Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1990 Feb;49(2):76–80. doi: 10.1136/ard.49.2.76

Effects of fish oil supplementation in rheumatoid arthritis.

H van der Tempel 1, J E Tulleken 1, P C Limburg 1, F A Muskiet 1, M H van Rijswijk 1
PMCID: PMC1003982  PMID: 2138449

Abstract

Sixteen patients with rheumatoid arthritis entered a trial to determine the clinical and biochemical effects of dietary supplementation with fractionated fish oil fatty acids. A randomised, double blind, placebo controlled crossover design with 12 week treatment periods was used. Treatment with non-steroidal anti-inflammatory drugs and with disease modifying drugs was continued throughout the study. Placebo consisted of fractionated coconut oil. The following results favoured fish oil rather than placebo: joint swelling index and duration of early morning stiffness. Other clinical indices improved but did not reach statistical significance. During fish oil supplementation relative amounts of eicosapentaenoic acid and docosahexaenoic acid in the plasma cholesterol ester and neutrophil membrane phospholipid fractions increased, mainly at the expense of the omega-6 fatty acids. The mean neutrophil leucotriene B4 production in vitro showed a reduction after 12 weeks of fish oil supplementation. Leucotriene B5 production, which could not be detected either in the control or in the placebo period, rose to substantial quantities during fish oil treatment. This study shows that dietary fish oil supplementation is effective in suppressing clinical symptoms of rheumatoid arthritis.

