , 0.001). At 4 weeks, C-reactive protein decreased 16% (ns, p . 0.05), RA factor decreased 10% (ns, p . 0.05), while erythrocyte sedimentation rate was unchanged (p . 0.05).Conclusion: This study showed that patients with moderate-to-severe RA, who switch to a very low-fat, vegan diet can experience significant reductions in RA symptoms. 71

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Interstitial granulomatous drug reaction (IGDR) is a distinct inflammatory process that often presents as annular, violaceous plaques distributed on the extremities, proximal trunk, and intertriginous areas. The list of drugs implicated for inciting IGDR is growing, but most prominently includes ACE inhibitors, antihistamines, beta-blockers, antidepressants, and anticonvulsants. Ustekinumab is a human monoclonal antibody that targets inflammatory cytokines IL-12 and IL-23 and has been have shown to be effective in treating IGDR. However, we present a case that suggests ustekinumab can also act as an inciting agent for IGDR.

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