Precision nutrition for rheumatoid arthritis management: integrating nutrigenomics, epigenetics, multi-omics, and artificial intelligence

Plant-based diets have been garnering increasing attention for their ability to reshape gut microbiota, reduce systemic inflammation, and alleviate joint pain in rheumatoid arthritis (RA). However, dietary responses are not uniform, as substantial inter-individual variability arises from genetic polymorphisms, metabolic diversity, and immune heterogeneity. In some patients, specific foods may exacerbate disease activity, emphasizing the need to identify personal dietary triggers and implement individualized nutritional strategies. Nutrigenomics, which integrates nutrition with genetic profiling, provides a valuable framework for understanding the influence of genetic variants on nutrient absorption, metabolism, inflammatory signaling, and immune regulation. Notably, dietary bioactive compounds can also modulate RA pathogenesis through epigenetic mechanisms, including DNA methylation, histone modifications, and microRNA-mediated regulation, thereby altering gene expression programs associated with autoimmunity and chronic inflammation. Diet-derived metabolites and microbial products further interact with host genomic and epigenomic networks, creating a dynamic nutrient–gene–microbiome axis that shapes RA susceptibility, disease severity, and therapeutic responsiveness. Recent advances in multi-omics technologies, including genomics, epigenomics, transcriptomics, proteomics, metabolomics, and microbiome profiling, have offered deeper insights into nutrient-driven molecular pathways and immune dysregulation in RA. These findings enable precision dietary interventions enriched with anti-inflammatory nutrients and functional bioactive to improve symptom control and long-term outcomes. Artificial intelligence (AI) offers an emerging strategy by integrating multi-omics, clinical, and dietary data to generate actionable personalized nutrition approaches. This review highlights current evidence on nutrigenomic and epigenetic regulation in RA and discusses AI-driven precision nutrition as a future strategy to enhance disease management and patient wellbeing. Nutrigenomics uses genetic differences to tailor specific dietary interventions for individuals. Plant-based foods lower RA inflammation by boosting antioxidants, improving gut health, and cutting saturated fats. Bioactive compounds in food directly modulate immune responses and inflammatory pathways in RA. Nutrition alters gene expression through epigenetic mechanisms, directly influencing how the disease progresses. Combining multi-omics data with AI enables precise nutrition strategies to improve RA management.