Fish oil and rheumatoid arthritis: does a herring a day keep rheumatologists away?

In Vitro Transcutaneous Delivery of Ketoprofen and Essential Polyunsaturated Fatty Acids from a Fish Oil Vehicle Incorporating 1,8-Cineole

Transcutaneous administration of nonsteroidal anti-inflammatory drugs and essential fatty acids from fish oil, principally eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), may simultaneously lead to increased cyclooxygenase inhibition and the production of less potent inflammatory mediators within joints. The objective of our study was to determine the permeation of ketoprofen, EPA, and DHA (from fish oil) across pig ear skin in vitro in the presence of the enhancer 1,8-cineole. Formulations containing 2.5% ketoprofen in fish oil with varying concentrations of 1,8-cineole were prepared and applied to full-thickness pig ear skin mounted in all glass Franz-type diffusion cells. Simultaneous permeation of ketoprofen and EPA and DHA from these formulations was determined by reverse phase HPLC over a 48-hr period (n = 6). We found that fish oil alone enhanced the permeation of ketoprofen across pig ear by a factor of 1.72 relative to a water vehicle. There was a dose-dependent increase in the rate of permeation of ketoprofen relative to the concentration of 1,8-cineole. The highest Q24 and Q48 was obtained with a 20% 1,8-cineole formulation with values of 355.78 +/- 50.73 microg cm(-2) and 963.29 +/- 136.69 microg cm(-2), respectively. Surprisingly, no clear effect upon the permeation of EPA and DHA by 1,8-cineole was observed, with the highest Q24 and Q48 values seen in a formulation containing no 1,8-cineole. This may have been due to differential solvation effects prior to or during the permeation process or modulation of the skin during the permeation process.

The in vitro delivery of NSAIDs across skin was in proportion to the delivery of essential fatty acids in the vehicle--evidence that solutes permeate skin associated with their solvation cages?

As part of our investigations into novel dual action topical anti-arthritis systems, the permeation of ibuprofen or ketoprofen plus eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were determined from a fish oil vehicle across pig ear skin in vitro. The steady state fluxes of ibuprofen and ketoprofen were 9.17+/-1.98 microgram cm(-2)h(-1) and 6.12+/-2.39 microgram cm(-2)h(-1), respectively. At 24h, 5.7 microgram cm(-2) EPA and 3.1 microgram cm(-2) DHA permeated when the solute was ibuprofen; 1.4 microgram cm(-2) EPA and 1.0 microgram cm(-2) DHA when ketoprofen was the solute. At 12h, the ketoprofen/ibuprofen ratio of the moles permeated was 0.27, the ratio of EPA permeated simultaneously with ketoprofen and ibuprofen was 0.22 and the ratio of DHA permeated simultaneously with ketoprofen and ibuprofen was 0.24. We believe this is the first time that simultaneous permeation across skin of a solute and its vehicle has been determined purposefully. The data successfully demonstrated that simultaneous permeation of NSAIDs and essential fatty acids, EPA and DHA from a formulation containing fish oil is feasible. In addition, for both NSAIDs, the relative rates of permeation of EPA and DHA, were in proportion to their levels in the fish oil and the permeation rate of either fatty acid was higher when the permeation rate of the solute was greater. This suggested that the greater the rate of permeation of the NSAID, the greater the rate of permeation of the vehicle, and that a solute permeates skin complete with its vehicular solvation cage. This apparent relationship between solute and vehicle fluxes may be of more widespread significance to skin permeation experimentation.

The effects of dietary supplementation with n-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: a randomized, double blind trial

STUDY OBJECTIVE

To determine the effect of dietary supplementation with n-3 polyunsaturated fatty acids (n-3 PUFA) on disease variables in patients with rheumatoid arthritis.

DESIGN

Multicenter, randomized, placebo controlled, double blind.

SETTING

Three Danish hospital Departments of Rheumatology.

PATIENTS

Fifty-one patients with active rheumatoid arthritis.

INTERVENTION

Random allocation to 12 weeks of treatment with either six n-3 PUFA capsules (3.6 g) or six capsules with fat composition as the average Danish diet.

MAIN RESULTS

Significant improvement of morning stiffness and joint tenderness. No significant effect on the four other assessed clinical parameters. No serious side effects.

CONCLUSIONS

Dietary supplementation with n-3 PUFA in patients with rheumatoid arthritis improved two out of six patient reported disease parameters. Further studies are needed to clarify the more precise role of n-3 PUFA in the treatment of rheumatoid arthritis.

Dietary fish oil and rheumatic diseases

Dietary fish oil supplementation can induce several metabolic changes relevant to rheumatic diseases. Both experimental and clinical evidence show that dietary fish oil supplementation modulates inflammatory and immune responses. Many studies have shown beneficial, albeit modest, effects in the treatment of rheumatoid arthritis. Studies in murine models of systemic lupus erythematosus have been encouraging, but few studies have been performed to assess the effects of dietary fish oil in the human disease or in other systemic rheumatic diseases. Further study on the efficacy of dietary fish oil supplementation in the treatment of specific rheumatic diseases is warranted.