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.
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.
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.
OBJECTIVES: Rheumatoid arthritis (RA) is a chronic, autoimmune inflammatory disease of multiple joints that puts the patient at high risk for developing cardiovascular diseases (CVDs). The aim of the present study was to conduct an up-to-date systematic review and meta-analysis of published randomized controlled trials (RCTs) to assess potential changes in RA disease activity, inflammation, and CVD risk after oral intake of ω-3 polyunsaturated fatty acids.
METHODS: Publications up to July 31, 2016 were examined using the PubMed, SCOPUS, and EMBASE databases.
INCLUSION CRITERIA: English language; human subjects; both sexes; RCTs; oral intake of ω-3 fatty acids; minimum duration of 3 mo; and no medication change throughout intervention. The Cochrane Risk of Bias tool was used to assess quality of trials. We included 20 RCTs, involving 717 patients with RA in the intervention group and 535 RA patients in the control group.
RESULTS: Despite the evidence of overall low quality of trials, consumption of ω-3 fatty acids was found to significantly improve eight disease-activity-related markers. Regarding inflammation, only leukotriene B4 was reduced (five trials, standardized mean difference [SMD], -0.440; 95% confidence interval [CI], -0.676 to -0.205; I(2) = 46.5%; P < 0.001). A significant amelioration was found for blood triacylglycerol levels (three trials, SMD, -0.316; 95% CI, -0.561 to -0.070; I(2) = 0.0%; P = 0.012).
CONCLUSION: The beneficial properties of ω-3 polyunsaturated fatty acids on RA disease activity confirm the results of previous meta-analyses. Among five proinflammatory markers evaluated, only leukotriene B4 was found to be reduced. However, a positive effect on blood lipid profile of patients with RA was evident, perhaps for the first time.
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.
Se piensa que los beneficios de los fármacos antiinflamatorios no esteroides orales (AINE) en los ensayos clínicos pueden estar relacionados con los diseños de llamaradas. El objetivo de este estudio fue examinar la diferencia en la respuesta de los AINE (incluyendo inhibidores de la ciclooxigenasa-2 (COX-2)) en los ensayos de osteoartritis (OA) basados en diferentes diseños. MÉTODOS: Se realizó una revisión sistemática de las bases de datos MEDLINE, EMBASE, AMED, CINAHL y la biblioteca Cochrane hasta febrero de 2015. Los ensayos controlados aleatorios que evaluaban el dolor, la función y / o la rigidez después del inicio de los AINE en diseños de bengalas y no inflamables eran elegibles. Los ensayos se evaluaron mediante la herramienta Cochrane de riesgo de sesgo. Se realizaron metaanálisis para evaluar el tamaño de los efectos (AE) de los AINE para OA con diseños de ensayos de bengalas en comparación con diseños de ensayos no inflamables. RESULTADOS: Cincuenta y siete estudios, incluidos 33 263 participantes que evaluaron 26 AINE fueron incluidos. Veintidós (39%) fueron diseño de llamaradas, 24 (42%) eran diseños sin llamaradas, 11 (19%) eran diseños de llamaradas. En el metanálisis, no hubo diferencias estadísticamente significativas en la ES de los AINE versus placebo entre los diseños de ensayos de flare y non-flare para el dolor absoluto y la función o rigidez a corto plazo (1 semana), a corto plazo (2-4 semanas) O períodos de seguimiento a largo plazo (12-13 semanas) (p> 0,05). Sin embargo, hubo un ES más bajo para el cambio medio en el dolor en la llamarada y los posibles ensayos de llamarada en comparación con los ensayos sin brote en el seguimiento a corto plazo (0,36 vs 0,69; p = 0,05). CONCLUSIONES: Contrariamente a la comprensión anterior, los diseños de ensayos de bengalas no resultan en un mayor efecto de tratamiento para los AINEs en personas con OA en comparación con el diseño sin llamarada. Si el diseño de la llamarada influye en otros resultados como la efusión conjunta sigue siendo desconocido.
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.
