The role of fish oils in the treatment of rheumatoid arthritis
The role of fish oils in the treatment of rheumatoid arthritis
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DOI：
10.2165/00003495-200363090-00001
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发表时间：
2003-01-01
期刊：
影响因子：
11.5
通讯作者：
Proudman, SM
中科院分区：
文献类型：
--
作者：
Cleland, LG;James, MJ;Proudman, SM
鱼油是ω-3长链多不饱和脂肪酸（n-3 LC PUFA）的丰富来源。特定的脂肪酸二十碳五烯酸和二十二碳六烯酸是n-6脂肪酸花生四烯酸（AA）的同系物。这种化学作用提供了n-3 LC PUFA对AA代谢为促炎和促血栓形成n-6类二十烷酸的拮抗作用，以及产生活性较低的n-3类二十烷酸。此外，n-3 LC PUFA可抑制促炎细胞因子和软骨降解酶的产生。根据生化效应，膳食鱼油的有益抗炎作用已在类风湿关节炎（RA）的随机、双盲、安慰剂对照试验中得到证实。此外，鱼油对闭塞性心血管疾病具有保护性临床作用，RA患者的风险增加。临床使用抗炎鱼油剂量的实施情况一直很差。由于鱼油没有为工业界提供与专利处方项目相关的大量利润的机会，它们没有得到支持采用常规药物疗法的营销投入。因此，许多开处方的人仍然不知道它们的生物化学、治疗效果、配方、应用原理和补充性饮食改变。有证据表明，这种方法可以实现使用散装鱼油增加摄取。这种方法在RA患者中的使用具有良好的依从性。此外，一个指数的n-3营养可以用来提供有用的反馈信息给患者，并监测实现的目标levels.Collectively，这些问题突出了挑战，在推进使用鱼油中的复杂性，现代管理的RA，其重点是联合化疗早期应用。
Fish oils are a rich source of omega-3 long chain polyunsaturated fatty acids (n-3 LC PUFA). The specific fatty acids, eicosapentaenoic acid and docosahexaenoic acid, are homologues of the n-6 fatty acid, arachidonic acid (AA). This chemistry provides for antagonism by n-3 LC PUFA of AA metabolism to pro-inflammatory and pro-thrombotic n-6 eicosanoids, as well as production of less active n-3 eicosanoids. In addition, n-3 LC PUFA can suppress production of pro-inflammatory cytokines and cartilage degradative enzymes.In accordance with the biochemical effects, beneficial anti-inflammatory effects of dietary fish oils have been demonstrated in randomised, double-blind, placebo-controlled trials in rheumatoid arthritis (RA). Also, fish oils have protective clinical effects in occlusive cardiovascular disease, for which patients with RA are at increased risk.Implementation of the clinical use of anti-inflammatory fish oil doses has been poor. Since fish oils do not provide industry with the opportunities for substantial profit associated with patented prescription items, they have not received the marketing inputs that underpin the adoption of usual pharmacotherapies. Accordingly, many prescribers remain ignorant of their biochemistry, therapeutic effects, formulations, principles of application and complementary dietary modifications. Evidence is presented that increased uptake of this approach can be achieved using bulk fish oils. This approach has been used with good compliance in RA patients. In addition, an index of n-3 nutrition can be used to provide helpful feedback messages to patients and to monitor the attainment of target levels.Collectively, these issues highlight the challenges in advancing the use of fish oil amid the complexities of modern management of RA, with its emphasis on combination chemotherapy applied early.