Lupus and Omega-3's

Systemic lupus erythematosus, or simply Lupus, is a chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, and inflammation in other body organs. Available treatment options for lupus have increased dramatically over the years. The treatment of Lupus should be individualized to each patient and the aim of treatment should be to: prevent flares, actively treat periods of exacerbation, minimize organ damage, and prevent complications. Current medication interventions include treatment with: nonsteroidal anti-inflammatory drugs (NSAIDs), antimalarials, corticosteroids, immunosuppressive agents, and disease-modifying antirheumatic drugs.

Given the cost of prescription medications and sometimes potential serious side effects associated with them, many patients seek alternative and complementary therapies to manage their disease. According to information from the NIH, some alternative approaches people with Lupus try include: special diets, nutritional supplements, fish oils, ointments and creams, chiropractic treatment, and homeopathy. It is thought that such alternative interventions may be associated with symptomatic benefit and help the patient cope with suffering from a chronic illness. Such alterative treatments should complement a patient’s treatment plan and should not replace regular health care and standard treatment interventions. It is important for physicians and the patients they serve to have an open dialogue about the relative risk/benefits of complementary and alternative therapies in the treatment of Lupus—this ideally allows the patient to make an informed choice about all the treatment options available to him/her.

Promising Results in Clinical Trials with Lupus

Systemic lupus erythematosus is characterized by a high level of pro-inflammatory cytokine interleukin 1 (IL-1) and pro-inflammatory leukotriene (LTB4).   These two pro-inflammatory agents are largely derived from Omega-6 fatty acids.  While Omega-3s perform anti-inflammatory activities in the body, Omega-6s, on the other hand, largely have  the opposite effect, firing up the immune system and provoking a pro-inflammatory response.

There are several small double blind placebo-controlled studies (see reference section) that show supplementation with Omega-3 fatty acids yield therapeutic effects for those suffering from systemic lupus erythematosus (SLE).  In one small double-blind cross over study, SLE patients taking Omega-3 fatty acids reported statistically significant improvements compared to placebo.  In fact, 83% of patients taking Omega-3 reported improvement vs. only 24% taking placebo. In another study by Duffy et al (2004) examining the medical management of SLE, dietary supplementation with Omega 3 fish oil was found to be beneficial in modifying symptomatic disease activity in SLE.

References

Clark WF, Parbtani A, Huff MW, Reid B, Holub BJ, Falardeau P. Omega-3 fatty acid dietary supplementation in systemic lupus erythematosus. Kidney Int 1989;36:653-60.

Clark WF, Parbtani A, Naylor CD, et al. Fish oil in lupus nephritis: clinical findings and methodological implications. Kidney Int 1993;44:75-86.

Das UN. Beneficial effect of eicosapentaenoic acid and docosahexaenoic acids in the management of systemic lupus erythematosus and its relationship to the cytokine network.
Prostaglandins Leukot Essent Fatty Acids 1994;51:207-13.

Duffy EM, Meenagh GK, McMillan SA, Strain JJ, Hannigan BM, Bell AL. The clinical effect of dietary supplementation with omega-3 fish oils and/or copper in systemic lupus erythematosus. J Rheumatol. 2004 Aug;31(8):1551-6.

Fortin P, Lew R, Liang M, et al. Validation of a meta-analysis: The effects of fish oil in rheumatoid arthritis. J Clin Epidemiol 1995;

Innis S. Essential dietary lipids. In: Ziegler EE, Filer, LJ Jr, editors. Present knowledge in nutrition. Washington, DC: International Life Sciences Institute; 1996.

MacLean CH, Mojica WA, Morton SC, Pencharz J, Hasenfeld Garland R, Tu W, Newberry SJ, Jungvig LK, Grossman J, Khanna P, Rhodes S, Shekelle P. Effects of Omega-3 Fatty Acids on Lipids and Glycemic Control in Type II Diabetes and the Metabolic Syndrome and on Inflammatory Bowel Disease, Rheumatoid Arthritis, Renal Disease, Systemic Lupus Erythematosus, and Osteoporosis. Evidence Report/Technology Assessment No. 89 (Prepared by Southern California/RAND Evidence-based Practice Center under Contract No. 290-02-0003). AHRQ Publication No. 04-E012-2. Rockville, MD: Agency for Healthcare Research and Quality. March 2004.

Minami Y, Sasaki T, Komatsu S, et al. Female systemic lupus erythematosus in Miyagi prefecture, Japan: A case-control study of dietary and reproductive factors. Tohoku J Exp Med 1993;169:245-52.

Mohan JK, Das UN. Oxidant stress, anti-oxidants and essential fatty acids in systemic lupus erythematosus. Prost Leukot Essent Fatty Acids 1997;56:193-8.

Walton AJE, Snaith ML, Locniskar M, Cumberland AG, Morrow WJW, Isenberg DA. Dietary fish oil and the severity of symptoms in patients with systemic lupus erythematosus. Ann Rheum Dis 1991;50:463-6.