Another Treatment Option for Rheumatoid Arthritis

Source: Tufts University
February 8, 2002 (Reviewed: February 22, 2004)

'Alternative therapies' -- herbs, nutrients, and other substances -- easily attract the attention of people who suffer from arthritis, especially those not satisfied with their conventional medications. Nutrition Reviews recently published a review of the science behind two such treatment options -- fish oil and vitamin E -- with an eye for what potential benefit they might have for people with rheumatoid arthritis (RA).

Testing fish oil in arthritis treatment

Researchers are taking a close look at how polyunsaturated fatty acids -- particularly the omega-3 fatty acids in fish oil -- might affect the development of autoimmune diseases like RA. Omega-3 fatty acids -- eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) -- help preserve the integrity of the phospholipids that make up cell membranes by limiting the inflammatory effect of arachidonic acid (an omega-6 fatty acid). The body is not able to produce EPA and DHA -- they must come from dietary sources -- so diet has a direct effect on how much protective omega-3s are in cell membranes. Scientists think that increased omega-3s in the cell membrane leads to reduced production of certain inflammatory substances.

Markers that indicate immune dysfunction -- interleukin (IL)-1, IL-6, and tumor necrosis factor (TNF-alpha) -- are elevated in patients with RA. Some studies have found that a daily dose of approximately 3 to 5 grams of EPA and DHA from fish oil reduces blood levels of these markers. Several studies have been able to show that this improvement in immune function correlates with less joint pain, less reliance on non-steroidal anti-inflammatory drugs, and an improved global assessment for some patients with RA.

Potential synergy of fish oils and vitamin E

Fish oil, like all polyunsaturated fatty acids, is readily prone to oxidation. Studies done in both humans and mice have found that vitamin E -- a potent antioxidant -- appears to help preserve the integrity of polyunsaturated fatty acids, and may augment the protective effect of the omega-3 fatty acids in fish oil. Some scientists have taken the question one step further, investigating whether vitamin E by itself can moderate the symptom of RA. In several studies, high doses of vitamin E (1200 mg/day) brought pain relief to subjects without having an effect on immune function markers. The scientists speculate that the supplemental vitamin E may have had an analgesic effect, but no mechanism to explain such an effect has been proposed.

Advice to patients

The authors point out that fish oil therapy is not likely to become a first line of treatment for RA. The study results so far have been modest, and there are still some significant research gaps, particularly as to the effectiveness of therapy that includes both fish oil and vitamin E. In addition, some patients balk at the side effects -- a fishy aftertaste and potential gastrointestinal distress -- and the large number of capsules needed to reach therapeutic doses. But as an adjunct to conventional medication, fish oil may give some RA sufferers an added level of support, especially those who have not responded well to their current treatment protocol.

Source

• Effects of diets containing fish oil and vitamin E on rheumatoid arthritis. S. Tidow-Kebritchi, S. Mobarhan, Nutrition Reviews., 2001, vol. 59, pp. 335--338

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