The beneficial effects of omega-3 polyunsaturated fatty acids have been widely described in the literature in particular those on cardiovascular system. In the last decade there has been an increased interest in the role of these nutrients in the reduction of articular inflammation as well as in the improvement of clinical symptoms in subjects affected by rheumatic diseases, in particular rheumatoid arthritis (RA).
While the typical diet in the United States has a much greater ratio of omega-6 fatty acids compared with omega-3 fatty acids, research is showing that shifting this ratio-by increased consumption of fatty fish or fish oil supplements-may provide significant health benefits. Reductions in cardiovascular risk, depression, and rheumatoid arthritis symptoms have been correlated with omega-3 fatty acid intake, and there is increased interest in the use of omega-3 fatty acid supplementation for other psychiatric illnesses and prevention of Alzheimer's disease.
The beneficial properties of fish oil are well known and are related to its fatty acid composition rich in omega-3 polyunsaturated fatty acids. A variety of epidemiological and clinical studies have demonstrated the efficacy of fish oil supplementation in rheumatoid arthritis (RA). The anti-inflammatory effects of fish oil are linked to the production of alternative eicosanoids, to the reduction of proinflammatory cytokines, to the inhibition of the activation of T lymphocytes and of catabolic enzymes. Fish oil supplementation could represent a valuable support to the traditional pharmacological treatment of rheumatoid arthritis.
A study by Berbert AA et al (Nutrition Feb 21 (2): 131-6, 2005) 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.
Forty-three patients were investigated in a parallel randomized design. Patients were assigned to one of three groups. In addition to their usual medication, the first group received placebo (soy oil), the second group received fish oil omega-3 fatty acids (3 g/d), and the third group received fish oil omega-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. There was a statistically significant improvement in relation to group 1 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. Group 3, but not Group 2, in relation to Group 1 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, Group 3 showed a significant improvement in patient global assessment in relation to Group 2 after 12 wk.
Ingestion of fish oil omega-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.
More convincing data support the efficacy of omega-3 PUFA in reducing pain, number of tender joints, duration of morning stiffness, use of non-steroidal anti-inflammatory drugs and improving physical performance in RA patients. Kolahi et al (Clin Biochem Dec 23, 2009) from the Biotechnology Research Center in Tabriz University of Medical Sciences conducted a clinical trial to prove that fish oil supplementation decreases serum soluble receptor activator of nuclear factor-kappa B ligand in female patients with RA.
Soluble receptor activator of nuclear factor-kappa B ligand (sRANKL) to osteoprotegerin ratio is designated as a bone metabolism equation in many rheumatologic disorders and would be modified with fish oil (FO) supplementation. Eighty-three females with rheumatoid arthritis were divided randomly to 40 and 43 patients treated with (1 g/day) or without FO for 3 months accompanied with conventional drugs, respectively. Osteoprotegerin, sRANKL, tumor necrosis factor alpha (TNFalpha) serum levels were measured before and after treatment. Serum levels of osteoprotegerin increased, although sRANKL, TNFalpha and sRANKL/osteoprotegerin ratio decreased with FO therapy. A significant positive correlation was observed between sRANKL/osteoprotegerin ratio and TNFalpha levels (r=0.327, p=0.040) in the FO-treated group. CONCLUSIONS: FO could decrease the inflammatory response by lowering of serum TNFalpha levels and sRANKL/osteoprotegerin ratio.
In another study, Adam et al ( Rheumatol Intl Jan;(1):27-36) investigated the effects of both dietary measures, alone and in combination, on inflammation, fatty acid composition of erythrocyte lipids, eicosanoids, and cytokine biosynthesis in patients with RA.
Sixty-eight patients with definitive RA were matched into two groups of 34 subjects each. One group was observed for 8 months on a normal western diet (WD) and the other on an anti-inflammatory diet (AID) providing an arachidonic acid intake of less than 90 mg/day. Patients in both groups were allocated to receive placebo or fish oil capsules (30 mg/kg body weight) for 3 months in a double-blind crossover study with a 2-month washout period between treatments.
Clinical examination and routine laboratory findings were evaluated every month, and erythrocyte fatty acids, eicosanoids, and cytokines were evaluated before and after each 3-month experimental period. Sixty patients completed the study. In AID patients, but not in WD patients, the numbers of tender and swollen joints decreased by 14% during placebo treatment. In AID patients, as compared to WD patients, fish oil led to a significant reduction in the numbers of tender (28% vs 11%) and swollen (34% vs 22%) joints Compared to baseline levels, higher enrichment of eicosapentaenoic acid in erythrocyte lipids (244% vs 217%) and lower formation of leukotriene B(4) , 11-dehydro-thromboxane B(2) (15% vs 10%, P less than 0.05), and prostaglandin metabolites (21% vs 16%, P less than 0.003) were found in AID patients, especially when fish oil was given during months 6-8 of the experiment.
A diet low in arachidonic acid ameliorates clinical signs of inflammation in patients with RA and augments the beneficial effect of fish oil supplementation.
