Omega-3 Fatty Acids in Rheumatic Diseases: A Critical Review (original) (raw)
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Omega-3 Fatty Acids in Rheumatic Diseases
JCR: Journal of Clinical Rheumatology, 2017
Many clinical trials of omega-3 fatty acids, supplied as fish oil supplements, have been carried out in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), lupus nephritis, and osteoarthritis (OA) over the past 3 decades. This review attempts to summarize the highlights of these studies to evaluate the clinical efficacy for omega-3 fatty acids to be added alongside existing treatment regimens. A total of 20 clinical trials have been carried out in RA, of which 16 exhibited significant improvements in multiple disease clinical outcomes. Nine clinical trials have been completed in SLE and lupus nephritis, of which 6 exhibited significant improvements in 1 or more clinical outcomes. A total of 4 clinical trials have been conducted in OA, of which 3 exhibited significant improvements in at least 1 clinical parameter. Multiple mechanisms for the clinical effects of omega-3 fatty acids have been implicated, including the modulation of eicosanoid synthesis toward a more anti-inflammatory profile and suppressed production of proinflammatory cytokines. Overall, fish oil supplements appear to be a safe and effective agent that could be added to the current treatment regimens in RA. Longer-term trials with larger patient cohort sizes are warranted to establish any long-term benefits of fish oil supplements in SLE, lupus nephritis, and OA.
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.
The place of omega-3 and omega-6 acids in supplementary treatment of inflammatory joint diseases
Reumatologia/Rheumatology
Eating habits have been analysed for years as a factor influencing the development of autoimmune diseases and susceptibility to infections. On the basis of research, observational studies and metaanalyses, special attention was paid to omega-3 and omega-6 acids. The purpose of the review is to show the importance of omega-3 and omega-6 acids as important ingredients in the healthy diet and as factors protecting against the development of the most common inflammatory rheumatic diseases. The influence of these omega-3 and-6 acids on the course of rheumatic diseases and arguments for their use as complementary therapy are also presented.
Global Journal of Health Science, 2015
Background: Rheumatoid arthritis is a symmetric peripheral polyarthritis of unknown etiology that, untreated or if unresponsive the therapy, typically leads to deformity and destruction of joints due to erosion of cartilage and bone. Omega-3 fatty acids have been shown to reduce morning stiffness, the number of tender joints and swollen joints in patients with rheumatoid arthritis. This study is designed for evaluation of omega-3 effects on disease activity and remission of rheumatoid arthritis in DMARDs treated patients and on weight changes and reduction of analgesic drugs consumption versus placebo. Methods: Sixty patients with active rheumatoid arthritis (49 female and 11 male) underwent rheumatologist examination and disease activity score were calculated. Then patients were enrolled in this 12 week, double blind, randomized, placebo-controlled study. The patients in both groups continued their pre study standard treatment. The patients were visited every 4 weeks, 4 times and data were recorded. Results: Significant improvement in the patient's global evaluation and in the physician's assessment of disease was observed in those taking omega-3. The proportions of patients who improved and of those who were able to reduce their concomitant analgesic medication were significantly greater with omega-3 consumption. There were no weight changes. Conclusion: Daily supplementation with omega-3 results has significant clinical benefit and may reduce the need for concomitant analgesic consumption without weight changes.
Omega-3 fatty acid dietary supplementation in systemic lupus erythematosus
Kidney International, 1989
Omega-3 fatty acid dietary supplementation in systemic lupus erythematosus. The effect of dietary fish oil (Omega-3 fatty acids-eicosapentenoic acid [EPA] and docosahexaenoic acid [DHA] on several mechanisms involved in immune, inflammatory and atherosclerotic vascular disease was determined in 12 subjects with systemic lupus erythematosus (SLE) and nephritis. These outpatients supplemented their usual diet for five weeks with daily doses of 6 g of fish oil, followed by a five-week washout period, then five weeks of 18 g of fish oil daily. The platelet EPA content rose six-fold with the lower and 15-fold with the higher dose of fish oil, and similar changes occurred to the platelet DHA content. The platelet arachidonic acid incorporation was reduced by 16 and 20%, respectively. These changes were associated with a reduction in collagen-induced platelet aggregation and an increase in red cell flexibility and a decrease in whole blood viscosity. Prostacyclin (PGI2) production was unaffected by the fish oil, but P013 formation correlated with its administration and dosage. Neutrophil leukotriene B., release was reduced 78 and 42%, respectively, by the low and higher doses of fish oil. The higher fish oil dose induced a 38% decrease in triglyceride and a 39% reduction in VLDL cholesterol associated with a 28% rise in HDL cholesterol. The fish oil had no effect on immune complex or anti-DNA antibody titer, albuminuria, intraplatelet serotonin or serotonin release from platelets. We conclude that in patients with lupus nephritis, dietary supplementation with fish oil affects the mechanisms involved in inflammatory and atherosclerotic vascular disease. The prognosis of patients with lupus nephritis continues to improve [1-4]. Much of the success is attributed to a more rational application of therapeutic agents which alter immune and inflammatory mechanisms [4-6]. These advances have directed clinical attention to an emergent pattern of morbidity and mortality in patients with systemic lupus erythematosus (SLE) related to accelerated atherosclerosis [7-9]. The longterm therapeutic approach may now involve the use of agents which effect not only immunologic and inflammatory, but also atherosclerotic mechanisms. The successful treatment of the experimental female NZBxNZW F1 lupus mouse with fish oil (omega-3 fatty acids) dietary supplementation arouses interest in an agent which potentially modulates inflammtory and immune, as well as atherosclerotic events [10-14]. The protective effect in the female NZBxNZW F1 mouse could be demon
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.
The Role of Fish Oils In the Treatment of Rheumatoid Arthritis
Drugs, 2003
Fish oils are a rich source of omega-3 long chain polyunsaturated fatty acids Abstract (n-3 LC PUFA). The specific fatty acids, eicosapentaenoic acid and docosahexaenoic acid, are homologues of the n-6 fatty acid, arachidonic acid (AA). This chemistry provides for antagonism by n-3 LC PUFA of AA metabolism to pro-inflammatory and pro-thrombotic n-6 eicosanoids, as well as production of less active n-3 eicosanoids. In addition, n-3 LC PUFA can suppress production of pro-inflammatory cytokines and cartilage degradative enzymes. In accordance with the biochemical effects, beneficial anti-inflammatory effects of dietary fish oils have been demonstrated in randomised, double-blind, placebo-controlled trials in rheumatoid arthritis (RA). Also, fish oils have protective clinical effects in occlusive cardiovascular disease, for which patients with RA are at increased risk. Implementation of the clinical use of anti-inflammatory fish oil doses has been poor. Since fish oils do not provide industry with the opportunities for substantial profit associated with patented prescription items, they have not received the marketing inputs that underpin the adoption of usual pharmacotherapies. Accordingly, many prescribers remain ignorant of their biochemistry, therapeutic effects, formulations, principles of application and complementary dietary modifications. Evidence is presented that increased uptake of this approach can be achieved using bulk fish oils. This approach has been used with good compliance in RA patients. In addition, an index of n-3 nutrition can be used to provide helpful feedback messages to patients and to monitor the attainment of target levels. Collectively, these issues highlight the challenges in advancing the use of fish oil amid the complexities of modern management of RA, with its emphasis on combination chemotherapy applied early.