AIM: To investigate different approaches to RA treatment that might lead to greater efficacy and better safety profiles. METHODS: The Search strategy was based on medical subject headings, and screening and selection were based on inclusion/exclusion criteria. RESULTS & DISCUSSION: Early therapy is critical for disease control and loss of bodily function. The most promising outcomes came from the development of disease-modifying anti-rheumatic drugs. Different foods have anti-inflammatory and antioxidant qualities that protect against the development of rheumatoid arthritis (RA). Some dietary patterns and supplements have been shown to have potential protective benefits against RA. CONCLUSION: Improvement in the quality of life of RA patients requires a tailored management approach based on the current patient medical data.
OBJECTIVE: To evaluate safety and efficacy of dietary polyphenols in the treatment of rheumatoid arthritis (RA).
METHODS: CNKI, Pubmed, Cochrane library, Embase were searched to collect randomized controlled trials (RCTs) of dietary polyphenols in the treatment of RA. The databases were searched from the time of their establishment to November 8nd, 2022. After 2 reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies, Meta-analysis was performed using RevMan5.4 software.
RESULTS: A total of 49 records (47 RCTs) were finally included, involving 3852 participants and 15 types of dietary polyphenols (Cinnamon extract, Cranberry extract, Crocus sativus L. extract, Curcumin, Garlic extract, Ginger extract, Hesperidin, Olive oil, Pomegranate extract, Puerarin, Quercetin, Resveratrol, Sesamin, Tea polyphenols, Total glucosides of paeony). Pomegranate extract, Resveratrol, Garlic extract, Puerarin, Hesperidin, Ginger extract, Cinnamon extract, Sesamin only involve in 1 RCT. Cranberry extract, Crocus sativus L. extract, Olive oil, Quercetin, Tea polyphenols involve in 2 RCTs. Total glucosides of paeony and Curcumin involve in more than 3 RCTs. These RCTs showed that these dietary polyphenols could improve disease activity score for 28 joints (DAS28), inflammation levels or oxidative stress levels in RA. The addition of dietary polyphenols did not increase adverse events.
CONCLUSION: Dietary polyphenols may improve DAS28, reduce C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and improve oxidative stress, etc. However, more RCTs are needed to verify or modify the efficacy and safety of dietary polyphenols.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD42022315645.
CONTEXT: The impact of various dietary interventions on rheumatoid arthritis (RA), characterized by immune-inflammatory response, has been subject to increased attention.
OBJECTIVE: A systematic review was conducted to update the current knowledge on the effects of nutritional, dietary supplement, and fasting interventions on RA outcomes.
DATA SOURCES: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with prespecification of all methods, Medline and Embase were systematically searched for relevant articles.
DATA EXTRACTION: Data were extracted by 2 independent reviewers.
RESULTS: A total of 70 human studies were identified. Administration of omega-3 polyunsaturated fatty acids at high doses resulted in a reduction in RA disease activity and a lower failure rate of pharmacotherapy. Vitamin D supplementation and dietary sodium restriction were beneficial on some RA outcomes. Fasting resulted in significant but transient subjective improvements. While the Mediterranean diet demonstrated improvements in some RA disease activity measures, outcomes from vegetarian, elimination, peptide, or elemental diets suggested that responses are very individualized.
CONCLUSION: Some dietary approaches may improve RA symptoms and thus it is recommended that nutrition should be routinely addressed.
BACKGROUND: Omega-3 polyunsaturated fatty acids from oily fish (long-chain omega-3 (LCn3)), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), as well as from plants (alpha-linolenic acid (ALA)) may benefit cardiovascular health. Guidelines recommend increasing omega-3-rich foods, and sometimes supplementation, but recent trials have not confirmed this.
OBJECTIVES: To assess the effects of increased intake of fish- and plant-based omega-3 fats for all-cause mortality, cardiovascular events, adiposity and lipids.
SEARCH METHODS: We searched CENTRAL, MEDLINE and Embase to February 2019, plus ClinicalTrials.gov and World Health Organization International Clinical Trials Registry to August 2019, with no language restrictions. We handsearched systematic review references and bibliographies and contacted trial authors.
SELECTION CRITERIA: We included randomised controlled trials (RCTs) that lasted at least 12 months and compared supplementation or advice to increase LCn3 or ALA intake, or both, versus usual or lower intake.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion, extracted data and assessed validity. We performed separate random-effects meta-analysis for ALA and LCn3 interventions, and assessed dose-response relationships through meta-regression.
MAIN RESULTS: We included 86 RCTs (162,796 participants) in this review update and found that 28 were at low summary risk of bias. Trials were of 12 to 88 months' duration and included adults at varying cardiovascular risk, mainly in high-income countries. Most trials assessed LCn3 supplementation with capsules, but some used LCn3- or ALA-rich or enriched foods or dietary advice compared to placebo or usual diet. LCn3 doses ranged from 0.5 g a day to more than 5 g a day (19 RCTs gave at least 3 g LCn3 daily). Meta-analysis and sensitivity analyses suggested little or no effect of increasing LCn3 on all-cause mortality (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.93 to 1.01; 143,693 participants; 11,297 deaths in 45 RCTs; high-certainty evidence), cardiovascular mortality (RR 0.92, 95% CI 0.86 to 0.99; 117,837 participants; 5658 deaths in 29 RCTs; moderate-certainty evidence), cardiovascular events (RR 0.96, 95% CI 0.92 to 1.01; 140,482 participants; 17,619 people experienced events in 43 RCTs; high-certainty evidence), stroke (RR 1.02, 95% CI 0.94 to 1.12; 138,888 participants; 2850 strokes in 31 RCTs; moderate-certainty evidence) or arrhythmia (RR 0.99, 95% CI 0.92 to 1.06; 77,990 participants; 4586 people experienced arrhythmia in 30 RCTs; low-certainty evidence). Increasing LCn3 may slightly reduce coronary heart disease mortality (number needed to treat for an additional beneficial outcome (NNTB) 334, RR 0.90, 95% CI 0.81 to 1.00; 127,378 participants; 3598 coronary heart disease deaths in 24 RCTs, low-certainty evidence) and coronary heart disease events (NNTB 167, RR 0.91, 95% CI 0.85 to 0.97; 134,116 participants; 8791 people experienced coronary heart disease events in 32 RCTs, low-certainty evidence). Overall, effects did not differ by trial duration or LCn3 dose in pre-planned subgrouping or meta-regression. There is little evidence of effects of eating fish. Increasing ALA intake probably makes little or no difference to all-cause mortality (RR 1.01, 95% CI 0.84 to 1.20; 19,327 participants; 459 deaths in 5 RCTs, moderate-certainty evidence),cardiovascular mortality (RR 0.96, 95% CI 0.74 to 1.25; 18,619 participants; 219 cardiovascular deaths in 4 RCTs; moderate-certainty evidence), coronary heart disease mortality (RR 0.95, 95% CI 0.72 to 1.26; 18,353 participants; 193 coronary heart disease deaths in 3 RCTs; moderate-certainty evidence) and coronary heart disease events (RR 1.00, 95% CI 0.82 to 1.22; 19,061 participants; 397 coronary heart disease events in 4 RCTs; low-certainty evidence). However, increased ALA may slightly reduce risk of cardiovascular disease events (NNTB 500, RR 0.95, 95% CI 0.83 to 1.07; but RR 0.91, 95% CI 0.79 to 1.04 in RCTs at low summary risk of bias; 19,327 participants; 884 cardiovascular disease events in 5 RCTs; low-certainty evidence), and probably slightly reduces risk of arrhythmia (NNTB 91, RR 0.73, 95% CI 0.55 to 0.97; 4912 participants; 173 events in 2 RCTs; moderate-certainty evidence). Effects on stroke are unclear. Increasing LCn3 and ALA had little or no effect on serious adverse events, adiposity, lipids and blood pressure, except increasing LCn3 reduced triglycerides by ˜15% in a dose-dependent way (high-certainty evidence).
AUTHORS' CONCLUSIONS: This is the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date. Moderate- and low-certainty evidence suggests that increasing LCn3 slightly reduces risk of coronary heart disease mortality and events, and reduces serum triglycerides (evidence mainly from supplement trials). Increasing ALA slightly reduces risk of cardiovascular events and arrhythmia.
The aim was to compile the evidence from Randomized Controlled Trials (RCTs) of diet or dietary supplements used to reduce disease activity in adults with Rheumatoid Arthritis (RA). Searches were performed in the databases PubMed, Scopus and Cochrane. Only RCT studies of diets, foods or dietary supplements, looking at effects on the Disease Activity Score in 28 joints (DAS28) among adults with RA, published in peer-reviewed journals, were included. A total of 27 articles were included-three of whole diets (Mediterranean diet, raw food and anti-inflammatory diet), five of food items, five of n-3 fatty acids, five of single micronutrient supplements, four of single antioxidant supplements and five of pre-, pro- or synbiotics. Studies that showed moderate strength evidence for positive effects on disease activity in RA included interventions with a Mediterranean diet, spices (ginger powder, cinnamon powder, saffron), antioxidants (quercetin and ubiquinone), and probiotics containing Lactobacillus Casei. Other diets or supplements had either no effects or low to very low strength of evidence. In conclusion, RCT studies on diet or dietary supplements are limited in patients with RA, but based on the results in this review there is evidence that some interventions might have positive effects on DAS28.
OBJECTIVES: To summarize all good quality randomized controlled trials (RCTs) using complementary and alternative medicine (CAM) interventions in patients with rheumatic diseases.
METHODS: A systematic literature review guided by the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) was performed. We excluded non-English language articles and abstract-only publications. Due to the large number of RCTs identified, we only include "good quality" RCTs with Jadad score of five.
RESULTS: We identified 60 good quality RCTs using CAM as intervention for patients with rheumatic diseases: acupuncture (9), Ayurvedic treatment (3), homeopathic treatment (3), electricity (2), natural products (31), megavitamin therapies (8), chiropractic or osteopathic manipulation (3), and energy healing therapy (1). The studies do not seem to suggest a particular type of CAM is effective for all types for rheumatic diseases. However, some CAM interventions appear to be more effective for certain types of rheumatic diseases. Acupuncture appears to be beneficial for osteoarthritis but not rheumatoid arthritis. For the other therapeutic modalities, the evidence base either contains too few trials or contains trials with contradictory findings which preclude any definitive summary. There were only minor adverse reactions observed for CAM interventions presented.
CONCLUSION: We identified 60 good quality RCTs which were heterogenous in terms of interventions, disease, measures used to assess outcomes, and efficacy of CAM interventions. Evidence indicates that some CAM therapies may be useful for rheumatic diseases, such as acupuncture for osteoarthritis. Further research with larger sample size is required for more conclusive evidence regarding efficacy of CAM interventions.
Los pacientes con artritis suelen tomar suplementos de aceite de pescado para aliviar los síntomas, pero existen pruebas limitadas sobre su eficacia. El objetivo fue evaluar si los suplementos de aceite marino reducen el dolor y / o mejoran otros resultados clínicos en pacientes con artritis. Se registraron sistemáticamente seis bases de datos (24 de febrero de 2015). Se incluyeron ensayos aleatorios de suplementos orales de todos los aceites marinos en comparación con un control en pacientes con artritis. La validez interna se evaluó mediante la herramienta Cochrane de riesgo de sesgo y se exploró la heterogeneidad utilizando el análisis de metarregresión basado en el máximo de verosimilitud (REML) restringido. Clasificación de Recomendaciones Evaluación, Desarrollo y Evaluación (GRADE) se utilizó para calificar la calidad general de la evidencia. Cuarenta y dos ensayos se incluyeron; 30 ensayos informaron datos completos sobre el dolor. La diferencia de medias estandarizada (DME) sugirió un efecto favorable (-0,24, intervalo de confianza del 95%, IC, -0,42 a -0,07, heterogeneidad, I² = 63%, y un efecto significativo en los pacientes con artritis reumatoide (22 ensayos; 0,21; IC del 95%: -0,42 a -0,004) y otros diagnósticos mixtos (3 ensayos; -0,63; IC del 95%: -1,20 a -0,06), pero no en pacientes con osteoartritis (5 ensayos; -0,17; IC del 95% , -0.57-0.24) La evidencia para el uso de aceite marino para aliviar el dolor en pacientes con artritis fue en general de baja calidad, pero de calidad moderada en pacientes con artritis reumatoide.
El dolor es un problema importante en la artritis reumatoide (AR) y está asociado con prostaglandinas derivadas del ácido araquidónico ácido graso poliinsaturado (AGPI) ω-6. Se ha demostrado que los ω-3 PUFAs ácido eicosapentaenoico y ácido docosahexaenoico reducen la inflamación, con algunos estudios que muestran mejorías clínicas en la AR. El objetivo de esta revisión sistemática fue investigar el efecto de los PUFA ω-3 sobre el dolor artrítico. MÉTODO: Se realizó una revisión sistemática de la literatura de los AGPI ω-3 y el dolor asociado con la AR hasta diciembre de 2015. Ensayos controlados aleatorios (ECAs) que investigaban el efecto de los PUFA ω-3 (> 2 g / d) Dolor o evaluación por el paciente y el médico. Se utilizó la herramienta de la Colaboración Cochrane para evaluar el riesgo de sesgo. Los datos para los resultados de interés se extrajeron y se recopilaron para la interpretación. Resultados Se incluyeron dieciocho ECA publicados entre 1985 y 2013 con 1143 pacientes. La dosificación de los PUFA ω-3 usados fue de 2,1 a 9,1 g / d, con duraciones de estudio de 12 a 52 semanas. Diez estudios apoyaron la hipótesis de que existe una reducción en la evaluación del dolor asociado con AR por parte del paciente o del médico después de la ingesta de PUFA ω-3. Ocho estudios no encontraron ningún efecto estadísticamente significativo de ω-3 PUFAs en el dolor artrítico. CONCLUSIONES: Los AGPI ω-3 pueden tener un papel terapéutico en la disminución del dolor asociado con la AR, con dosis de 3 a 6 g / d que parecen tener un mayor efecto. Debido a las limitaciones identificadas en los ECA incluidos en esta revisión, se necesita más investigación para investigar los AGPI ω-3 en poblaciones más grandes y durante largos períodos de tiempo.
Many clinical trials of omega-3 fatty acids, supplied as fish oil supplements, have been carried out in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), lupus nephritis, and osteoarthritis (OA) over the past 3 decades. This review attempts to summarize the highlights of these studies to evaluate the clinical efficacy for omega-3 fatty acids to be added alongside existing treatment regimens. A total of 20 clinical trials have been carried out in RA, of which 16 exhibited significant improvements in multiple disease clinical outcomes. Nine clinical trials have been completed in SLE and lupus nephritis, of which 6 exhibited significant improvements in 1 or more clinical outcomes. A total of 4 clinical trials have been conducted in OA, of which 3 exhibited significant improvements in at least 1 clinical parameter. Multiple mechanisms for the clinical effects of omega-3 fatty acids have been implicated, including the modulation of eicosanoid synthesis toward a more anti-inflammatory profile and suppressed production of proinflammatory cytokines. Overall, fish oil supplements appear to be a safe and effective agent that could be added to the current treatment regimens in RA. Longer-term trials with larger patient cohort sizes are warranted to establish any long-term benefits of fish oil supplements in SLE, lupus nephritis, and OA.
ANTECEDENTES: n-3 ácidos grasos poliinsaturados derivados de Marina (AGPI) pueden tener un efecto beneficioso sobre la inflamación a través de la reducción de las concentraciones de eicosanoides proinflamatorios. El objetivo fue evaluar el efecto de los PUFA n-3 de origen marino de la prostaglandina E2 (PGE2), tromboxano B2 (TXB2) y el leucotrieno B4 (LTB4) mediante la revisión sistemática y meta-análisis de ensayos controlados aleatorios.
MÉTODO Y RESULTADOS: Una estrategia de búsqueda estructurada en PubMed, Web of Science y Cochrane hasta noviembre de 2015 representaba a cabo en este meta-análisis. Diferencia de medias estándar se utilizó para calcular el tamaño del efecto de origen marino n-3 PUFA en PGE2, TXB2 y LTB4 en un modelo de efectos aleatorios. Un total de 18 ECA con 826 sujetos fueron incluidos en esta revisión sistemática y meta-análisis. La suplementación de AGPI n-3 de origen marino se redujo significativamente las concentraciones de TXB2 en el suero / plasma en sujetos con alto riesgo de enfermedades cardiovasculares (DME: -1,26; IC del 95%: -1.65, -0.86) y LTB4 en los neutrófilos en sujetos saludables ( sujetos con enfermedades no autoinmunes crónicas o enfermedades autoinmunes) (DME: -0,59: IC del 95%: -1.02, -0.16). Los análisis de subgrupos mostró una reducción significativa de LTB4 en sujetos con artritis reumatoide (DME: -0,83; IC del 95%: -1.37, -0.29), pero no en pacientes no autoinmunes enfermedad crónica (DME: -0,33; IC del 95%: - 0,97, 0,31). Sin sesgo de publicación significativo se muestra en el meta-análisis.
Conclusiones de origen marino n-3 PUFA tuvo un efecto beneficioso en la reducción de la concentración de TXB2 en la sangre de los sujetos con alto riesgo de enfermedades cardiovasculares, así como LTB4 en los neutrófilos en sujetos saludables, y que los sujetos con AR mostró menor contenido de LTB4 con la suplementación de de origen marino n-3 PUFA.
To investigate different approaches to RA treatment that might lead to greater efficacy and better safety profiles.
METHODS:
The Search strategy was based on medical subject headings, and screening and selection were based on inclusion/exclusion criteria.
RESULTS & DISCUSSION:
Early therapy is critical for disease control and loss of bodily function. The most promising outcomes came from the development of disease-modifying anti-rheumatic drugs. Different foods have anti-inflammatory and antioxidant qualities that protect against the development of rheumatoid arthritis (RA). Some dietary patterns and supplements have been shown to have potential protective benefits against RA.
CONCLUSION:
Improvement in the quality of life of RA patients requires a tailored management approach based on the current patient medical data.