scholarly journals Fish oil and rheumatoid arthritis: past, present and future

2010 ◽  
Vol 69 (3) ◽  
pp. 316-323 ◽  
Author(s):  
Michael James ◽  
Susanna Proudman ◽  
Les Cleland
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Risk ◽  
Drug Use ◽  
Fish Oil ◽  
Controlled Trial ◽  
Joint Damage ◽  
Recent Onset ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Randomised Controlled

Meta- and mega-analysis of randomised controlled trials indicate reduction in tender joint counts and decreased use of non-steroidal anti-inflammatory drugs with fish-oil supplementation in long-standing rheumatoid arthritis (RA). Since non-steroidal anti-inflammatory drugs confer cardiovascular risk and there is increased cardiovascular mortality in RA, an additional benefit of fish oil in RA may be reduced cardiovascular risk via direct mechanisms and decreased non-steroidal anti-inflammatory drug use. Potential mechanisms for anti-inflammatory effects of fish oil include inhibition of inflammatory mediators (eicosanoids and cytokines), and provision of substrates for synthesis of lipid suppressors of inflammation (resolvins). Future studies need progress in clinical trial design and need to shift from long-standing disease to examination of recent-onset RA. We are addressing these issues in a current randomised controlled trial of fish oil in recent-onset RA, where the aim is to intervene before joint damage has occurred. Unlike previous studies, the trial occurs on a background of drug regimens determined by an algorithm that is responsive to disease activity and drug intolerance. This allows drug use to be an outcome measure whereas in previous trial designs, clinical need to alter drug use was a ‘problem’. Despite evidence for efficacy and plausible biological mechanisms, the limited clinical use of fish oil indicates there are barriers to its use. These probably include the pharmaceutical dominance of RA therapies and the perception that fish oil has relatively modest effects. However, when collateral benefits of fish oil are included within efficacy, the argument for its adjunctive use in RA is strong.

Fish oil in recent onset rheumatoid arthritis: A randomized, double-blind, controlled trial within algorithm-based drug use

2014 ◽  
Vol 2 (3) ◽  
pp. 86
Author(s):  
S.M. Proudman ◽  
L.G. Cleland ◽  
L. Spargo ◽  
C.A. Hall ◽  
L. McWilliams ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Drug Use ◽  
Fish Oil ◽  
Controlled Trial ◽  
Double Blind ◽  
Recent Onset

scholarly journals Rheumatoid arthritis: influence of inflammation and anti-inflammatory therapy on cardiovascular risk factors

2020 ◽  
pp. 32-44
Author(s):  
D. I. Trukhan ◽  
D. S. Ivanova ◽  
K. D. Belus
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Diseases ◽  
Cardiovascular Risk Factors ◽  
Chronic Inflammation ◽  
Pharmacological Intervention ◽  
Increased Risk ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Rheumatoid arthritis is a frequent and one of the most severe immuno-inflammatory diseases in humans, which determines the great medical and socio-economic importance of this pathology. One of the priority problems of modern cardiac rheumatology is an increased risk of cardiovascular complications in rheumatoid arthritis. In patients with rheumatoid arthritis, traditional cardiovascular risk factors for cardiovascular diseases (metabolic syndrome, obesity, dyslipidemia, arterial hypertension, insulin resistance, diabetes mellitus, smoking and hypodynamia) and a genetic predisposition are expressed. Their specific features also have a certain effect: the “lipid paradox” and the “obesity paradox”. However, chronic inflammation as a key factor in the development of progression of atherosclerosis and endothelial dysfunction plays a leading role in morbidity and mortality from cardiovascular diseases in rheumatoid arthritis. This review discusses the effect of chronic inflammation and its mediators on traditional cardiovascular risk factors and its independent significance in the development of CVD. Drug therapy (non-steroidal anti-inflammatory drugs, glucocorticosteroids, basic anti-inflammatory drugs, genetically engineered biological drugs) of the underlying disease also has a definite effect on cardiovascular risk factors in patients with rheumatoid arthritis. A review of studies on this problem suggests a positive effect of pharmacological intervention in rheumatoid arthritis on cardiovascular risk factors, their reduction to a level comparable to the populations of patients not suffering from rheumatoid arthritis. The interaction of rheumatologists, cardiologists and first-contact doctors (therapist and general practitioner) in studying the mechanisms of the development of atherosclerosis in patients with rheumatoid arthritis will allow in real clinical practice to develop adequate methods for the timely diagnosis and prevention of cardiovascular diseases in patients with rheumatoid arthritis.

Impact of non-steroidal anti-inflammatory drugs on cardiovascular risk: Is it the same in osteoarthritis and rheumatoid arthritis?

2016 ◽  
Vol 27 (4) ◽  
pp. 559-569 ◽  
Author(s):  
Vasiliki-Kalliopi Bournia ◽  
George Kitas ◽  
Athanasios D. Protogerou ◽  
Petros P. Sfikakis
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Risk ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

DAS-driven therapy versus routine care in patients with recent-onset active rheumatoid arthritis

2009 ◽  
Vol 69 (01) ◽  
pp. 65-69 ◽  
Author(s):  
Y P M Goekoop-Ruiterman ◽  
J K de Vries-Bouwstra ◽  
P J S M Kerstens ◽  
M M J Nielen ◽  
K Vos ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Disease Activity Score ◽  
Controlled Trial ◽  
Joint Damage ◽  
Routine Care ◽  
Activity Score ◽  
Recent Onset ◽  
Group A ◽  
Group B

