The Role of Fish Oils In the Treatment of Rheumatoid Arthritis (original) (raw)
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Annals of the Rheumatic Diseases, 2013
BackgroundThe effects of fish oil (FO) in rheumatoid arthritis (RA) have not been examined in the context of contemporary treatment of early RA. This study examined the effects of high versus low dose FO in early RA employing a ‘treat-to-target’ protocol of combination disease-modifying anti-rheumatic drugs (DMARDs).MethodsPatients with RA <12 months’ duration and who were DMARD-naïve were enrolled and randomised 2:1 to FO at a high dose or low dose (for masking). These groups, designated FO and control, were given 5.5 or 0.4 g/day, respectively, of the omega-3 fats, eicosapentaenoic acid + docosahexaenoic acid. All patients received methotrexate (MTX), sulphasalazine and hydroxychloroquine, and DMARD doses were adjusted according to an algorithm taking disease activity and toxicity into account. DAS28-erythrocyte sedimentation rate, modified Health Assessment Questionnaire (mHAQ) and remission were assessed three monthly. The primary outcome measure was failure of triple DMARD t...
Fish oil - An example of an anti-inflammatory food
Asia Pacific Journal of Clinical Nutrition
With regard to anti-inflammatory effects of diet away from the gut, altering the balance of dietary polyunsaturated fatty acids (PUFA) in favour of n-3 PUFA provides the best documented examples of effective dietary intervention. PUFA are essential macronutrients of which there are two non-interchangeable classes, n-6 and n-3. These fatty acids are metabolized to mediators that regulate cardiovascular homeostasis and inflammation. n-6 rich diets tend to be pro-inflammatory and, by comparison diets rich in n-3 PUFA are antiinflammatory. The difference is explained by the action of n-3 PUFA as competitive inhibitors of enzymes that metabolize n-6 fats and by the lesser biological activities of most n-3 mediators, compared with their n-6 counterparts. Fish oils are a particularly rich source of desirable long chain n-3 PUFA. Fish oil has been used with benefit in the treatment of inflammatory diseases of joints and other organs and tissues. Our long-term studies in rheumatoid arthritis (RA) show that this approach, in conjunction with pharmacotherapy, can be sustained in the long term (>5 years). A potential collateral benefit is reduced risk for adverse cardiovascular events, which are increased in RA. Lack of knowledge amongst physicians of relevant biochemistry, evidence of efficacy, dose response relationships, latency in effect, availability of affordable preparations and tactics for discussing issues efficiently with patients appears to be a barrier to broader clinical use.
Supplementation of fish oil and olive oil in patients with rheumatoid arthritis
Nutrition, 2005
Objective: This study evaluated whether supplementation with olive oil could improve clinical and laboratory parameters of disease activity in patients who had rheumatoid arthritis and were using fish oil supplements. Methods: Forty-three patients (34 female, 9 male; mean age ϭ 49 Ϯ 19y) were investigated in a parallel randomized design. Patients were assigned to one of three groups. In addition to their usual medication, the first group (G1) received placebo (soy oil), the second group (G2) received fish oil -3 fatty acids (3 g/d), and the third group (G3) received fish oil -3 fatty acids (3 g/d) and 9.6 mL of olive oil. Disease activity was measured by clinical and laboratory indicators at the beginning of the study and after 12 and 24 wk. Patients' satisfaction in activities of daily living was also measured. Results: There was a statistically significant improvement (P Ͻ 0.05) in G2 and G3 in relation to G1 with respect to joint pain intensity, right and left handgrip strength after 12 and 24 wk, duration of morning stiffness, onset of fatigue, Ritchie's articular index for pain joints after 24 wk, ability to bend down to pick up clothing from the floor, and getting in and out of a car after 24 wk. G3, but not G2, in relation to G1 showed additional improvements with respect to duration of morning stiffness after 12 wk, patient global assessment after 12 and 24 wk, ability to turn faucets on and off after 24 wk, and rheumatoid factor after 24 wk. In addition, G3 showed a significant improvement in patient global assessment in relation to G2 after 12 wk. Conclusions: Ingestion of fish oil -3 fatty acids relieved several clinical parameters used in the present study. However, patients showed a more precocious and accentuated improvement when fish oil supplements were used in combination with olive oil. .br (I. Dichi).
