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Estudio primario

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The Effect of Omega-3 Fatty Acids in Patients With Active Rheumatoid Arthritis Receiving DMARDs Therapy: Double-Blind Randomized Controlled Trial.

Revista Global journal of health science
Año 2015
Enlaces Pubmed DOI PubMed Central

Este artículo está incluido en 1 Síntesis amplia Síntesis amplias (1 referencia) 2 Revisiones sistemáticas Revisiones sistemáticas (2 referencias)

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BACKGROUND: Rheumatoid arthritis is a symmetric peripheral polyarthritis of unknown etiology that, untreated or if unresponsive the therapy, typically leads to deformity and destruction of joints due to erosion of cartilage and bone. Omega-3 fatty acids have been shown to reduce morning stiffness, the number of tender joints and swollen joints in patients with rheumatoid arthritis. This study is designed for evaluation of omega-3 effects on disease activity and remission of rheumatoid arthritis in DMARDs treated patients and on weight changes and reduction of analgesic drugs consumption versus placebo. METHODS: Sixty patients with active rheumatoid arthritis (49 female and 11 male) underwent rheumatologist examination and disease activity score were calculated. Then patients were enrolled in this 12 week, double blind, randomized, placebo- controlled study. The patients in both groups continued their pre study standard treatment. The patients were visited every 4 weeks, 4 times and data were recorded. RESULTS: Significant improvement in the patient's global evaluation and in the physician's assessment of disease was observed in those taking omega-3. The proportions of patients who improved and of those who were able to reduce their concomitant analgesic medication were significantly greater with omega-3 consumption. There were no weight changes. CONCLUSION: Daily supplementation with omega-3 results has significant clinical benefit and may reduce the need for concomitant analgesic consumption without weight changes.

Estudio primario

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El aceite de pescado en la artritis reumatoide de reciente aparición: un ensayo aleatorizado, doble ciego y controlado dentro del consumo de drogas basado en algoritmos.

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Revista Annals of the rheumatic diseases
Año 2015
Enlaces Pubmed DOI

Este artículo está incluido en 1 Resúmenes estructurados de estudios primarios Resúmenes estructurados de estudios primarios (1 referencia) 1 Síntesis amplia Síntesis amplias (1 referencia) 2 Revisiones sistemáticas Revisiones sistemáticas (2 referencias)

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ANTECEDENTES: Los efectos del aceite de pescado (AP) en la artritis reumatoide (AR), no han sido examinados en el contexto del tratamiento contemporáneo de la AR temprana. Este estudio examinó los efectos de la alta versus dosis baja FO en la AR temprana empleando un protocolo 'tratar-to-target' de una combinación de medicamentos antirreumáticos modificadores de la enfermedad (DMARD). MÉTODOS: Los pacientes con AR <12 meses de duración y que eran DMARD naïve fueron inscritos y aleatorizados 2: 1 a FO a una dosis alta o baja dosis (para el enmascaramiento). Estos grupos, designados FO y control, recibieron 5,5 ó 0,4 g / día, respectivamente, de las grasas omega-3, ácido eicosapentaenoico + ácido docosahexaenoico. Todos los pacientes recibieron metotrexato (MTX), sulfasalazina e hidroxicloroquina, y dosis DMARD se ajustaron de acuerdo con un algoritmo teniendo actividad de la enfermedad y la toxicidad en cuenta. Velocidad de sedimentación globular-DAS28, modificado Health Assessment Questionnaire (mHAQ) y remisión fueron evaluados cada tres meses. La medida de resultado primario fue el fracaso de la terapia triple DMARD. RESULTADOS: En el grupo de FO, el fracaso de la terapia triple DMARD fue menor (IC HR = 0,28 (95%: 0,12 a 0,63; p = 0,002) sin ajustar y 0,24 (IC 95% 0,10 a 0,54; p = 0,0006) después de ajustar por los antecedentes de tabaquismo , epítopo compartido y anti-citrullinated péptido cíclico línea de base. La tasa de primera Colegio Americano de Reumatología (ACR) remisión fue significativamente mayor en el FO en comparación con el grupo control (IC HR = 2,17 (95%: 1,07 a 4,42; p = 0,03) no ajustada y 2,09 (IC 95% 1.2 a 4.30; p = 0,04) ajustado). No hubo diferencias entre los grupos en la dosis de MTX, DAS28 o puntuaciones MHAQ, o eventos adversos. CONCLUSIONES: FO se asoció con beneficios adicionales a los obtenidos por la combinación con DMARD uso MTX similares 'tratar para objetivo'. Estos incluyen el fracaso DMARD triples reducida y una mayor tasa de remisión ACR.

