Background and aimMarine n-3 fatty acids and γ-linolenic acid both have anti-inflammatory effects and may be useful to help treat inflammatory diseases. The effects of these alone or combined were examined in patients with arthritis in a randomized controlled trial.DesignPatients with rheumatoid arthritis or psoriatic arthritis were randomized into four groups in a double-blind, placebo-controlled parallel designed study. Patients received the respective capsules (1: 3.0 g n-3 LC-PUFA/d; 2: 3.2 g γ-linolenic acid/d; 3: 1.6 g n-3 LC-PUFA + 1.8 g γ-linolenic acid/d; 4: 3.0 g olive oil) for a twelve week period. Clinical status was evaluated and blood samples were taken at the beginning and at the end of the period. Differences before and after intervention were tested with paired t-test or with Wilcoxon test for non-normal data distribution.Results60 patients (54 rheumatoid arthritis, 6 psoriatic arthritis) were randomised, 47 finished per protocol. In group 1, the ratio of arachidonic acid (AA)/eicosapentaenoic acid (EPA) decreased from 6.5 ± 3.7 to 2.7 ± 2.1 in plasma lipids and from 25.1 ± 10.1 to 7.2 ± 4.7 in erythrocyte membranes (p ≤ 0.001). There was no significant influence on AA/EPA ratio due to interventions in group 2-4. In group 2, the intake of γ-linolenic acid resulted in a strong rise of γ-linolenic acid and dihomo-γ-linolenic acid concentrations in plasma lipids, cholesteryl esters, and erythrocyte membranes. The combination of n-3 LC-PUFA and γ-linolenic acid (group 3) led to an increase of γ-linolenic acid and dihomo-γ-linolenic acid concentrations in plasma lipids, cholesteryl esters, and erythrocyte mem-branes. This increase was only half of that in group 2.ConclusionsIncorporation of eicosanoid precursor FAs was influenced by an intake of n-3 LC-PUFA and γ-linolenic acid suggesting a possible benefit for therapy of chronic inflammatory diseases.Trial RegistrationClinicalTrials NCT01179971

PurposeChronic pain is the predominant condition for use of complementary medicine in Western countries. While many modalities have proven efficacy as a single intervention, therapeutical failure is often due to longer histories, comorbidities or complex etiologic conditions. Therefore, individually tailored therapies may show more efficacy, but little research could be retrieved. We investigated outcomes of inpatients after an intensive period of approximatey 2 weeks with individual combinations of therapies, composed of diet and fasting, physical therapy, relaxation, herbs, acupuncture, and neural therapy. MethodsOngoing inpatients (age 18 -70, M and F) with chronic musculoskeletal pain of different origin (Gerbershagen classification III and IV, multi-morbidity allowed) for more than 2 years were included. Main outcome parameters were changes in VAS (0-100) for global pain and SF-36 between T1 before therapy and final visit T5 after 1 year with no further protocol treatment. Results of this pivotal uncontrolled trial were interpreted as descriptive. ResultsTwo hundred twenty-one patients (intent to treat, mean age 57.2+12.2y) were enrolled with full data sets from 101 (per protocol). Most frequent diagnoses were low back pain (n=53, 24.0%), fibromyalgia (44, 19.9%), rheumatoid arthritis (25, 11.3%), and chronic neck pain (22, 10.0%). Mean VAS decreased by 15.1 from 60.7+23.0 (T1) to 45.6+26.2 (T5) (p<0.0001, two-sided t-test), with highest improvement for low back pain (decrease of 17.5) and no differentiation for multi-morbidity (n=46 with, n=55 without). SF-36 physical and mental component scores improved significantly from 40.0+12.2 to 44.3 +12.5 and from 29.6+8.2 to 32.9+10.5, respectively (p<0.0001 for each). ConclusionAn individual multidimensional treatment for chronic musculoskeletal pain with inpatients may result in sustaining beneficial effects over one year. Surprisingly, differential improvement in quality of life extended to both physical and emotional dimensions. Non-compliance was attributed to the long interval between the end of therapy and visit for primary outcome measurement.