Treatment
of Rheumatoid Arthritis
By
Morten Bryhn MD, Ph D
2/19/2002
Several well conducted clinical
studies have clearly demonstrated the potential for omega-3
fatty acids for treatment of joint pain and stiffness. New
data showes that omega-3 fatty acids also reduce cartilage
degradation. Omega-3 fatty acids should be used together
with antirheumatic drugs for optimal treatment of rheumatic
diseases.
Rheumatoid
arthritis (RA) is a chronic disease affecting about 1% of
the population, women three times more often than men. About
80% develop the disease between the ages of 35 and 50. Family
studies indicate that RA is a hereditary disease. About
79% of people with the genetic code of HLA-DR4 develop RA
compared to only 28% of those with other constitutions.
However, genetic risk factors cannot fully account for the
incidence of RA, suggesting that dietary habits and other
environmental factors also play a role in the etiology of
the disease. Even if the Japanese population is genetically
exposed to the same risk of getting RA as the Western population
the prevalence of the disease is much lower (1). Dietary
habits may influence the risk of acquiring the disease and
may also influence the course and symptoms related to the
disease.
Inhabitants
of Greenland and the Faroe Islands have less rheumatic problems
compared to people in the Nordic region. A cohort study
in these two populations revealed that RA occurred with
a prevalence similar to elsewhere in the World. But the
clinical picture and the long-term outcome of the disease
were quite different. Patients with an overt clinical picture
of RA and a history of 10-30 years were working full time
in the fishing industry with exposure to a cold and humid
environment. Even more interesting x-ray pictures of their
hands showed very little joint deformations. And they had
only traces of inflammatory cytokines (IL-1 and TNF) in
plasma, laboratory parameters that are constantly elevated
in these patients.
The
inhabitants of Greenland, the Faroe Islands and the coastal
population of Japan have easily access to fish and seafood
is accepted as very healthy. In seafood and sea mammals
we find the omega-3 fatty acids known to interfere with
a series of inflammatory events in the human body protecting
against RA and other autoimmune diseases.
The
London Medical Journal published the first scientific publication
on effects of fish oil against rheumatism in 1783 describing
the current practice at Manchester Infirmary. This report
was based on positive observations in a disease with no
treatment at that time. However, the modern documentation
on omega-3 fatty acids in rheumatic disease comprise well
designed, controlled studies showing positive effects on
symptoms such as pain, morning stiffness and grip strength.
A meta-analysis on all these studies has been published
(2) and recommendations on dose have been given (3).
The
modern basis for treatment of patients with RA constitutes
a combination of symptom treatment and prevention of joint
deformation. Symptom relief increase quality-of-life but
even more important is prevention of joint destruction,
which inevitably will lead to reduced function and invalidity.
Pharmacological treatment reduces or prevents negative effects
of compounds released by the immune system responsible for
the disease. Potent pharmaceuticals have been developed
which may change the long-term outcome for RA. However,
the omega-3 fatty acids from fish oil, EPA and DHA do the
same thing as the pharmaceuticals. The mode-of-action may
be different and the potency lower but the effects brought
about is certainly more natural compared to the drugs. This
may explain why treatment with omegega-3 capsules is usually
well tolerated with no risk of serious side effects. It
has also been demonstrated that omega-3 fatty acids reduce
the cartilage destructing enzymes responsible for joint
destruction (4). This finding is very important and places
omega-3 fatty acids as a natural supplement in combination
with anti-rheumatic drugs.
A therapeutic
effect on RA utilizing omega-3 fatty acids cannot be achieved
by means of increasing the number of fishmeals only. A high-quality
omega-3 concentrate in the dose of 3g or more daily should
be used. Clinical response will not occur immediately but
will start after 2-3 months and may even increase further
during chronic use (5). At the same time the intake of red
meat (high in AA and saturates) should be restricted (2).
Omega-3 capsules may be used concomitantly with antirheumatic
pharmaceuticals, which may increase efficacy or even reduce
the risk of gastro-intestinal discomfort, which is a regular
problem for so called NSAID drugs (6). For people with only
minor or transient joint problems omega-3 fatty acids could
be the first choice for self-medication.
REFERENCES:
1) Shichikawa K et al. Ryumachi. Prevalence of rheumatoid
arthritis in the Japanese population 1981;21:35-43
2) Fortin
PR et al. Validation of a meta-analysis: The effects of
fish oil in rheumatoid arthritis. J Clin Epidemiol 1995;48(11):1379-90
3) James
MJ and Cleland LG. Dietary n-3 fatty acids and therapy for
rheumatoid arthritis. Semin Arthritis Rheum 1997;27:85-97
4) Curtis
CL, Hughes CE, Flannery CR, et al. n-3 fatty acids specifically
modulate catabolic factors involved in articular cartilage
degradation
J Biol Chem 2000;275:721-724
5) Geusens
P et al. Long-term effect of omega-3 fatty acid supplementation
in active rheumatoid arthritis. Arhtr & Rheumat 1994;37:824-829
6) Lau
CS 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;32:982-989
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