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elisia
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| Posted: January 22 2007 at 4:02pm
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January 2007 - CRA Journal Club Review by Dr. BETH HAZEL
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Reduction of cardiovascular risk factors with longterm fish oil treatment in early rheumatoid arthritis. Cleland LG, Caughey GE, James MJ, Proudman SM. J Rheumatol. 2006 Oct;33(10):1973-9
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Beth Hazel, MD
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Review by
Beth Hazel, MD
Learning Objectives
- Understand the supplemental role of fish oil in RA.
- Recognize the long term cardiovascular risk faced by patients with RA.
- Understand the limitations of extrapolating any study involving neutriceuticals; the dosing and quality of supplements available to our patients is not uniform.
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The Night Before Christmas (with apologies to Clement Clarke Moore)
‘Twas the night before Christmas, chez Mrs. McDermitt
Her RA was not active, not even a bit;
She had taken all ten of her medications with care,
In hopes that her RA would not soon start to flare;
The addition of fish oil to her complex regime,
Was to keep her heart healthy; to live out her dreams;
The enormous dose gave her the “scent of the sea”,
But it seemed to reduce the pains in her knee,
For three years she had taken the fish oil potion,
And for many months, saw no change in her locomotion.
But her lipid profile, it gave her a reprieve,
And she allowed herself some eggnog, this Christmas Eve.
She looked out the window at the new-fallen snows,
And put on her socks to ward off her Raynaud’s.
Her fingers were gnarled, with swan-necks abound
(Which are not nearly as beautiful as they may sound)
But her serum thromboxane B2 was down.
And she knew the ramifications of that were profound.
Her doctor also seemed happy, (she had no clue)
That her lipopolysaccharide-stimulated whole blood prostaglandin E2
Was down to the level of 14.2!
And then, in a twinkling, she heard on the roof
The prancing and pawing of each reindeer hoof.
As she rolled out of bed, and was turning around,
Down the chimney St. Nicholas came with a bound.
He was dressed all in fur, from his head to his foot,
And his clothes were all tarnished with ashes and soot;
The stump of a pipe he held tight in his teeth,
And the smoke it encircled his head like a wreath;
He was chubby and plump, a right jolly old elf,
She gasped as she calculated his Framingham score to herself;
He spoke not a word, but smiled as he munched,
The flax-seed cupcakes she’d set out for his lunch.
Santa had brought her the best present by far:
Pharmaceutical-grade fish-oil in a festive jar!
This goop had decreased her levels of arachidonic acid,
Perhaps enough to keep her arthritis placid
All that she knew, the bane of Pfizer et al,
Was that she was off NSAIDS, one and all.
The study had small numbers and a bias of selection,
And more trials are needed to prove this connection.
But the science looks promising and the horizon is bright,
"So Happy Christmas to all, and to all a good-night."
ABSTRACT
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%).
CONCLUSION: Fish oil reduces cardiovascular risk in patients with RA through multiple mechanisms.
PMID: 16881100 [PubMed - in process]
Click HERE Full Text Article (PDF)
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January, 2007
Edited by elisia - January 22 2007 at 4:29pm
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oswald
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| Posted: January 24 2007 at 12:07pm
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Brava!
Edited by oswald - January 24 2007 at 12:09pm
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davis1
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| Posted: January 24 2007 at 4:40pm
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Dr Hazel is clearly wasted as a rheumatologist.
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uddin
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| Posted: January 24 2007 at 10:28pm
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F I S H O I L
Oil out of fish
into our gut,
not a nice dish
nor it's smart.
If super fish oil
good for all ill
it's fine & swell.
Who pays the bill?
(c) Jamal Uddin
Jan.24,2007
Edited by uddin - August 08 2007 at 8:37pm
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darracott
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| Posted: January 28 2007 at 4:47pm
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Anybody remember the Oil of Primrose story in the old Eular Journal?
Or the refined sugar?
It should at least arouse curiosity
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uddin
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| Posted: January 28 2007 at 8:53pm
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F I S H O I L
-2-
Will all oil
help us foil
the toil
of the soil!
Help us swim
like a fish,in a whim!
Not to waste muscle
in an urban hassle!
(c) Jamal Uddin
Jan.28,2007
Edited by uddin - March 01 2007 at 8:24am
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CRA Forum : Review by Dr. BETH HAZEL - both versions: English and French
Topic: Review by Dr. Hazel - English
