[Role of omega-3 polyunsaturated fatty acids in diet of patients with rheumatic diseases]

Omega-3 fatty acids in juvenile idiopathic arthritis: effect on cytokines (IL-1 and TNF-α), disease activity and response criteria

This study aims to demonstrate the effect of omega-3 fatty acids (ω-3 FAs) supplements on the clinical manifestations, laboratory investigations, disease activity, functional capacity, response criteria as well as interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α) levels in juvenile idiopathic arthritis (JIA) patients. Twenty-seven JIA patients were included in this study. Dietary supplements of ω-3 FAs 2 g/day were given for 12 weeks. Juvenile arthritis disease activity score in 27 joints (JADAS-27) and pediatric American College of Rheumatology (ACR) response criteria were determined. Childhood Health Assessment Questionnaire (CHAQ) was used to measure the functional status. Assessment of serum IL-1 and TNF-α level was performed using enzyme-linked immunosorbent assay. The mean age of the patients was 12.78 ± 3.26 years, the disease duration was 5.93 ± 3.06 years, and the age at disease onset was 6.78 ± 3.26 years. The TNF-α and IL-1 were significantly higher in the JIA patients compared to the control. There was a significant improvement of active joint count, number of swollen joints, JADAS-27, CHAQ, TNF-α, and IL-1 levels. The pediatric ACR response criteria improved in 92.59% of the patients. The daily requirements of nonsteroidal anti-inflammatory drugs (NSAIDs) obviously decreased. ω-3 FAs supplements reduce the inflammatory response and improve the clinical manifestation in JIA patient. The daily intake of NSAID dose decreased thus reducing the risk of related side effects. Our results support the use of omega-3 fatty acids as an add-on therapy to conventional treatment of JIA.

Can vagus nerve stimulation halt or ameliorate rheumatoid arthritis and lupus?

Acetylcholine, the principal vagus neurotransmitter, inhibits inflammation by suppressing the production of pro-inflammatory cytokines through a mechanism dependent on the α7 nicotinic acetylcholine receptor subunit (alpha7nAChR) that explains why vagus nerve stimulation is anti-inflammatory in nature. Strong expression of alpha7nAChR in the synovium of rheumatoid arthritis and psoriatic arthritis patients was detected. Peripheral macrophages and synovial fibroblasts respond in vitro to specific alpha7nAChR cholinergic stimulation with potent inhibition of proinflammatory cytokines. Fibroblasts balance inflammatory mechanisms and arthritis development through feedback cholinergic stimulation by nearby immune cells. Collagen induced arthritis in alpha7nAChR^(-/-) mice was significantly severe and showed increased synovial inflammation and joint destruction compared to the wild-type mice. Similar to vagal nerve stimulation and alpha7nAChR agonists, polyunsaturated fatty acids: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) also suppress inflammation. In view of their similar anti-inflammatory actions, it is proposed that vagal nerve stimulation, alpha7nAChR agonists and EPA and DHA may augment the formation of anti-inflammatory lipid molecules: lipoxins, resolvins, protectins and maresins. This implies that therapies directed at regulation of the cholinergic and alpha7nAChR mediated mechanisms and enhancing the formation of lipoxins, resolvins, protectins and maresins may halt and/or ameliorate rheumatoid arthritis, lupus and other rheumatological conditions.