Nutrient supplementation with polyunsaturated fatty acids and micronutrients in rheumatoid arthritis: clinical and biochemical effects.
OBJECTIVE
To investigate in a double-blind placebo-controlled, parallel group study, the effects of a nutrient supplement, containing, among other ingredients, the omega-3 fatty acids eicosapentaenoic acid (1.4 g EPA), docosahexaenoic acid (0.211 g DHA), omega-6 fatty acid gamma-linolenic acid (0.5 g GLA) and micronutrients in patients with active rheumatoid arthritis (RA).


METHODS
RA patients were randomized to receive either daily liquid nutrient supplementation or placebo for 4 months. The primary end point was the change in tender joint count at 2 and 4 months. Other clinical variables included swollen joint count, visual analogue scales for pain and disease activity, grip strength, functionality score and morning stiffness. Biochemical parameters included plasma concentrations of PUFA and vitamins C and E.


METHODS
Outpatient university clinic.


RESULTS
In all, 66 patients enrolled, 55 completed the study. No significant change from baseline in tender joint count or any of the other clinical parameters was detected in either group. Patients receiving nutrient supplementation, but not those receiving placebo, had significant increases in plasma concentrations of vitamin E (P=0.015), and EPA, DHA and docosapentaenoic acid concomitant with decreases of arachidonic acid (P=0.01). Intergroup differences for PUFA and vitamin E were significantly different (P=0.01 and 0.03, respectively).


CONCLUSIONS
This double-blind, placebo-controlled study in RA patients did not show superior clinical benefit of daily nutrient supplementation with EPA, GLA and micronutrients at the doses tested as compared to placebo. The study adds information regarding doses of omega-3 fatty acids, below which anti-inflammatory effects in RA are not seen.
Remans
P H J
PH
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Sont
J K
JK
Wagenaar
L W
LW
Wouters-Wesseling
W
W
Zuijderduin
W M
WM
Jongma
A
A
Breedveld
F C
FC
Van Laar
J M
JM
D000975:Antioxidants / Q000032:analysis; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy*; D001205:Ascorbic Acid / Q000097:blood; D019587:Dietary Supplements; D004281:Docosahexaenoic Acids / Q000008:administration & dosage / Q000097:blood; D004311:Double-Blind Method; D015118:Eicosapentaenoic Acid / Q000008:administration & dosage / Q000097:blood; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage / Q000097:blood; D043371:Fatty Acids, Omega-6 / Q000008:administration & dosage / Q000097:blood; D005231:Fatty Acids, Unsaturated / Q000008:administration & dosage* / Q000097:blood; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage*; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology; D016896:Treatment Outcome; D014810:Vitamin E / Q000097:blood; D017965:gamma-Linolenic Acid / Q000008:administration & dosage / Q000097:blood
D000975:Antioxidants; D015525:Fatty Acids, Omega-3; D043371:Fatty Acids, Omega-6; D005231:Fatty Acids, Unsaturated; D018977:Micronutrients; D014810:Vitamin E; D004281:Docosahexaenoic Acids; D017965:gamma-Linolenic Acid; D015118:Eicosapentaenoic Acid; D001205:Ascorbic Acid