A Prospective Observational Study: Does Ramadan Fasting Worsen Rheumatoid Arthritis Disease Activity?

Introduction: The impact of Ramadan fasting on rheumatoid arthritis (RA) disease activity remains insufficiently documented, and available data are limited.This study aimed to assess the effect of Ramadan fasting on RA disease activity in patients deemed fit to fast.Secondary objectives were to explore factors potentially associated with worsening disease activity during Ramadan and to assess treatment adherence before and after Ramadan.Methods: We conducted a prospective, observational, single-center study in the Rheumatology B Department of El Ayachi Hospital, Ibn Sina University Hospital Center, Rabat, Morocco, during Ramadan 2026.Patients over 18 years of age with RA meeting the American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) classification criteria and deemed fit to fast were recruited consecutively during the month preceding Ramadan.Disease activity was assessed before and after Ramadan using clinical and biological parameters, including tender and swollen joint counts, morning stiffness, nocturnal awakenings, pain visual analog scale (VAS), fatigue, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and DAS28-ESR.The primary endpoint was the change in 28-joint Disease Activity Score (DAS28) between the pre-and post-Ramadan assessments.An exploratory univariate analysis was performed to identify factors associated with worsening disease activity.Treatment adherence was assessed before and after Ramadan using the four-item Morisky-Green-Levine scale.Results: A total of 50 patients were included in the study.The mean age was 55.96 ± 10.40 years, and 44 patients (88.0%) were women.No statistically significant change in overall disease activity was observed before and after Ramadan.DAS28 changed from 2.85 ± 1.28 to 2.96 ± 1.31 (p = 0.481).No significant differences were found in pain VAS, nocturnal awakenings, fatigue, morning stiffness, tender joint count, swollen joint count, ESR, or CRP.Overall, 38 patients (76.0%) showed no worsening of disease activity, while 12 patients (24.0%) showed worsening.Worsening was associated with longer RA duration (18.13 ± 6.49 vs. 12.54 ± 9.77 years; p = 0.023) and lower baseline DAS28 (2.33 ± 0.81 vs. 3.01 ± 1.16; p = 0.031).High treatment adherence was observed in 47 patients (94.0%) before Ramadan and 46 patients (92.0%) after Ramadan.Conclusion: Ramadan fasting was not associated with a statistically significant worsening of RA disease activity.Most patients remained clinically stable, and treatment adherence remained high before and after Ramadan.These findings suggest that Ramadan fasting may be well tolerated in patients with RA who are deemed fit to fast and receive appropriate clinical follow-up.