Dietary n-3 fatty acids and therapy for rheumatoid arthritis

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Abstract

Objective:

To examine the potential for dietary n-3 fats to be components of therapy for rheumatoid arthritis (RA).

Methods:

Studies of encapsulated fish oil use in RA were reviewed andcritiqued, and possible biochemical mechanisms for fish oil effects were examined. The potential for use of n-3 fats was evaluated within a dietary framework rather than a quasi-pharmaceutical framework.

Results:

There is consistent evidence from double-blind, placebo-controlledclinical trials that dietary n-3 fats, supplied as fish oil, can have beneficial effects in RA. The beneficial effects appear modest, but their size and extent may have been moderated by common trial design factors such as high n-6 polyunsaturated fat diets and concurrent antiinflammatory drug use. Mechanisms for the clinical effects of n-3 fats in RA may involve their ability to suppress production of inflammatory mediators, including n-6 eicosanoids and proinflammatory cytokines. Supression of n-6 eicosanoid and cytokine production will be possible using foodstuffs that are rich in n-3 fats and poor in n-6 fats.

Conclusions:

There are many overlapping biochemical effects of n-3 fatty acids and antiinflammatory pharmaceuticals that could explain the clinical actions of n-3 fats in RA. They suggest that there is the potential for complementarity between drug therapy and dietary choices that increase intake of n-3 fats and decrease intake of n-6 fats. In particular, there is the potential for drug-sparing effects. Future studies with n-3 fats in RA need to address the fat composition of the background diet and the issue of concurrent drug use.

References (83)

  • ClelandL.G. et al.

    Dietary (n-9) eicosatrienoic acid from a cultured fungus inhibits leukotriene B4 synthesis in rats and the effect is modified by dietary linoleic acid

    J Nutr

    (1996)
  • LandsW.E.M. et al.

    Maintenance of lower proportions of (n-6) eicosanoid precursors in phospholipids of human plasma in response to added dietary (n-3) fatty acids

    Biochem Biophys Acta

    (1992)
  • ClelandL.G. et al.

    Linoleate inhibits EPA incorporation from dietary fish oil supplements in human subjects

    Am J Clin Nutr

    (1992)
  • GoldmanD.W. et al.

    Human neutrophil chemotactic and degranulating activities of leukotriene B5 (LTB5) derived from eicosapentaenoic acid

    Biochem Biophys Res Commun

    (1983)
  • HawkesJ.S. et al.

    Separation and quantification of PGE3 following derivitization with panacyl bromide by high pressure liquid chromatography with fluorometric detection

    Prostaglandins

    (1991)
  • JamesM.J. et al.

    Interaction between fish and vegetable oils in relation to rat leucocyte leukotriene production

    J Nutr

    (1991)
  • DinarelloC.A.

    Interleukin-1 and its biologically related cytokines

    Adv Immunol

    (1989)
  • CaugheyG.E. et al.

    The effect on human tumor necrosis factor a and interleukin-lβ production of diets enriched in n-3 fatty acids from vegetable oil or fish oil

    Am J Clin Nutr

    (1996)
  • MeydaniS. et al.

    Oral (n-3) fatty acid supplementation suppresses cytokine production and lymphocyte proliferation: Comparison between younger and older women

    J Nutr

    (1991)
  • JamesM.J. et al.

    Inhibition of human neutrophil leukotriene B4 synthesis by combination auranofin and eicosapentaenoic acid

    Biochem Pharmacol

    (1992)
  • PincusT. et al.

    Prediction of longterm mortality in patients with rheumatoid arthritis according to simple questionnaire and joint count measures

    Ann Intern Med

    (1994)
  • GranJ.T.

    The epidemiology of rheumatoid arthritis

    Monogr Allergy

    (1987)
  • MacGregorA. et al.

    HLA-DRB1*01/0404 genotype and rheumatoid arthritis: increased association in men, young age at onset, and disease severity

    J Rheumatol

    (1995)
  • JawaheerD. et al.

    “Homozygosity” for the HLA-DR shared epitope contributes the highest risk for rheumatoid arthritis concordance in identical twins

    Arthritis Rheum

    (1994)
  • RothmanK.J.

    Causes

    Am J Epidemiol

    (1976)
  • PincusT. et al.

    Remodeling the pyramid or remodeling the paradigms concerning rheumatoid arthritis: lessons from Hodgkin's disease and coronary artery disease

    J Rheumatol

    (1990)
  • PincusT. et al.

    Variability in individual responses of 532 patients with rheumatoid arthritis to first-line and second-line drugs

    Agents Actions Suppl

    (1993)
  • PrashkerM.J. et al.

    The total costs of drug therapy for rheumatoid arthritis: a model based on costs of drug, monitoring, and toxicity

    Arthritis Rheum

    (1995)
  • SeibertK. et al.

    Pharmacological and biochemical demonstration of the role of cyclooxygenase 2 in inflammation and pain

  • KremerJ.M. et al.

    Fish-oil fatty acid supplementation in active rheumatoid arthritis

    Ann Intern Mod

    (1987)
  • ClelandL.G. et al.

    Clinical and biochemical effects of dietary fish oil supplements in rheumatoid arthritis

    J Rheumatol

    (1988)
  • KremerJ.M. et al.

    Dietary fish oil and olive oil supplementation in patients with rheumatoid arthritis

    Arthritis Rheum

    (1990)
  • TullekenJ.E. et al.

    Vitamin E status during dietary fish oil supplementation in rheumatoid arthritis

    Arthritis Rheum

    (1990)
  • van der TempelH. et al.

    Effects of fish oil supplementation in rheumatoid arthritis

    Ann Rheum Dis

    (1990)
  • SkoldstamL. et al.

    Effect of six months of fish oil supplementation in stable rheumatoid arthritis: A double blind, controlled study

    Scand J Rheumatol

    (1992)
  • Kjeldsen-KraghJ. et al.

    Dietary omega-3 fatty acid supplementation and naproxen treatment in patients with rheumatoid arthritis

    J Rheumatol

    (1992)
  • NielsenG.L. et al.

    The effects of dietary supplementation with n-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: A randomized double blind trial

    Eur J Clin Invest

    (1992)
  • LauC.S. et al.

    Effects of fish oil supplementation on non-steroidal anti-inflammatory drug requirement in patients with mild rheumatoid arthritis: A double blind placebo controlled study

    Br J Rheumatol

    (1993)
  • GeusensP. et al.

    Long-term effect of omega-3 fatty acid supplementation in active rheumatoid arthritis

    Arthritis Rheum

    (1994)
  • KremerJ.M. et al.

    Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs

    Arthritis Rheum

    (1995)
  • GabrielS.E. et al.

    NSAID induced ulcers: An emerging epidemic?

    J Rheumatol

    (1990)
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