Session 3: Joint Nutrition Society and Irish Nutrition and Dietetic Institute Symposium on 'Nutrition and autoimmune disease' PUFA, inflammatory processes and rheumatoid arthritis
Session 3: Joint Nutrition Society and Irish Nutrition and Dietetic Institute Symposium on 'Nutrition and autoimmune disease' PUFA, inflammatory processes and rheumatoid arthritis
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DOI：
10.1017/s0029665108008690
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发表时间：
2008-11-01
影响因子：
7
通讯作者：
Calder, Philip C.
中科院分区：
文献类型：
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作者：
Calder, Philip C.
类风湿性关节炎（RA）是一种慢性炎症性自身免疫性疾病，主要表现为关节肿胀、疼痛、骨质侵蚀和功能障碍。关节病变的特征在于T淋巴细胞、巨噬细胞和B淋巴细胞浸润到滑膜中，以及涉及类花生酸、细胞因子和基质金属蛋白酶的滑膜炎症。关于炎症过程，主要的脂肪酸是n-6 PUFA花生四烯酸，其是炎症性类花生酸如PCEZ和白三烯134的前体，以及n-3 PUFA EPA和DHA，其存在于油性鱼和鱼油中。衍生自n-6 PUFA花生四烯酸的类花生酸在RA中起作用，并且非甾体抗炎药在RA中的功效表明花生四烯酸的促炎性环氧合酶途径产物在疾病的病理生理学中的重要性。EPA和DHA抑制花生四烯酸代谢为炎性类花生酸。EPA还产生比由花生四烯酸产生的那些炎症更小的类二十烷酸介质，并且EPA和DHA都产生抗炎和炎症消退的消退素。除了改变脂质介质概况，n-3 PUFA对与RA相关的免疫的其他方面发挥作用，例如抗原呈递、T细胞反应性和炎性细胞因子产生。鱼油已被证明可以减缓动物模型中关节炎的发展，并降低疾病的严重程度。随机临床试验已经证明了RA患者的一系列临床益处，包括减轻疼痛，晨僵持续时间和使用非甾体抗炎药。
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease manifested by swollen and painful joints, bone erosion and functional impairment. The joint lesions are characterised by infiltration of T lymphocytes, macrophages and B lymphocytes into the synovium and by synovial inflammation involving eicosanoids, cytokines and matrix metalloproteinases. In relation to inflammatory processes, the main fatty acids of interest are the n-6 PUFA arachidonic acid, which is the precursor of inflammatory eicosanoids such as PCEZ and leukotriene 134, and the n-3 PUFA EPA and DHA, which are found in oily fish and fish oils. Eicosanoids derived from the n-6 PUFA arachidonic acid play a role in RA, and the efficacy of non-steroidal anti-inflammatory drugs in RA indicates the importance of pro-inflammatory cyclooxygenase pathway products of arachidonic acid in the pathophysiology of the disease. EPA and DHA inhibit arachidonic acid metabolism to inflammatory eicosanoids. EPA also gives rise to eicosanoid mediators that are less inflammatory than those produced from arachidonic acid and both EPA and DHA give rise to resolvins that are anti-inflammatory and inflammation resolving. In addition to modifying the lipid mediator profile, n-3 PUFA exert effects on other aspects of immunity relevant to RA such as antigen presentation, T-cell reactivity and inflammatory cytokine production. Fish oil has been shown to slow the development of arthritis in an animal model and to reduce disease severity. Randomised clinical trials have demonstrated a range of clinical benefits in patients with RA that include reducing pain, duration of morning stiffness and use of non-steroidal anti-inflammatory drugs.