The Journal of Rheumatology, 2006
Objective. Rheumatoid arthritis (RA) is associated with increased risk for cardiovascular (CV) events through multiple factors. Fish oil has been shown to reduce symptoms in RA and to reduce CV risk. We assessed the effect of an antiinflammatory dose of fish oil on CV risk factors within a program of combination chemotherapy for patients with early RA. Methods. Patients who chose not to take fish oil (n = 13) were compared with patients who achieved a sustained elevation of eicosapentaenoic acid (EPA) in plasma phospholipid fatty acids (> 5% total fatty acids) while taking fish oil over a 3-year period (n = 18). We examined cellular content of arachidonic acid (AA), synthesis of thromboxane A 2 and prostaglandin E 2 , use of nonsteroidal antiinflammatory drugs (NSAID), traditional CV lipid risk factors, and disease activity at 3 years. Results. At 3 years, AA (as a proportion of AA plus long-chain n-3 fatty acids that can compete with AA for cyclooxygenase metabolism) was 30% lower in platelets and 40% lower in peripheral blood mononuclear cells in subjects taking fish oil. Serum thromboxane B 2 was 35% lower and lipopolysaccharide-stimulated whole-blood prostaglandin E 2 was 41% lower with fish oil ingestion compared to no fish oil. NSAID use was reduced by 75% from baseline with fish oil (p < 0.05) and by 37%
Rheumatology, 2008
Objectives. Dose-dependant gastrointestinal and cardiovascular side-effects limit the use of NSAIDs in the management of RA. The n-3 essential fatty acids (EFAs) have previously demonstrated some anti-inflammatory and NSAID-sparing properties. The objective of this study was to determine whether cod liver oil supplementation helps reduce daily NSAID requirement of patients with RA. Methods. Dual-centre, double-blind placebo-controlled randomized study of 9 months' duration. Ninety-seven patients with RA were randomized to take either 10 g of cod liver oil containing 2.2 g of n-3 EFAs or air-filled identical placebo capsules. Documentation of NSAID daily requirement, clinical and laboratory parameters of RA disease activity and safety checks were done at 0, 4, 12, 24 and 36 weeks. At 12 weeks, patients were instructed to gradually reduce, and if possible, stop their NSAID intake. Relative reduction of daily NSAID requirement by >30% after 9 months was the primary outcome measure. Results. Fifty-eight patients (60%) completed the study. Out of 49 patients 19 (39%) in the cod liver oil group and out of 48 patients 5 (10%) in the placebo group were able to reduce their daily NSAID requirement by >30% (P ¼ 0.002, chi-squared test). No differences between the groups were observed in the clinical parameters of RA disease activity or in the side-effects observed. Conclusions. This study suggests that cod liver oil supplements containing n-3 fatty acids can be used as NSAID-sparing agents in RA patients.
Effects of fish oil supplementation in rheumatoid arthritis
Annals of the Rheumatic Diseases, 1990
Sixteen patients with rheumatoid arthritis entered a trial to determine the clinical and biochemical effects ofdietary supplementation with fractionated fish oil fatty acids. A randomised, double blind, placebo controlled crossover design with 12 week treatment periods was used. Treatment with nonsteroidal anti-inflammatory drugs and with disease modifying drugs was continued throughout the study. Placebo consisted of fractionated coconut oil. The following results favoured fish oil rather than placebo: joint swelling index and duration of early morning stiffness. Other clinical indices improved but did not reach statistical significance. During fish oil supplementation relative amounts of eicosapentaenoic acid and docosahexaenoic acid in the plasma cholesterol ester and neutrophil membrane phospholipid fractions increased, mainly at the expense of the omega-6 fatty acids. The mean neutrophil leucotriene B4 production in vitro showed a reduction after 12 weeks of fish oil supplementation. Leucotriene B5 production, which could not be detected either in the control or in the placebo period, rose to substantial quantities during fish oil treatment. This study shows that dietary fish oil supplementation is effective in suppressing clinical symptoms of rheumatoid arthritis.
Polyunsaturated fatty acids and rheumatoid arthritis
Current Opinion in Clinical Nutrition and Metabolic Care, 2001
The n-3 polyunsaturated fatty (PUFA) acids and among them the n-3 PUFAs from fish oil -eicosapentaenoic acid and docosahexaenoic acid -own potent immunomodulatory potential. This can be beneficially utilized in cardiovascular disease or depression as well as in rheumatoid arthritis. A commonly accepted opinion about the minimum dosage to gain a therapeutic effect has not been formed yet. In order to achieve an amelioration of symptoms in RA the concluding recommendation is to consume dietary supplements containing three to six gram n-3 fatty acids daily for > 12 weeks. Following these suggestions patients taking dietary supplements of fish oil show improvements in clinical parameters including the number of tender joints, the duration of morning stiffness as well as the patient´s evaluation of global arthritis activity. Finally, the intake of n-3 PUFAs can only be recommended as an add-on therapy and must not replace the standard therapeutic regimes. A large research agenda remains to be worked on in order to be able to determine the role of therapeutic effects of n-3 PUFAs in RA.
Arthritis & Rheumatism, 1990
Forty-nine patients with active rheumatoid arthritis completed a 24-week, prospective, double-blind, randomized study of dietary supplementation with 2 dflerent dosages of fish oil and 1 dosage of olive oil. Clinical evaluations were performed at baseline and every 6 weeks thereafter, and ipmunologk variables were measured at baseline and after 24 weeks of study. The 3 groups of patients were matched for age, sex, disease Severity, and use of disease-modifying antirheumatic drugs (DMARDs). Subjects continued receiving DMARDs and other background medications without change during the study. Twenty patients consumed daily dietary supplements of n3 fatty acids containing 27 m&g eicosapentaenoic acid (EPA) and 18 mgkg docosahexaenoic acid (DHA) (low dose), 17 patients ingested 54 mg/kg EPA and 36 mgkg DHA (high dose), and 12 patients ingested olive oil capsules containing 6.8 gm of oleic acid. Significant improvements from baseline in the number of tender joints were noted in the low-dose group at week 24 (P = 0.05) and in the high-dose group at weeks 18 (P = 0.04) and 24 (P = 0.02). Significant decreases from baseline in the number of swollen joints were noted in the low-dose group at weeks 12 (P = 0.003), 18 (P = 0.002), and 24 (P = ~~ -From the Division ' 0.001) and in the high-dose group at weeks 12 (P = O.OOOl), 18 (P = 0.008), and 24 (P = 0.02). A total of