Objectives:To compare the efficacy of Disease Activity Score (DAS)-driven therapy and routine care in patients with recent-onset rheumatoid arthritis.Methods:Patients with recent-onset rheumatoid arthritis receiving traditional antirheumatic therapy from either the BeSt study, a randomised controlled trial comparing different treatment strategies (group A), or two Early Arthritis Clinics (group B) were included. In group A, systematic DAS-driven treatment adjustments aimed to achieve low disease activity (DAS ⩽2.4). In group B, treatment was left to the discretion of the treating doctor. Functional ability (Health Assessment Questionnaire (HAQ)), Disease Activity Score in 28 joints (DAS28) and Sharp/van der Heijde radiographic score (SHS) were evaluated.Results:At baseline, patients in group A (n = 234) and group B (n = 201) had comparable demographic characteristics and a mean HAQ of 1.4. Group A had a longer median disease duration than group B (0.5 vs 0.4 years, p = 0.016), a higher mean DAS28 (6.1 vs 5.7, p<0.001), more rheumatoid factor-positive patients (66% vs 42%, p<0.001) and more patients with erosions (71% vs 53%, p<0.001). After 1 year, the HAQ improvement was 0.7 vs 0.5 (p = 0.029), and the percentage in remission (DAS28 <2.6) 31% vs 18% (p<0.005) in groups A and B, respectively. In group A, the median SHS progression was 2.0 (expected progression 7.0), in group B, the SHS progression was 1.0 (expected progression 4.4).Conclusions:In patients with recent-onset rheumatoid arthritis receiving traditional treatment, systematic DAS-driven therapy results in significantly better clinical improvement and possibly improves the suppression of joint damage progression.

scholarly journals The impact of non-pharmacological treatments for diseases of the locomotor system on the prescribed drug use and lifestyles of the patients in the sanatoria in Busko-Zdroj

2015 ◽  
Vol 28 (4) ◽  
pp. 273-277
Author(s):  
Milena Korczak ◽  
Jacek Owczarek
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Drug Use ◽  
Pharmacological Treatments ◽  
Locomotor System ◽  
The Third ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
The Impact

Abstract The article is the result of research on the impact of non-pharmacological therapies for diseases of the locomotor system on the prescribed drug use and lifestyles of the patients of the sanatoria in Busko-Zdroj. The reported research uses primary and secondary measures. The former includes the assessment of the impact of non-pharmacological sanatorium treatments for locomotor system diseases on the use of prescribed drug regimes, while the latter is aimed at assessing the patients’ quality of life. The research was conducted on adult patients of both genders in the sanatoria in Busko-Zdroj. The subjects were patients suffering from disorders of the musculoskeletal system such as rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, osteoporosis and discopathies. The research included two visits, the first at the start of the research and the second at the end of the research. The patients were examined for a period of three consecutive weeks. The study involved 170 patients, 50% of them were women and 50% men. A decline in the use of painkillers and anti-inflammatory drugs makes a very interesting finding. After the first week, as many as 38% of the examined patients limited the use of painkillers and/or anti-inflammatory drugs. After the second week, 62% of the patients reduced the use of the drugs, and after the third week of treatment, up to 90% of the patients did so. The improvement of patients’ lives is noticeable in the psychological, physical and motor fields.

301. Effect of non-steroidal anti-inflammatory drugs (NSAIDs) on post-operative analgesia after ceaserean section: Randomised controlled trial

2018 ◽  
Vol 13 ◽  
pp. S41-S42
Author(s):  
Angela Makris ◽  
Charlene Thornton ◽  
Jane Tooher ◽  
Geoffrey Brieger ◽  
Robert Ogle ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Randomised Controlled

scholarly journals Influence of marinen-3 polyunsaturated fatty acids on immune function and a systematic review of their effects on clinical outcomes in rheumatoid arthritis

2012 ◽  
Vol 107 (S2) ◽  
pp. S171-S184 ◽  
Author(s):  
Elizabeth A. Miles ◽  
Philip C. Calder
Keyword(s):  
Rheumatoid Arthritis ◽  
Systematic Review ◽  
Cell Function ◽  
Oily Fish ◽  
Pain Duration ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Randomised Controlled ◽  
Inflammatory Autoimmune Disease ◽  
Eicosanoid Mediators

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease of the joints and bones. Then-6 polyunsaturated fatty acid (PUFA) arachidonic acid (ARA) is the precursor of inflammatory eicosanoids which are involved in RA. Some therapies used in RA target ARA metabolism. Marinen-3 PUFAs (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) found in oily fish and fish oils decrease the ARA content of cells involved in immune responses and decrease the production of inflammatory eicosanoids from ARA. EPA gives rise to eicosanoid mediators that are less inflammatory than those produced from ARA and both EPA and DHA give rise to resolvins that are anti-inflammatory and inflammation resolving, although little is known about these latter mediators in RA. Marinen-3 PUFAs can affect other aspects of immunity and inflammation relevant to RA, including dendritic cell and T cell function and production of inflammatory cytokines and reactive oxygen species, although findings for these outcomes are not consistent. Fish oil has been shown to slow the development of arthritis in animal models and to reduce disease severity. A number of randomised controlled trials of marinen-3 PUFAs have been performed in patients with RA. A systematic review included 23 studies. Evidence is seen for a fairly consistent, but modest, benefit of marinen-3 PUFAs on joint swelling and pain, duration of morning stiffness, global assessments of pain and disease activity, and use of non-steroidal anti-inflammatory drugs.

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