Full text

PDF
77

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beri D., Malaviya A. N., Shandilya R., Singh R. R. Effect of dietary restrictions on disease activity in rheumatoid arthritis. Ann Rheum Dis. 1988 Jan;47(1):69–72. doi: 10.1136/ard.47.1.69. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Borgeat P., Samuelsson B. Arachidonic acid metabolism in polymorphonuclear leukocytes: effects of ionophore A23187. Proc Natl Acad Sci U S A. 1979 May;76(5):2148–2152. doi: 10.1073/pnas.76.5.2148. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bray M. A., Ford-Hutchinson A. W., Smith M. J. Leukotriene B4: an inflammatory mediator in vivo. Prostaglandins. 1981 Aug;22(2):213–222. doi: 10.1016/0090-6980(81)90036-8. [DOI] [PubMed] [Google Scholar]
  4. Elmgreen J., Nielsen O. H., Ahnfelt-Rønne I. Enhanced capacity for release of leucotriene B4 by neutrophils in rheumatoid arthritis. Ann Rheum Dis. 1987 Jul;46(7):501–505. doi: 10.1136/ard.46.7.501. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Ford-Hutchinson A. W., Bray M. A., Doig M. V., Shipley M. E., Smith M. J. Leukotriene B, a potent chemokinetic and aggregating substance released from polymorphonuclear leukocytes. Nature. 1980 Jul 17;286(5770):264–265. doi: 10.1038/286264a0. [DOI] [PubMed] [Google Scholar]
  6. Hafström I., Ringertz B., Gyllenhammar H., Palmblad J., Harms-Ringdahl M. Effects of fasting on disease activity, neutrophil function, fatty acid composition, and leukotriene biosynthesis in patients with rheumatoid arthritis. Arthritis Rheum. 1988 May;31(5):585–592. doi: 10.1002/art.1780310502. [DOI] [PubMed] [Google Scholar]
  7. Higgs G. A. The effects of dietary intake of essential fatty acids on prostaglandin and leukotriene synthesis. Proc Nutr Soc. 1985 Jul;44(2):181–187. doi: 10.1079/pns19850037. [DOI] [PubMed] [Google Scholar]
  8. Hoover R. L., Karnovsky M. J., Austen K. F., Corey E. J., Lewis R. A. Leukotriene B4 action on endothelium mediates augmented neutrophil/endothelial adhesion. Proc Natl Acad Sci U S A. 1984 Apr;81(7):2191–2193. doi: 10.1073/pnas.81.7.2191. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hoving E. B., Jansen G., Volmer M., Van Doormaal J. J., Muskiet F. A. Profiling of plasma cholesterol ester and triglyceride fatty acids as their methyl esters by capillary gas chromatography, preceded by a rapid aminopropyl-silica column chromatographic separation of lipid classes. J Chromatogr. 1988 Dec 30;434(2):395–409. doi: 10.1016/s0378-4347(88)80006-9. [DOI] [PubMed] [Google Scholar]
  10. Hoving E. B., Prins J., Rutgers H. M., Muskiet F. A. Behaviour of plasmalogens during high-performance liquid chromatography on a silica column with a mobile phase containing phosphoric acid. J Chromatogr. 1988 Dec 30;434(2):411–416. doi: 10.1016/s0378-4347(88)80007-0. [DOI] [PubMed] [Google Scholar]
  11. Kelley V. E., Ferretti A., Izui S., Strom T. B. A fish oil diet rich in eicosapentaenoic acid reduces cyclooxygenase metabolites, and suppresses lupus in MRL-lpr mice. J Immunol. 1985 Mar;134(3):1914–1919. [PubMed] [Google Scholar]
  12. Klickstein L. B., Shapleigh C., Goetzl E. J. Lipoxygenation of arachidonic acid as a source of polymorphonuclear leukocyte chemotactic factors in synovial fluid and tissue in rheumatoid arthritis and spondyloarthritis. J Clin Invest. 1980 Nov;66(5):1166–1170. doi: 10.1172/JCI109947. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kremer J. M., Bigauoette J., Michalek A. V., Timchalk M. A., Lininger L., Rynes R. I., Huyck C., Zieminski J., Bartholomew L. E. Effects of manipulation of dietary fatty acids on clinical manifestations of rheumatoid arthritis. Lancet. 1985 Jan 26;1(8422):184–187. doi: 10.1016/s0140-6736(85)92024-0. [DOI] [PubMed] [Google Scholar]
  14. Kremer J. M., Jubiz W., Michalek A., Rynes R. I., Bartholomew L. E., Bigaouette J., Timchalk M., Beeler D., Lininger L. Fish-oil fatty acid supplementation in active rheumatoid arthritis. A double-blinded, controlled, crossover study. Ann Intern Med. 1987 Apr;106(4):497–503. doi: 10.7326/0003-4819-106-4-497. [DOI] [PubMed] [Google Scholar]
  15. Lee T. H., Hoover R. L., Williams J. D., Sperling R. I., Ravalese J., 3rd, Spur B. W., Robinson D. R., Corey E. J., Lewis R. A., Austen K. F. Effect of dietary enrichment with eicosapentaenoic and docosahexaenoic acids on in vitro neutrophil and monocyte leukotriene generation and neutrophil function. N Engl J Med. 1985 May 9;312(19):1217–1224. doi: 10.1056/NEJM198505093121903. [DOI] [PubMed] [Google Scholar]