Estudio primario

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ω-3 fatty acids infusions as adjuvant therapy in rheumatoid arthritis

Revista JPEN. Journal of parenteral and enteral nutrition
Año 2010
Enlaces Pubmed DOI

Este artículo está incluido en 1 Síntesis amplia Síntesis amplias (1 referencia) 1 Revisión sistemática Revisiones sistemáticas (1 referencia)

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Background: The present study investigated the efficacy and safety of parenteral ω-3 fatty acids (ω-3 FA) in patients with active rheumatoid arthritis (RA). Methods: We performed a double-blind, randomized, placebo-controlled study in 23 patients with moderate to severe RA. Patients received either 0.2 g of fish oil emulsion/kg (active) or 0.9% saline (placebo) infusion intravenously for 14 consecutive days, followed by 20 weeks of 0.05 g of fish oil/kg (active) or paraffin wax (placebo) ingested orally as capsules. A decrease in swollen and tender joint counts was the primary efficacy measure. Results: At baseline, both swollen and tender joint counts were not significantly different between patients in the treatment and placebo groups. Twenty patients completed the infusion portion of the study, and 13 completed the oral portion. Swollen joint count was significantly lower in the ω-3 FA group compared with the placebo group after 1 week of infusion (P =.002) as well as after 2 weeks of infusion (P =.046). Tender joint count also tended to be lower in the ω-3 FA group, although this did not reach statistical significance. Both swollen and tender joint counts were significantly lower in the ω-3 FA group compared with the placebo group during and at the end of oral treatment. Conclusion: Our pilot study indicates that parenteral ω-3 FAs are well tolerated and improve clinical symptoms of RA. Subsequent oral administration of ω-3 FAs may prolong the beneficial effects of the infusion therapy. These results warrant validation in larger multicenter studies. © 2010 American Society for Parenteral and Enteral Nutrition.

Estudio primario

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Long-term moderate intervention with n-3 long-chain PUFA-supplemented dairy products: effects on pathophysiological biomarkers in patients with rheumatoid arthritis.

Revista The British journal of nutrition
Año 2009
Enlaces Pubmed DOI

Este artículo está incluido en 2 Síntesis amplias Síntesis amplias (2 referencias) 3 Revisiones sistemáticas Revisiones sistemáticas (3 referencias)

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n-3 long-chain PUFA (n-3 LC-PUFA) may improve cardiovascular and inflammatory diseases. The effects of n-3 LC-PUFA-supplemented dairy products on inflammation and immunological parameters, biomarkers of oxidative stress, serum lipids, and on disease activity were determined in patients with rheumatoid arthritis (RA). Forty-five subjects (forty-three females and two males) were randomly divided into two groups in a double-blind, placebo-controlled cross-over study. Both groups received placebo or verum products consecutively for 3 months with a 2-month washout phase between the two periods. Blood samples were taken at the beginning and at the end of each period. The dairy products generally improved serum lipids by increasing HDL and lowering lipoprotein a. The n-3 LC-PUFA supplements act to lower TAG. Additionally, a decreased lipopolysaccharide-stimulated cylo-oxygenase-2 expression was found in patients who had consumed the enriched dairy products. The majority of the CD analysed were not influenced, although n-3 LC-PUFA did suppress the immune response as lymphocytes and monocytes were found to be significantly decreased. The n-3 LC-PUFA did not increase the biomarkers of oxidative stress such as 8-iso-PGF2α and 15-keto-dihydro PGF2α, and DNA damage like 7,8-dihydro-8-oxo-2α-deoxyguanosine. The long-term consumption of dairy products (2 × 12 weeks) diminished the excretion of hydroxypyridinium crosslinks, and favoured the diastolic blood pressure. The consumption of moderate doses of n-3 LC-PUFA in combination with dairy products did not improve the disease activity. However, there is evidence of cardioprotective effects. Furthermore, the long-term consumption of dairy products acts against the cartilage and bone destruction in RA.

Estudio primario

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Cod liver oil (n-3 fatty acids) as an non-steroidal anti-inflammatory drug sparing agent in rheumatoid arthritis.

Revista Rheumatology (Oxford, England)
Año 2008
Enlaces Pubmed DOI

Este artículo está incluido en 2 Síntesis amplias Síntesis amplias (2 referencias) 7 Revisiones sistemáticas Revisiones sistemáticas (7 referencias)

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OBJECTIVES: Dose-dependant gastrointestinal and cardiovascular side-effects limit the use of NSAIDs in the management of RA. The n-3 essential fatty acids (EFAs) have previously demonstrated some anti-inflammatory and NSAID-sparing properties. The objective of this study was to determine whether cod liver oil supplementation helps reduce daily NSAID requirement of patients with RA. METHODS: Dual-centre, double-blind placebo-controlled randomized study of 9 months' duration. Ninety-seven patients with RA were randomized to take either 10 g of cod liver oil containing 2.2 g of n-3 EFAs or air-filled identical placebo capsules. Documentation of NSAID daily requirement, clinical and laboratory parameters of RA disease activity and safety checks were done at 0, 4, 12, 24 and 36 weeks. At 12 weeks, patients were instructed to gradually reduce, and if possible, stop their NSAID intake. Relative reduction of daily NSAID requirement by >30% after 9 months was the primary outcome measure. RESULTS: Fifty-eight patients (60%) completed the study. Out of 49 patients 19 (39%) in the cod liver oil group and out of 48 patients 5 (10%) in the placebo group were able to reduce their daily NSAID requirement by >30% (P = 0.002, chi-squared test). No differences between the groups were observed in the clinical parameters of RA disease activity or in the side-effects observed. CONCLUSIONS: This study suggests that cod liver oil supplements containing n-3 fatty acids can be used as NSAID-sparing agents in RA patients.

Estudio primario

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Intravenous application of omega-3 fatty acids in patients with active rheumatoid arthritis. The ORA-1 trial. An open pilot study.

Autores Leeb BF , Sautner J , Andel I , Rintelen B
Revista Lipids
Año 2006
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Este artículo está incluido en 1 Síntesis amplia Síntesis amplias (1 referencia)

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The objective of this work was to assess the therapeutic efficacy and tolerability of intravenously applied n-3-PUFA in patients with active rheumatoid arthritis (RA). Thirty-four patients with active RA [identified as having a DAS28 (disease activity score including a 28 joint count) > 4.0] were enrolled into this 5-wk open pilot study (one group design). From the time of screening (visit 0, or V0), background therapy had to remain unchanged. Patients received 2 mL/kg (= 0.1-0.2 g fish oil/kg) fish oil emulsion intravenously on 7 consecutive days (Visit 1-Visit 2, or V1-V2) in addition to their background therapy. A decrease of the DAS28 > 0.6 at day 8 (Visit 2) was the primary efficacy measure. Moreover, the DAS28 at day 35 (Visit 3, or V3), the modified Health Assessment Questionnaire, the American College of Rheumatology (ACR) response criteria (V2, V3) and the Short Form-36 (V3) were assessed. Thirty-three patients completed the trial. The mean DAS28 at V1 was 5.45;at V2, 4.51 (P < .001 V1-V2) and at V3, 4.73 (P < .001 V1-V3; V2-V3, not significantly different). Of the 34 patients, 56% achieved a reduction of the DAS28 > 0.6 at V2 (mean 1.52); 27% > 1.2. At V3, 41% of the patients showed a DAS28 reduction > 0.6 (mean 1.06), and 36% > 1.2. ACR 20 and 50% responses at V2 were seen in 29 and 12% of patients, respectively; at V3, the comparable values were 18 and 9%, respectively. Overall tolerability was excellent. Intravenous application of n-3-PUFA (as an add-on therapy) was considerably well tolerated and led to improvement of the disease activity status in a reasonable number of RA patients. Future trials are warranted to answer whether the intravenous application of n-3-PUFA constitutes a therapeutic option in RA patients.

