A Case For Omega-3 FA Consumption to Prevent RA

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The impact of omega-3 fatty acids (FA) on systemic inflammatory responses has been demonstrated in a number of dietary and epidemiologic studies. A recent editorial in Joint Bone Spine by Olfa Saidane1 and colleagues suggests a prophylactic role of Omega-3 FAs in the possible prevention of inflammatory diseases such as rheumatoid arthritis (RA).

Omega-3 FAs are believed to modulate inflammatory processes via a number of mechanisms, including decreased expression of adhesion molecules, suppressed leukocyte responses and by triggering release of lipid mediators, among other effects.

Plasma levels of components of omega-3 FA have also been suggested as potential biomarkers for RA outcomes. A 2015 study by Proudman et al2 showed improved remission rates and decreased use of disease-modifying anti-rheumatic drug (DMARD) therapies in RA patients taking fish oil supplements, and specifically that a single unit increase in eicosapentaenoic acid (EPA) equivalent to 1% of total fatty acids projected a 12% greater chance of remission.

PROTECTION AGAINST DEVELOPMENT OF RA

The Saidane review discussed several studies in which omega-3 FA levels were inversely associated with the presence of auto-antibodies suggestive of a higher risk for RA. And, while some large scale observational studies detected a protective effect of fatty fish consumption, other case control trials were inconclusive. Saidane and colleagues pointed out that actual benefits may have been muted in these studies as the Scandinavian populations used were much more likely to consume fatty fish than other populations. When a large US cohort was evaluated, a far more striking effect was reported, whereby “even moderate fish consumption was associated with a decreased risk of RA,” they wrote.

While the current studies cannot establish a clear preventive effect, the Saidane editorial concludes that the evidence provides sufficient rationale for interventional trials on the impact of Omega-3 FA supplementation on outcomes in individuals at high risk of developing RA.

REFERENCES:

Saidane O, Semerano L, Sellam J. Could omega-3 fatty acids prevent rheumatoid arthritis? Joint Bone Spine 2019 Jan;86(1):9-12. doi: 10.1016/j.jbspin.2018.05.007. Epub 2018 Jun 5.

Proudman SM, James MJ, Spargo LD, et al. Plasma n-3 fatty acids and clinical outcomes in recent-onset rheumatoid arthritis. Br J Nutr 2015 Sep 28;114(6):885-90. doi: 10.1017/S0007114515002718. Epub 2015 Aug 18.