OMEGA-3 FATTY ACIDS RHEUMATOID ARTHRITIS
Rheumatoid
Arthritis (RA) is an autoimmune disorder that causes systematic inflammation of
the joints. Autoimmune disorder is the disorder that occur when the body’s
tissues are mistakenly attacked by their own immune system.
A joint is where two bones meet to allow
movement of body parts. Arthritis means joint inflammation. The joint
inflammation of rheumatoid arthritis causes swelling, pain, stiffness, and
redness in the joints. The inflammation of rheumatoid disease can also occur in
tissues around the joints, such as the tendons, ligaments, and muscles.(1)
Although
Rheumatoid Arthritis can occur at any age, but it usually occurs after the age
of 40. According to the recent studies it has been seen that the disorder is
more common in women than in men.
SYMPTOMS
Signs and
symptoms of rheumatoid arthritis may include:
Ø Tender, warm,
swollen joints
Ø Morning
stiffness that may last for hours
Ø Firm bumps of
tissue under the skin of the arms
Ø Fatigue, fever
and weight loss.
Over time,
rheumatoid arthritis can cause joints to deform and shift out of place.(2)
CAUSES
Doctors still
have no clue what exactly causes Rheumatoid Arthritis, although genetic
components are most likely to be involved. Smoking is the most significant
non-genetic risk.(3)
TREATMENTS
OMEGA- FATTY ACIDS FOR RHEUMATOID ARTHRITIS
There is no
proper cure for rheumatoid arthritis. Medications can reduce the inflammation
in the joints in order to get relief from pain and prevent or slow down the joint
damage. The drugs mainly given as a medication for rheumatoid arthritis have
several side effects.
However, a 2012
systematic review concluded that the omega-3 fatty acid found in seafood and
fish oil may be modestly helpful in relieving symptoms of rheumatoid arthritis.
In the studies included many participants reported that taking fish oil
containing omega-3 fatty acid had less joint swelling and pain, and less need
for anti-inflammatory drugs to control the rheumatoid arthritis symptoms.(4)
Omega-3 fatty
acids exist in two forms namely;
Ø Long-chain forms
(DHA) which is found in higher levels in oily fish
Ø Short chain
forms mainly found in rapeseed oil, walnuts etc.
Amongst the
classic inflammatory conditions, fish oil have been extensively used as a topic
of research for treating rheumatoid arthritis. Animal models have been
demonstrated that omega-3 fatty acids can delay the onset of arthritis, reduce
its severity and improve joint pathology.
Omega-3 fatty
acids are considered essential fatty acids. They are very much essential for
the human health, but the body can’t make them and hence it is given as the
supplement with the food an individual take. Omega-3fatty acid have turned out
to be best supplement that can be used as the supplement to treat rheumatoid
arthritis. Omega-3 fatty acids can be found in fish, such as salmon, tuna,
sardines, anchovies, mackerel, other sea food including algae and krill, some
plants and nut oils. Also termed as Polyunsaturated Fatty acids (PUFAs).
Omega-e fatty acids play an important role in proper functioning of the brain,
as well as the normal growth and development. The American Heart Association
recommends eating fish at least twice a week. The most widely studied omega-3
fatty acids namely eicosapentaenoic acid (EPA) and docosaxaenoic acid (DHA)
have various effects in the body. In the immune systems, EPA is a precursor for
eicosanoids, which are messenger molecules that are less inflammatory. EPA and
DHA also produces inflammatory molecules called resolvins ( Norling and
Peretti), and reduce the expression of gene that produces inflammatory
components (Calder). As rheumatoid arthritis is caused by inflammatory
molecules attacking healthy cells, reducing inflammation can treat the cause of
the disease.(5)
Laboratory studies
of University of Maryland suggests that diets rich in omega-3 fatty acids (and
low in the inflammatory omega-6 fatty acids) may help people with
osteoarthritis, although more study is needed for the same. New Zealand green
lipped mussel (Perna canaliculus),
another source of omega-fatty acids, has been reported to reduce joint
stiffness and pain, increase grip strength, and improve walking pace in a small
group of people with rheumatoid arthritis. Exceptionally, in some cases the
symptoms got worse before they are improved.