  16. Lee T. H., Menica-Huerta J. M., Shih C., Corey E. J., Lewis R. A., Austen K. F. Characterization and biologic properties of 5,12-dihydroxy derivatives of eicosapentaenoic acid, including leukotriene B5 and the double lipoxygenase product. J Biol Chem. 1984 Feb 25;259(4):2383–2389. [PubMed] [Google Scholar]
  17. Leslie C. A., Conte J. M., Hayes K. C., Cathcart E. S. A fish oil diet reduces the severity of collagen induced arthritis after onset of the disease. Clin Exp Immunol. 1988 Aug;73(2):328–332. [PMC free article] [PubMed] [Google Scholar]
  18. Malmsten C. L. Prostaglandins, thromboxanes, and leukotrienes in inflammation. Semin Arthritis Rheum. 1985 Nov;15(2 Suppl 1):29–35. doi: 10.1016/s0049-0172(85)80007-x. [DOI] [PubMed] [Google Scholar]
  19. Muskiet F. A., van Doormaal J. J., Martini I. A., Wolthers B. G., van der Slik W. Capillary gas chromatographic profiling of total long-chain fatty acids and cholesterol in biological materials. J Chromatogr. 1983 Dec 9;278(2):231–244. doi: 10.1016/s0378-4347(00)84782-9. [DOI] [PubMed] [Google Scholar]
  20. Palmer R. M., Stepney R. J., Higgs G. A., Eakins K. E. Chemokinetic activity of arachidonic and lipoxygenase products on leuocyctes of different species. Prostaglandins. 1980 Aug;20(2):411–418. doi: 10.1016/s0090-6980(80)80058-x. [DOI] [PubMed] [Google Scholar]
  21. Panush R. S., Stroud R. M., Webster E. M. Food-induced (allergic) arthritis. Inflammatory arthritis exacerbated by milk. Arthritis Rheum. 1986 Feb;29(2):220–226. doi: 10.1002/art.1780290210. [DOI] [PubMed] [Google Scholar]
  22. Parke A. L., Hughes G. R. Rheumatoid arthritis and food: a case study. Br Med J (Clin Res Ed) 1981 Jun 20;282(6281):2027–2029. doi: 10.1136/bmj.282.6281.2027. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Payan D. G., Wong M. Y., Chernov-Rogan T., Valone F. H., Pickett W. C., Blake V. A., Gold W. M., Goetzl E. J. Alterations in human leukocyte function induced by ingestion of eicosapentaenoic acid. J Clin Immunol. 1986 Sep;6(5):402–410. doi: 10.1007/BF00915380. [DOI] [PubMed] [Google Scholar]
  24. Samuelsson B., Dahlén S. E., Lindgren J. A., Rouzer C. A., Serhan C. N. Leukotrienes and lipoxins: structures, biosynthesis, and biological effects. Science. 1987 Sep 4;237(4819):1171–1176. doi: 10.1126/science.2820055. [DOI] [PubMed] [Google Scholar]
  25. Samuelsson B. Leukotrienes: mediators of immediate hypersensitivity reactions and inflammation. Science. 1983 May 6;220(4597):568–575. doi: 10.1126/science.6301011. [DOI] [PubMed] [Google Scholar]
  26. Sperling R. I., Weinblatt M., Robin J. L., Ravalese J., 3rd, Hoover R. L., House F., Coblyn J. S., Fraser P. A., Spur B. W., Robinson D. R. Effects of dietary supplementation with marine fish oil on leukocyte lipid mediator generation and function in rheumatoid arthritis. Arthritis Rheum. 1987 Sep;30(9):988–997. doi: 10.1002/art.1780300905. [DOI] [PubMed] [Google Scholar]
  27. Strasser T., Fischer S., Weber P. C. Leukotriene B5 is formed in human neutrophils after dietary supplementation with icosapentaenoic acid. Proc Natl Acad Sci U S A. 1985 Mar;82(5):1540–1543. doi: 10.1073/pnas.82.5.1540. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Terano T., Salmon J. A., Moncada S. Biosynthesis and biological activity of leukotriene B5. Prostaglandins. 1984 Feb;27(2):217–232. doi: 10.1016/0090-6980(84)90075-3. [DOI] [PubMed] [Google Scholar]
  29. Udén A. M., Trang L., Venizelos N., Palmblad J. Neutrophil functions and clinical performance after total fasting in patients with rheumatoid arthritis. Ann Rheum Dis. 1983 Feb;42(1):45–51. doi: 10.1136/ard.42.1.45. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Verhagen J., Walstra P., Veldink G. A., Vliegenthart J. F., Bruynzeel P. L. Separation and quantitation of leukotrienes by reversed-phase high-performance liquid chromatography. Prostaglandins Leukot Med. 1984 Jan;13(1):15–20. doi: 10.1016/0262-1746(84)90097-0. [DOI] [PubMed] [Google Scholar]
  31. Ziff M. Diet in the treatment of rheumatoid arthritis. Arthritis Rheum. 1983 Apr;26(4):457–461. doi: 10.1002/art.1780260402. [DOI] [PubMed] [Google Scholar]
  32. Zijlstra F. J., Naaktgeboren M., Mons H., Vincent J. E. Formation of prostaglandins and leukotrienes by human lung tissue in vitro after activation by the calcium ionophore A23187. Eur J Clin Invest. 1987 Aug;17(4):325–329. doi: 10.1111/j.1365-2362.1987.tb02195.x. [DOI] [PubMed] [Google Scholar]
  33. van der Steege G., Muskiet F. A., Martini I. A., Hutter N. H., Boersma E. R. Simultaneous quantification of total medium- and long-chain fatty acids in human milk by capillary gas chromatography with split injection. J Chromatogr. 1987 Mar 20;415(1):1–11. doi: 10.1016/s0378-4347(00)83186-2. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES