“In adults with autoimmune inflammatory arthritis, how does adherence to a Mediterranean diet compared to a standard diet affect pain, stiffness, and inflammatory markers over 12 weeks?”

Purpose: This form guides the EBP team in developing an answerable EBP question. It is meant to be fluid and  dynamic as the team engages in the question development process. As the team becomes familiar with the evidence  base for the topic of interest, they revisit, revise, and refine the question, search terms, search strategy, and sources  of evidence.

What is the local problem? (the response can be a bulleted list or phrases)

●      High number of adult patients with arthritis in primary care settings.

●      Patients experience chronic pain, stiffness, fatigue, and reduced quality of life despite standard medical treatment.

●      Limited guidance or education on dietary interventions for arthritis symptom management in the local clinic.

●      Patients often rely on self-directed diets or unverified online advice, leading to inconsistent results.

●      Primary care providers have limited time and resources to discuss nutrition or lifestyle modifications with patients.

●      Lack of evidence-based protocols or recommendations integrating diet to improve arthritis outcomes in adults.

Why is this problem important and relevant? What would happen if it was not addressed?

●      Arthritis significantly impacts quality of life: Chronic joint pain, stiffness, and fatigue limit mobility, daily functioning, and independence in adults.

●      High prevalence in primary care: Many adults in the clinic suffer from autoimmune and inflammatory arthritis, making it a common and pressing issue.

●      Current management may be insufficient: Standard pharmacologic therapies often control symptoms but do not address inflammation related to diet or lifestyle, leaving patients with ongoing discomfort.

●      Potential for non-pharmacologic improvement: Evidence suggests that diet may influence inflammation and symptom severity, offering a low-risk, accessible intervention to complement medical management.

Consequences of inaction:

●      Patients may continue to experience pain, functional limitations, and decreased quality of life.

●      Over-reliance on medications could lead to side effects and increased healthcare costs.

●      Missed opportunity for preventing disease progression and improving overall health outcomes.

●      Urgency for practice change: Implementing dietary guidance and education could empower patients,

reduce symptom burden, and optimize chronic disease management in the primary care setting.

What is the current practice in the EBP team’s setting? 

●      Focus on pharmacologic management: Most adult patients with arthritis receive standard medical treatment, including NSAIDs, DMARDs, or biologic therapies, as per provider preference and clinical guidelines.

●      Limited dietary counseling: Nutrition and diet are rarely systematically addressed during routine visits. Discussion of diet is often brief, patient-initiated, or inconsistent.

●      Lack of structured protocols: There are no standardized clinic policies or guidelines for assessing dietary patterns or providing nutrition-based interventions for arthritis patients.

●      Education is ad hoc: Patient education on lifestyle or diet is variable; some staff provide general recommendations, while others do not discuss diet at all.

●      Gap or performance issue: There is a disconnect between evidence suggesting that diet can improve  arthritis symptoms and actual practice in the clinic. This creates a gap in holistic patient care

●      Staff perception: Most providers consider pharmacologic therapy and standard symptom management acceptable, with diet and lifestyle interventions viewed as supplementary rather than integral.

●      Alignment of policy and practice: Current policies focus on medication management, lab monitoring, and routine follow-up but do not explicitly integrate diet or lifestyle interventions, resulting in inconsistent practice and missed opportunities for symptom improvement.

What data from the EBP team’s setting indicates there is a problem?

1.  Safety and Risk Management Concerns

●      Patients with arthritis who rely solely on pharmacologic therapy often experience adverse effects such as gastrointestinal bleeding from NSAIDs or immune suppression from DMARDs.

●      Lack of dietary counseling may contribute to increased inflammation, leading to higher risk of joint damage and functional decline.

2.  Financial Information

●      Frequent clinic visits for uncontrolled pain or flares increase healthcare costs for patients and the organization.

●      Absence of non-pharmacologic interventions such as diet education may result in higher medication use and more expensive therapies over time. 

3.  Lack of Evidence for Current Practice

●      Clinic protocols primarily focus on medication management with minimal attention to nutrition or lifestyle interventions.

●      No standardized guidelines exist in the clinic for incorporating dietary strategies into arthritis care, despite evidence supporting anti-inflammatory and Mediterranean diets.

Identify the relevant elements of the EBP question (some items may not be used)

Population

●      Adults diagnosed with autoimmune inflammatory

arthritis (e.g., rheumatoid arthritis)

●      Both male and female patients, typically aged 30 years and older, experiencing pain, stiffness, and reduced mobility

Setting

●      Primary care clinics where adults receive ongoing management for arthritis.

●      Outpatient environment with routine follow-up visits and care coordination.

Topic (for broad questions) or   Intervention(s) (for intervention questions)

●      Dietary modification, specifically adherence to a Mediterranean diet or other anti-inflammatory diets.

●      Comparison: usual diet or standard care without structured dietary intervention.

Outcomes (as needed)

●      Primary outcomes: Reduction in joint pain, stiffness, and fatigue; improved functional status.

●      Secondary outcomes: Decreased inflammatory markers (CRP, ESR), improved quality of life, and potential reduction in reliance on pharmacologic therapy.

Use the information above, and the sentence templates below, to construct the EBP question.

For Intervention EBP Questions: 

According to the evidence, in adults with autoimmune inflammatory arthritis in primary care settings , what is the impact of adhering to a Mediterranean diet on  pain, stiffness, inflammatory markers, and quality of life, as compared to a standard diet?

Record the completed EBP question below.

“According to the evidence, in adults with autoimmune inflammatory arthritis in primary care settings, what is the impact of adhering to a Mediterranean diet on pain, stiffness, inflammatory markers, and quality of life, as compared to a standard diet?”

If needed after a preliminary evidence search/review, record an updated or revised EBP question here.