Effects of altering dietary essential fatty acids on requirements for non-steroidal anti-inflammatory drugs in patients with rheumatoid arthritis: a double blind placebo controlled study.

Belch, J. J. F.; Ansell, David; Madhok, Rajan; O'Dowd, Anne; Sturrock, R D

doi:10.1136/ard.47.2.96

Cited by 204 publications

(103 citation statements)

References 14 publications

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“…Lower doses of GLA used in previous studies (480 to 540 mg/day) were either not effective (27) or reduced only pain (28), without effects on objective physical findings. Results of a study in which we treated RA patients with 1.4 gm/day of GLA in borage seed oil suggested that the higher dosage is necessary to influence active synovitis (9).…”

mentioning

confidence: 59%

“…We have considered, and others have shown in a controlled clinical trial (28), that GLA can be an NSAID substitute. However, our observations that DGLA suppresses synovial cell proliferation (4), and the results of this study which indicate that RA patients are better after 12 months of GLA treatment than after 6 months, suggest that GLA might function as a so-called DMARD.…”

mentioning

confidence: 99%

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Gamma‐linolenic acid treatment of rheumatoid arthritis. A randomized, placebo‐controlled trial

Zurier

Rossetti

Jacobson

et al. 1996

Arthritis & Rheumatism

184

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Objective. To assess the clinical efficacy and adverse effects of γ‐linolenic acid (GLA), a plant seed oil‐derived unsaturated fatty acid that suppresses inflammation and joint tissue injury in animal models, in the treatment of active rheumatoid arthritis (RA). Methods. Fifty‐six patients with active RA were randomized to treatment groups in a 6‐month, double‐blind trial of GLA versus placebo. This was followed by a 6‐month, single‐blind trial during which all patients received GLA. Patients were treated with 2.8 gm/day of GLA as the free fatty acid or with sunflower seed oil (placebo) administered in identical capsules. Results. Treatment with GLA for 6 months resulted in statistically significant and clinically relevant reductions in the signs and symptoms of disease activity in patients with RA. Overall meaningful responses (at least 25% improvement in 4 measures) were also better in the GLA treatment group (14 of 22 patients versus 4 of 19 in the placebo group; P = 0.015). During the second 6 months, both groups exhibited improvement in disease activity. Thus, patients taking GLA during the entire study showed progressive improvement during the second 6 months. In this group, 16 of 21 patients showed meaningful improvement at 12 months compared with study entry. Conclusion. GLA at doses used in this study is a well‐tolerated and effective treatment for active RA. GLA is available as a component of several plant seed oils and is usually taken in far lower doses than were used in this trial. It is not approved in the United States for the treatment of any condition, and should not be viewed as therapy for any disease. Further controlled studies of its use in RA are warranted.

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mentioning

confidence: 59%

mentioning

confidence: 99%

Gamma‐linolenic acid treatment of rheumatoid arthritis. A randomized, placebo‐controlled trial

Zurier

Rossetti

Jacobson

et al. 1996

Arthritis & Rheumatism

184

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“…These PUFAs have been reported to show anti-inflammatory effects in patients with chronic inflammatory diseases such as rheumatoid arthritis, psoriasis, and chronic inflammatory bowel disease (18)(19)(20)(21)(22)(23)(24). Several reports have focused on the beneficial effects of EPAor fish oil on bronchial asthma (25)(26)(27)(28)(29).…”

Section: Discussionmentioning

confidence: 99%

Effects of Dietary Supplementation with n-3 Fatty Acids Compared with n-6 Fatty Acids on Bronchial Asthma.

et al. 2000

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Objective The effects of perilla seed oil (n-3 fatty acids) on bronchial asthma were compared with the effects of corn oil (n-6 fatty acids) in relation to the pulmonary function and the generation of leukotriene B4 (LTB4) and C4 (LTC4) by leucocytes.Methods and Subjects 14 asthmatic subjects were divided randomly into two groups: one group (7 subjects) consumedperilla seed oil-rich supplementation and the other group (7 subjects) consumed corn oil-rich supplementation for 4 weeks. Generation of LTsby leucocytes and respiratory function were comparedbetween the two groups.Results The generation of LTB4 and LTC4 by leucocytes tended to increase in subjects (N=7) with corn oil-rich supplementation, and decrease in subjects (N=7) with perilla seed oil-rich supplementation. Significant differences between the two groups were observed in the generation of LTB4 at 2 weeks (p<0.05) and LTC4 at 2 weeks (p<0.05) after dietary supplementation. Significant increases in the value of PEF (p<0.05), FVC (p<0.01), FEV1 0 (p<0.05) and V25 (p<0.05) were found in subjects who received perilla seed oil supplementation for 4 weeks. And significant differences in the value of FVC (p<0.05) and FEV1 0 (p<0.05) were observed between the two groups after 4 weeks of dietary supplementation.Conclusion These results suggest that perilla seed oilrich supplementation is useful for the treatment of asthma in terms of suppression of LTB4and LTC4generation by leucocytes, and improvement of pulmonary function.

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“…1). AA has 20 C and Skoldstam et al (6) , Belch et al (7) and Lau et al (8) Participants were instructed to titrate NSAID use according to the pain level NSAID sparing effect of fish oil…”

Section: Potential Mechanisms For Anti-inflammatory Effects Of Fish Oilmentioning

confidence: 99%

Fish oil and rheumatoid arthritis: past, present and future

2010

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Meta- and mega-analysis of randomised controlled trials indicate reduction in tender joint counts and decreased use of non-steroidal anti-inflammatory drugs with fish-oil supplementation in long-standing rheumatoid arthritis (RA). Since non-steroidal anti-inflammatory drugs confer cardiovascular risk and there is increased cardiovascular mortality in RA, an additional benefit of fish oil in RA may be reduced cardiovascular risk via direct mechanisms and decreased non-steroidal anti-inflammatory drug use. Potential mechanisms for anti-inflammatory effects of fish oil include inhibition of inflammatory mediators (eicosanoids and cytokines), and provision of substrates for synthesis of lipid suppressors of inflammation (resolvins). Future studies need progress in clinical trial design and need to shift from long-standing disease to examination of recent-onset RA. We are addressing these issues in a current randomised controlled trial of fish oil in recent-onset RA, where the aim is to intervene before joint damage has occurred. Unlike previous studies, the trial occurs on a background of drug regimens determined by an algorithm that is responsive to disease activity and drug intolerance. This allows drug use to be an outcome measure whereas in previous trial designs, clinical need to alter drug use was a ‘problem’. Despite evidence for efficacy and plausible biological mechanisms, the limited clinical use of fish oil indicates there are barriers to its use. These probably include the pharmaceutical dominance of RA therapies and the perception that fish oil has relatively modest effects. However, when collateral benefits of fish oil are included within efficacy, the argument for its adjunctive use in RA is strong.

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Effects of altering dietary essential fatty acids on requirements for non-steroidal anti-inflammatory drugs in patients with rheumatoid arthritis: a double blind placebo controlled study.

Cited by 204 publications

References 14 publications

Gamma‐linolenic acid treatment of rheumatoid arthritis. A randomized, placebo‐controlled trial

Gamma‐linolenic acid treatment of rheumatoid arthritis. A randomized, placebo‐controlled trial

Effects of Dietary Supplementation with n-3 Fatty Acids Compared with n-6 Fatty Acids on Bronchial Asthma.

Fish oil and rheumatoid arthritis: past, present and future

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