An analysis of
17 randomized, controlled clinical trials looked at the pain relieving effects
of omega-3 fatty acid supplements in people with rheumatoid arthritis or joint
pain caused by inflammatory bowel disease and painful menstruation. The results
suggests that omega-3 fatty acids, along with conventional therapies such as
Non-Steroidal anti-inflammatory drugs (NSAIDs), may help relieve joint pain
associated with these condition.(6)
The influence of
omega-3 fatty acids on the functional responses of various cell types involved
in inflammation and on the production of the rage of chemical mediators
produced has been a favorite topic for research of many. Various reports have
been found over the year which states the effects of omega-3 fatty acids acts
in anti-inflammatory manner, with more recent studies suggesting that they may
be involved in the resolution of inflammation. The anti-inflammatory effects of
omega-3fatty acids are widely reviewed round the globe. The ability of omega-3
fatty acid to down-regulate several aspects of inflammation suggests that these
fatty acids might be important in determining the development and severity of
inflammatory diseases and further they may be used as a useful component of
therapy.
The main
mechanism underlying the anti-inflammatory actions of omega-3 fatty acid
include altered cell membrane phospholipid fatty acid composition, disruption
of lipid rafts, inhibition of activation of the pro-inflammatory transcription
factor nuclear factor kappa B so reducing expression of inflammatory genes,
activation of the anti-inflammatory transcription factor NR1C3 (i.e. peroxisome
proliferator activated receptor ˠ) and binding to the G-protein.
For e.g.,
Cleland et al. found that patients
with RA who use fish oil supplements were more likely to reduce the use of
non-steroidal anti-inflammatory drugs (NSAIDs) with respect to those patients
that did not use fish oil as the supplement. The dose of omega-3 fatty acids
used in these trials has typically been high, between about 1 and 7g/day and
averaging about 3.5g/day. This dose would equate to 50mg per kg body wt. per
day which is quite difficult to get it achieved through supplement diet or
liquid oil.(7)
However, in the
current studies that are been conducted recently used a low dose of 0.4 gms per
day, which is able to be obtained from diet and a high dose of 5.5 gms per day.
Patients who had been diagnosed with rheumatoid arthritis over many years were
asked for the participation in the clinical trials that were conducted. The
progression of rheumatoid arthritis, including joint deformities can be delayed
if the treatment is started early to reduce the excessive amounts of
inflammatory molecules in the body. The fish oil treatment was additional to
the use of a single first-line disease-modifying anti-rheumatic drug (DMARDs).
The patients were guided by the physicians during the one-year study. After one
year of supplementation, the researchers found that the patients in the high
dose had a lower failure rate of first-line treatment. In the high-dose group,
only 10% reported failure of DMARDs, while in a low-dose group, 32% reported
DMARD failure. This meant that for around one quarter patients, fish oil
supplementation and the first-line treatment were enough to stabilize
rheumatoid arthritis, and for a further two-thirds, the first-line treatment
was likely sufficient.
Various other
meta-analyses results are also conducted for eg., Lee, Bae and Song analyzed
ten clinical trials in rheumatoid arthritis patients and found that omega-3
supplements significantly reduced the use of common pain killers. Trials also
found a non-significantly reduction in the number of tender and swollen joints,
improvements in physical function, and less joint stiffness in the morning. The
dose should be at least 2.7 gms per day, and the supplements should be taken
for longer than 3 months.(8)
However, omega-3
fatty acid intake do have some side effects in the human body. While conducting
various research studies it has been found that the patients who were
undertaking the omega-3 fatty acid as the supplement had mild stomach upsets
and diarrhea. Recently, there have been concerns about the possible link
between high levels of omega-3 fatty acid and prostate cancer. It is also often dangerous to take fish liver
oil in large doses because of the risk of overdosing with vitamin A. this is
particularly important for the pregnant women, or women who are likely to get
pregnant, because vitamin A can harm the newborn baby. Hence, it is always
recommended to consult the dose of omega-3 fatty acids before intake.
Unlike prescription medications, fish oil does
not appear to slow progression of rheumatoid arthritis, only to treat the
symptoms. Joint damage still occurs.
DOSE OF INTAKE
Researchers
suggest that one need at least 2.7 gm per day of the long chain omega-3 fatty
acids. Fish oil act quite slowly so it is recommended that one must have at
least 3 months supplements of fish oil for having effective results. It is
always recommended to have omega-3 fatty acid along with the diet that a person
is having to reduce the risk of cardiovascular diseases.
REFERNCES;
4.
Omega-3
fatty acids- university of Maryland medical Centre
5.
Marine
omega-3 fatty acids and inflammatory process: effects, mechanisms and clinical
relevance: Calder PC
6.
Omega-3
fatty acids, rheumatoid arthritis, and inflammation: Julia Bird
7.
The
benefits of omega-3 fatty acids: Linda Richards
9.
Omega-3
fatty acids and inflammatory processes: nutrition or pharmacology? : Philip C
Calder
10.
Rheumatoid
arthritis: William C Shiel Jr. MD, FACP, FACR
