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Rheumatoid Arthritis

Rheumatoid Arthritis Awareness Week: The Benefits of Fish Oil

Rheumatoid Arthritis and the Benefits of Fish Oil

June 13th marks the beginning of Rheumatoid Arthritis Awareness Week, a campaign run by the National Rheumatoid Arthritis Society. One of the main goals of the campaign is to heighten awareness of the early warning symptoms of this condition, and to support those who have been recently diagnosed.

Many people do not recognise the early warning signs of rheumatoid arthritis. This is because the symptoms can be blamed on ‘overdoing things’. By recognising the three key symptoms – swelling, stiffness and fatigue – sufferers can take early action to seek help and find the right treatment. Because the disease is progressive, if sufferers are able to recognise and address the condition early, they are more likely to find treatment effective.

What is Rheumatoid Arthritis?

Rheumatoid arthritis is an autoimmune disease. Normally the body’s immune system produces an inflammatory response as part of the healing process. If a joint is injured, special chemicals are released that cause short-term pain and swelling, immobilising the joint to give it opportunity to heal. However, sometimes this process can go awry and the immune system creates long-term chronic, painful inflammation that damages the joint tissues.

How is it Treated?

Medications for rheumatoid arthritis tend to work by suppressing inflammation. Examples are corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying anti-inflammatory drugs (DMARDs).

However, recent studies have also highlighted the success of natural agents in modifying the inflammatory response. One of the most promising natural supplements linked to treatment of rheumatoid arthritis is fish oil.

The Benefits of Fish Oil

A study published just last year tested the effects of fish oil versus placebo on 144 patients with recent onset rheumatoid arthritis. Most of the patients were women in their 50s, and were already taking conventional arthritis medication. The group was given either placebo capsules or supplements of high-dose fish oil (5.5g per day).

Those taking the fish oil showed greater improvement in daily function in the first three months. After a year, the women given the high dose fish oil showed double the rate of remission compared with those on placebo.

It makes sense that fish oil should relieve inflammatory diseases such as rheumatoid arthritis. Fish oil is a rich source of the omega-3 fatty acids, EPA and DHA. The body uses both omega-3 and omega-6 fatty acids to make chemicals called prostaglandins and leukotrienes. The right balance of these chemicals help to control inflammation, and EPA and DHA promote the anti-inflammatory chemicals.

These omega-3 fatty acids actually have a similar action to medications used in rheumatoid arthritis: they help to block production of several inflammatory chemicals involved in arthritis, including prostaglandin E2 and leukotriene B4, and peptide mediators, tumor necrosis factor (TNF)α and IL-1β (2).

Plant foods such as flaxseed and hempseed are sources are a type of omega-3 fat called ALA. However, the long chain omega-3 fats used in this study are only found in fish and seafood, such as salmon, herring and mackerel, and in algal oil which represents a vegan source.

The study authors concluded that fish oil led to ‘increased rates of remission and decreased drug use’ in those with recent onset rheumatoid arthritis. This study certainly indicates that fish oil supplementation would be a sensible supplement to consider for anyone recently diagnosed with rheumatoid arthritis.

References
1. Proudman Sm et al (2015) Fish oil in recent onset rheumatoid arthritis: a randomised, double-blind controlled trial within algorithm-based drug use. Ann Rheum Dis 2015;74:89-95
2. Proudman SM et al (2008) Dietary omega-3 fats for treatment of inflammatory joint disease: efficacy and utility. Rheum Dis Clin North Am. 34:469–79.

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Can rosehip be useful for sufferers of osteoarthritis and rheumatoid arthritis?


Rheumatoid arthritis is an autoimmune disease; a disease when, for unknown reasons, the body starts to attack itself.  In Rheumatoid arthritis the attack occurs on the membranes (synovial membranes) of a joint which becomes chronically inflamed – this can cause pain, swelling, morning stiffness, muscle wasting and osteoporosis.  Eventually bone and cartilage is damaged.  Rheumatoid arthritis can affect several joints and commonly occurs in people aged between 30 and 50.  The condition is three times more common in women than men and seems to run in families. Conventional treatment centres around pain relief and reduction of inflammation, most commonly with drugs called NSAIDs, Non steroidal anti-inflammatory drugs.



Osteoarthritis is the most common type of arthritis.  The disease occurs due to the gradual degeneration of the cartilage which lines the joints.  This causes pain, swelling and restricted movement.  The condition most commonly affects weight bearing joints such as the hips and knees but may also attack the joints in the hands and feet.  Women are twice as likely as men to be affected and the most common form of treatment are NSAIDs, non-steroidal anti-inflammatory drugs, to relieve pain and reduce swelling/inflammation.



