Effect of conjugated linoleic acids, vitamin E and their combination on the clinical outcome of Iranian adults with active rheumatoid arthritis.
BACKGROUND
Despite beneficial effects of conjugated linoleic acids (CLAs) in animal studies, there is little information on their effects on human inflammatory and autoimmune diseases.


OBJECTIVE
To investigate the effects of CLAs as an adjuvant therapy on the clinical manifestations of rheumatoid arthritis (RA) in adults with an active disease.


METHODS
In a randomized, double-blind placebo-controlled trial, 87 patients with active RA were divided into four groups receiving one of the following daily supplements for 3 months: group C: CLAs 2.5 g equivalent to 2 g mixture of cis 9-trans 11 and trans 10-cis12 CLAs at a rate of 50/50; group E: vitamin E: 400 mg; group CE: CLAs and vitamin E at above doses; group P: placebo. Serum alpha-tocopherol was determined by high-performance liquid chromatography. Clinical data was determined by physician examination and filling the questionnaire by interview. Complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP) and rheumatoid factor (RF) were measured in each patient. DAS28 (diseases activity score) was also determined.


RESULTS
A 3-month supplementation resulted significant reduction in DAS28, pain and morning stiffness in the groups C and CE compared with group P (P < 0.05). Compared with the baseline, ESR levels decreased significantly in the groups C (P < or = 0.05), E (P < or = 0.05) and CE (P < or = 0.001). Group CE had significantly lower ESR levels than group P (P v 0.05). CRP dropped non-significantly in all four groups (P > 0.1). The reduction of white blood cell count was significant in group CE compared with other groups (P < 0.05). Decrease in platelet count was non-significant in groups CE, C, and E. Changes in RF, body mass index, red blood cell count and hemoglobin were not significant in four groups, while RF decreased non-significantly in groups CE and E. In comparison with the baseline, alpha-tocopherol increased significantly in groups C (P < or = 0.05), E (P < or = 0.01) and CE (P < or = 0.001) and in groups E and CE compared with group P.


CONCLUSIONS
CLA supplementation resulted in significant improvement in clinical manifestation among RA patients and may be useful in their treatments.
Aryaeian
Naheed
N
Department of Nutrition and Biochemistry, School of Public Health Research and Institute of Public Health, Shariati Hospital, Tehran, Iran.
Shahram
Farhad
F
Djalali
Mahmoud
M
Eshragian
Mohammad Reza
MR
Djazayeri
Abolghassem
A
Sarrafnejad
Abdolfattah
A
Salimzadeh
Ahmad
A
Naderi
Nasim
N
Maryam
Chamari
C
D000328:Adult; D000368:Aged; D000975:Antioxidants / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000503:physiopathology; D001799:Blood Sedimentation / Q000187:drug effects; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D044243:Linoleic Acids, Conjugated / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014810:Vitamin E / Q000097:blood / Q000627:therapeutic use*; D055815:Young Adult; D024502:alpha-Tocopherol / Q000097:blood
D000975:Antioxidants; D018501:Antirheumatic Agents; D044243:Linoleic Acids, Conjugated; D014810:Vitamin E; D024502:alpha-Tocopherol