Estudio primario

No clasificado

Nutrient supplementation with polyunsaturated fatty acids and micronutrients in rheumatoid arthritis: clinical and biochemical effects.

Revista European journal of clinical nutrition
Año 2004
Enlaces Pubmed DOI

Este artículo está incluido en 2 Síntesis amplias Síntesis amplias (2 referencias) 6 Revisiones sistemáticas Revisiones sistemáticas (6 referencias)

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OBJECTIVE: To investigate in a double-blind placebo-controlled, parallel group study, the effects of a nutrient supplement, containing, among other ingredients, the omega-3 fatty acids eicosapentaenoic acid (1.4 g EPA), docosahexaenoic acid (0.211 g DHA), omega-6 fatty acid gamma-linolenic acid (0.5 g GLA) and micronutrients in patients with active rheumatoid arthritis (RA). DESIGN, SUBJECTS AND INTERVENTION: RA patients were randomized to receive either daily liquid nutrient supplementation or placebo for 4 months. The primary end point was the change in tender joint count at 2 and 4 months. Other clinical variables included swollen joint count, visual analogue scales for pain and disease activity, grip strength, functionality score and morning stiffness. Biochemical parameters included plasma concentrations of PUFA and vitamins C and E. SETTING: Outpatient university clinic. RESULTS: In all, 66 patients enrolled, 55 completed the study. No significant change from baseline in tender joint count or any of the other clinical parameters was detected in either group. Patients receiving nutrient supplementation, but not those receiving placebo, had significant increases in plasma concentrations of vitamin E (P=0.015), and EPA, DHA and docosapentaenoic acid concomitant with decreases of arachidonic acid (P=0.01). Intergroup differences for PUFA and vitamin E were significantly different (P=0.01 and 0.03, respectively). CONCLUSIONS: This double-blind, placebo-controlled study in RA patients did not show superior clinical benefit of daily nutrient supplementation with EPA, GLA and micronutrients at the doses tested as compared to placebo. The study adds information regarding doses of omega-3 fatty acids, below which anti-inflammatory effects in RA are not seen.

Estudio primario

No clasificado

Efficacy of fish oil concentrate in the treatment of rheumatoid arthritis.

Autores Volker D , Fitzgerald P , Major G , Garg M
Revista The Journal of rheumatology
Año 2000
Enlaces Pubmed

Este artículo está incluido en 1 Síntesis amplia Síntesis amplias (1 referencia) 6 Revisiones sistemáticas Revisiones sistemáticas (6 referencias)

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OBJECTIVE: To determine the efficacy of fish oil derived (n-3) fatty acid supplementation (3-6 capsules/day) in subjects with rheumatoid arthritis (RA) whose (n-6) fatty acid intake in the background diet was < 10 g/day, compared to olive/corn oil capsule supplement over a 15 week period. METHODS: A placebo controlled, double blind, randomized 15 week study to determine the effect of supplementation on clinical variables in 50 subjects with RA whose background diet was naturally low in (n-6) fatty acids. Fish oil containing 60% (n-3) fatty acids was supplemented at a rate of 40 mg/kg body weight. RESULTS: Analysis of 9 clinical variables indicated there was a significant difference (p < 0.02) between control and treatment groups. Five subjects in the treatment group and 3 in the control group met the American College of Rheumatology 20% improvement criteria. Dietary supplementation resulted in a significant increase in eicosapentaenoic acid in plasma and monocyte lipids in the supplemented group. CONCLUSION: The findings suggest that fish oil supplementation that delivers (n-3) fatty acids at a dose of 40 mg/kg body weight/day, with dietary (n-6) fatty acid intake < 10 g/day in the background diet, results in substantial cellular incorporation of (n-3) fatty acids and improvements in clinical status in patients with RA.

Estudio primario

No clasificado

Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Clinical and immune correlates.