Arthritis Care is an organisation there to help people with all forms of arthritis – please visit their website for further information.



Recently I was made aware that rose hip could be beneficial to individuals suffering with arthritis.  Rosehips are a particularly rich source of vitamin C and antioxidant flavonoids (plant chemicals).  Research seems to suggest that standardised rose-hip powder made from the seeds and husks of fruit from a wild variety of English rose-hip, called Rosa canina, may be helpful in reducing inflammation and hence be useful in rheumatoid- and also osteo- arthritis.



Laboratory cell studies (1,2,3,4) first indicated that rosehip may have anti-inflammatory properties and more recently studies using rosehip as a dietary supplement have found that it may be useful for those suffering from rheumatoid (5,6) and osteoarthritis (7,8,9,10)



A recently published study (5) was carried out to investigate if a rose-hip (Rosa canina) supplement could reduce symptoms in patients with rheumatoid arthritis.   The study was well designed and patients received treatment with 5g capsulated rose-hip powder 5g daily or matching placebo for 6 months.  After 6 months those receiving the rosehip had an improved score according to a recognised Health Assessment Questionnaire whereas the placebo group actually had a worsened score after 6 months.  There was also indication that physical scores were improved with rosehip supplementation. The authors of the study conclude that their results indicate that patients with rheumatoid arthritis may benefit from additional treatment with rose hip powder.  An earlier study (6) found that 5g of rosehip daily seemed to reduce joint tenderness and increase quality of life in patients with rheumatoid arthritis.  Both of these studies are preliminary and further research trials would be necessary before a firm conclusion can be drawn, but the evidence adds to previous research indicating that antioxidants and flavonoids are useful in rheumatoid arthritis 



An analysis(8) of different studies looking at the potential use of rosehip for the treatment of osteoarthritis found that supplementation with rosehip may be useful in pain reduction when compared to placebo.  The results indicated that rosehip may be more effective than paracetamol in reducing pain in osteoarthritis sufferers.  The authors of the study call for larger, long-term clinical trials.



The amount of rosehip used in studies has been around 5g daily.  Supplements made from powdered rosehip are easy to find.  More evidence is needed before firm recommendations for the use of rosehip in arthritis can be made however, you may wish to discuss the use of such a supplement with your health professional.  Please read the posts linked at the start of this piece for more interesting information on nutrients that may be useful in the treatment of osteoarthritis and rheumatoid arthritis.


 


(1)Larsen E.  Et al.  2003.  An antiinflammatory galactolipid from rose hip (Rosa canina) that inhibits chemotaxis of human peripheral blood neutrophils in vitro. J Nat Prod.  66: 994–995.
(2)Winther K. Et al.  1999.  The anti-inflammatory properties of rose-hip. Inflammopharmacology.7: 63–68.
(3)Kharazmi A & Winther K.  1999.  Rose hip inhibits chemotaxis and chemiluminescence of human peripheral blood neutrophils in vitro and reduces certain inflammatory parameters in vivo. Inflammopharmacology. 7: 377–386.
(4)Schwager J et al.  2008.  Anti-inflammatory and chondro-protective effects of rose hip powder and its constituent galactolipids GOPO. Poster presentation at the World Congress of Osteoarthritis (OARSI), Rome, 18–21 September 2008.
(5) Willich SN et al.  2010.  Rose hip herbal remedy in patients with rheumatoid arthritis – a randomised controlled trial. Phytomedicine. 17(2):87-93.
(6) Rossnagel K et al.  2007.  Can patients with rheumatoid arthritis benefit from the herbal remedy rose-hip? : a randomised, double-blind, placebo-controlled clinical trial January-June 2007. Rheum Dis.  66 (Suppl II): 603.
(7) Chrubasik C et al.  2008.  A one-year survey on the use of a powder from Rosa canina lito in acute exacerbations of chronic pain. Phytother Res. 22(9):1141-8.
(8) Christensen R et al.  2008.  Does the hip powder of Rosa canina (rosehip) reduce pain in osteoarthritis patients?–a meta-analysis of randomized controlled trials.  Osteoarthritis Cartilage.  16(9):965-72
(9) Chrubasik C et al.  2008.  A systematic review on the Rosa canina effect and efficacy profiles. Phytother Res. 22(6):725-33.
(10) Winther K et al.  2005.  A powder made from seeds and shells of a rose-hip subspecies (Rosa canina) reduces symptoms of knee and hip osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial. Scand J Rheumatol. 34(4):302-8.



Written by Ani Kowal

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