Reduction of cardiovascular risk factors with longterm fish oil treatment in early rheumatoid arthritis.
OBJECTIVE
Rheumatoid arthritis (RA) is associated with increased risk for cardiovascular (CV) events through multiple factors. Fish oil has been shown to reduce symptoms in RA and to reduce CV risk. We assessed the effect of an antiinflammatory dose of fish oil on CV risk factors within a program of combination chemotherapy for patients with early RA.


METHODS
Patients who chose not to take fish oil (n = 13) were compared with patients who achieved a sustained elevation of eicosapentaenoic acid (EPA) in plasma phospholipid fatty acids (> 5% total fatty acids) while taking fish oil over a 3-year period (n = 18). We examined cellular content of arachidonic acid (AA), synthesis of thromboxane A2 and prostaglandin E2, use of nonsteroidal antiinflammatory drugs (NSAID), traditional CV lipid risk factors, and disease activity at 3 years.


RESULTS
At 3 years, AA (as a proportion of AA plus long-chain n-3 fatty acids that can compete with AA for cyclooxygenase metabolism) was 30% lower in platelets and 40% lower in peripheral blood mononuclear cells in subjects taking fish oil. Serum thromboxane B2 was 35% lower and lipopolysaccharide-stimulated whole-blood prostaglandin E2 was 41% lower with fish oil ingestion compared to no fish oil. NSAID use was reduced by 75% from baseline with fish oil (p < 0.05) and by 37% without fish oil (NS). Favorable changes in fasting blood lipids were seen with, but not without fish oil. Remission at 3 years was more frequent with fish oil use (72%) compared to no fish oil (31%).


CONCLUSIONS
Fish oil reduces cardiovascular risk in patients with RA through multiple mechanisms.
Cleland
Leslie G
LG
Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Adelaide, Australia. lcleland@mail.rah.sa.gov.au
Caughey
Gillian E
GE
James
Michael J
MJ
Proudman
Susanna M
SM
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D016718:Arachidonic Acid / Q000378:metabolism; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control*; D019587:Dietary Supplements; D015232:Dinoprostone / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D015777:Eicosanoids / Q000378:metabolism; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D012307:Risk Factors; D012460:Sulfasalazine / Q000627:therapeutic use; D013928:Thromboxane A2 / Q000378:metabolism
D018501:Antirheumatic Agents; D015777:Eicosanoids; D005395:Fish Oils; D016718:Arachidonic Acid; D012460:Sulfasalazine; D006886:Hydroxychloroquine; D013928:Thromboxane A2; D015232:Dinoprostone; D008727:Methotrexate