Revista Arthritis and rheumatism
Año 1995
Enlaces Pubmed DOI www.cochranelibrary.com

Este artículo está incluido en 1 Síntesis amplia Síntesis amplias (1 referencia) 5 Revisiones sistemáticas Revisiones sistemáticas (5 referencias)

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OBJECTIVE: To determine the following: 1) whether dietary supplementation with fish oil will allow the discontinuation of nonsteroidal antiinflammatory drugs (NSAIDs) in patients with rheumatoid arthritis (RA); 2) the clinical efficacy of high-dose dietary omega 3 fatty acid fish oil supplementation in RA patients; and 3) the effect of fish oil supplements on the production of multiple cytokines in this population. METHODS: Sixty-six RA patients entered a double-blind, placebo-controlled, prospective study of fish oil supplementation while taking diclofenac (75 mg twice a day). Patients took either 130 mg/kg/day of omega 3 fatty acids or 9 capsules/day of corn oil. Placebo diclofenac was substituted at week 18 or 22, and fish oil supplements were continued for 8 weeks (to week 26 or 30). Serum levels of interleukin-1 beta (IL-1 beta), IL-2, IL-6, and IL-8 and tumor necrosis factor alpha were measured by enzyme-linked immunosorbent assay at baseline and during the study. RESULTS: In the group taking fish oil, there were significant decreases from baseline in the mean (+/- SEM) number of tender joints (5.3 +/- 0.835; P < 0.0001), duration of morning stiffness (-67.7 +/- 23.3 minutes; P = 0.008), physician's and patient's evaluation of global arthritis activity (-0.33 +/- 0.13; P = 0.017 and -0.38 +/- 0.17; P = 0.036, respectively), and physician's evaluation of pain (-0.38 +/- 0.12; P = 0.004). In patients taking corn oil, no clinical parameters improved from baseline. The decrease in the number of tender joints remained significant 8 weeks after discontinuing diclofenac in patients taking fish oil (-7.8 +/- 2.6; P = 0.011) and the decrease in the number of tender joints at this time was significant compared with that in patients receiving corn oil (P = 0.043). IL-1 beta decreased significantly from baseline through weeks 18 and 22 in patients consuming fish oil (-7.7 +/- 3.1; P = 0.026). CONCLUSION: Patients taking dietary supplements of fish oil exhibit improvements in clinical parameters of disease activity from baseline, including the number of tender joints, and these improvements are associated with significant decreases in levels of IL-1 beta from baseline. Some patients who take fish oil are able to discontinue NSAIDs without experiencing a disease flare.

Estudio primario

No clasificado

Alpha-linolenic acid in the treatment of rheumatoid arthritis. A double-blind, placebo-controlled and randomized study: flaxseed vs. safflower seed.

Revista Rheumatology international
Año 1995
Enlaces Pubmed DOI

Este artículo está incluido en 1 Síntesis amplia Síntesis amplias (1 referencia) 5 Revisiones sistemáticas Revisiones sistemáticas (5 referencias)

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In rheumatoid arthritis various pro-inflammatory metabolites of arachidonic acid (AA), such as leukotriene B4 (LTB4) and prostaglandin E2 (PGE2), contribute to tissue destruction and pain. In contrast to AA, which is an omega-6 fatty acid, the omega-3 fatty acids, after having been liberated from the cell membrane phospholipids, are further converted into the non- or anti-inflammatory eicosanoids LTB5 and PGI3. AA concentration is an important regulatory step in the synthesis of both prostanoids and leukotriens. Dietary supplementation with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) has therefore been used to decrease the ratio of AA to EPA or DHA to obtain beneficial clinical effects. EPA and DHA are found in animal fat and are quite expensive compared to their precursor alpha-linolenic acid (alpha-LNA) found in flaxseed oil. We, therefore, performed a placebo-controlled trial with alpha-LNA in 22 patients with rheumatoid arthritis, using a linoleic acid preparation as a placebo. After a 3-month follow-up, the treatment group showed an increased bleeding time, but the clinical, subjective (global assessment, classification of functional status, joint score index, visual analogue scale, pain tenderness score) and laboratory parameters (haemoglobin, erythrocyte sedimentation rate, C-reactive protein) did not show any statistical alterations. AA, EPA and DHA did not change either in spite of a significant increase in alpha-LNA in the treatment group. Thus, 3-month's supplementation with alpha-LNA did not prove to be beneficial in rheumatoid arthritis.