While the typical diet in the United States has a much greater ratio of omega-6 fatty acids compared with omega-3 fatty acids, research is showing that shifting this ratio-by increased consumption of fatty fish or fish oil supplements-may provide significant health benefits. Reductions in cardiovascular risk, depression, and rheumatoid arthritis symptoms have been correlated with omega-3 fatty acid intake, and there is increased interest in the use of omega-3 fatty acid supplementation for other psychiatric illnesses and prevention of Alzheimer's disease.
The beneficial properties of fish oil are well known and are related to its fatty acid composition rich in omega-3 polyunsaturated fatty acids. A variety of epidemiological and clinical studies have demonstrated the efficacy of fish oil supplementation in rheumatoid arthritis (RA). The anti-inflammatory effects of fish oil are linked to the production of alternative eicosanoids, to the reduction of proinflammatory cytokines, to the inhibition of the activation of T lymphocytes and of catabolic enzymes. Fish oil supplementation could represent a valuable support to the traditional pharmacological treatment of rheumatoid arthritis.
A study by Berbert AA et al (Nutrition Feb 21 (2): 131-6, 2005) 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.
Forty-three patients were investigated in a parallel randomized design. Patients were assigned to one of three groups. In addition to their usual medication, the first group received placebo (soy oil), the second group received fish oil omega-3 fatty acids (3 g/d), and the third group received fish oil omega-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. There was a statistically significant improvement in relation to group 1 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. Group 3, but not Group 2, in relation to Group 1 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, Group 3 showed a significant improvement in patient global assessment in relation to Group 2 after 12 wk.
Ingestion of fish oil omega-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.
More convincing data support the efficacy of omega-3 PUFA in reducing pain, number of tender joints, duration of morning stiffness, use of non-steroidal anti-inflammatory drugs and improving physical performance in RA patients. Kolahi et al (Clin Biochem Dec 23, 2009) from the Biotechnology Research Center in Tabriz University of Medical Sciences conducted a clinical trial to prove that fish oil supplementation decreases serum soluble receptor activator of nuclear factor-kappa B ligand in female patients with RA.
Soluble receptor activator of nuclear factor-kappa B ligand (sRANKL) to osteoprotegerin ratio is designated as a bone metabolism equation in many rheumatologic disorders and would be modified with fish oil (FO) supplementation. Eighty-three females with rheumatoid arthritis were divided randomly to 40 and 43 patients treated with (1 g/day) or without FO for 3 months accompanied with conventional drugs, respectively. Osteoprotegerin, sRANKL, tumor necrosis factor alpha (TNFalpha) serum levels were measured before and after treatment. Serum levels of osteoprotegerin increased, although sRANKL, TNFalpha and sRANKL/osteoprotegerin ratio decreased with FO therapy. A significant positive correlation was observed between sRANKL/osteoprotegerin ratio and TNFalpha levels (r=0.327, p=0.040) in the FO-treated group. CONCLUSIONS: FO could decrease the inflammatory response by lowering of serum TNFalpha levels and sRANKL/osteoprotegerin ratio.
In another study, Adam et al ( Rheumatol Intl Jan;(1):27-36) investigated the effects of both dietary measures, alone and in combination, on inflammation, fatty acid composition of erythrocyte lipids, eicosanoids, and cytokine biosynthesis in patients with RA.
Sixty-eight patients with definitive RA were matched into two groups of 34 subjects each. One group was observed for 8 months on a normal western diet (WD) and the other on an anti-inflammatory diet (AID) providing an arachidonic acid intake of less than 90 mg/day. Patients in both groups were allocated to receive placebo or fish oil capsules (30 mg/kg body weight) for 3 months in a double-blind crossover study with a 2-month washout period between treatments.
Clinical examination and routine laboratory findings were evaluated every month, and erythrocyte fatty acids, eicosanoids, and cytokines were evaluated before and after each 3-month experimental period. Sixty patients completed the study. In AID patients, but not in WD patients, the numbers of tender and swollen joints decreased by 14% during placebo treatment. In AID patients, as compared to WD patients, fish oil led to a significant reduction in the numbers of tender (28% vs 11%) and swollen (34% vs 22%) joints Compared to baseline levels, higher enrichment of eicosapentaenoic acid in erythrocyte lipids (244% vs 217%) and lower formation of leukotriene B(4) , 11-dehydro-thromboxane B(2) (15% vs 10%, P less than 0.05), and prostaglandin metabolites (21% vs 16%, P less than 0.003) were found in AID patients, especially when fish oil was given during months 6-8 of the experiment.
A diet low in arachidonic acid ameliorates clinical signs of inflammation in patients with RA and augments the beneficial effect of fish oil supplementation.
About the Author:
Dr. Jack Haddad, MD, MBA is the founder and owner of King of Home Care, an independently owned non-medical In-home care agency. In addition to his compassion and dedication to the home care industry, Dr. Haddad's expertise and knowledge with hospice care is evident by the clinical research trials that he has conducted over the years.
