Omega Fatty Acid Profile is Associated with Disease Activity in Patients with Rheumatoid Arthritis

by | Sep 19, 2022 | Arthritis, Autoimmune Disease, Joint Health, Omega - 3

Written by Chrystal Moulton, Staff Writer. High serum omega-3 fatty acid pattern was associated with low C-reactive protein (CRP) levels, less high disease activity (DAS28 > 5.1), and less corticosteroid treatment.

rheumatoid arthritis - joint healtRheumatoid arthritis (RA) is an autoimmune disease characterized by inflammation of the joints and production of antibodies such as rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPAs). Risk factors for rheumatoid arthritis includes genetics along with environmental factors such as smoking and silica exposure1,2. Omega- 3 and Omega- 6 polyunsaturated fatty acids have been scientifically shown to alter inflammatory responses and immune homeostasis3. However, these fatty acids are best taken through the diet4. Research has shown that dietary intake of omega-3 fatty acids is inversely associated with the incidence of rheumatoid arthritis5. However few studies have directly measured polyunsaturated fatty acid levels in patients with rheumatoid arthritis (RA) or early onset rheumatoid arthritis (RA) to determine prognosis and disease features long term. In the current trial1 [1], researchers used data from an epidemiological study to determine long term RA disease evolution in patients based on their fatty acid profile. They have hypothesized that patients with RA will have differences in prognosis depending on their fatty acid status.

Data was gathered from patients in the ESPOIR cohort study6. The ESPOIR cohort was a longitudinal cohort multicentric study based in France. Patients from 14 different rheumatology centers between the age of 18 and 70 years old with confirmed or suspected RA were enrolled in the cohort. A total of 813 patients were included in the cohort and followed for 15 years. In this trial, data was analyzed for 669 of those 813 patients. This subset of individuals had early arthritis and fulfilled the 2010 ACR/ EULAR criteria at enrollment or during the first two years of follow up. Patient underwent fasting blood draw at baseline along with other clinical, biological, and radiological data collection every six months during the first year and yearly thereafter for 15 years. Patients were categorized into three groups based on fatty acid pattern [i.e. omega-3, Omega 6, Omega 7- 9]. Using statistical analysis researchers compared disease activity at baseline and at six months between each group and calculated the association between specific fatty acid patterns and RA progression.

At inclusion, 57.6% of patients where rheumatoid factor (RF) positive and 47.1% of patients or anti-citrullinated peptide antibody (ACPA) positive. Participants were mostly Caucasian and female. The mean disease activity score (DAS28) was 5.2 indicating high disease activity with 15% of patients showing erosion of the joints. At baseline, only 52 patients were being treated with conventional disease-modifying anti-rheumatic drugs or cDMARDs. At 6 months, 78% of patients were taking either conventional or biologic disease-modifying anti-rheumatic drugs (cDMARDs or bDMARDs). At baseline, high serum omega-3 fatty acid profile was associated with low C-reactive protein (CRP) levels, less high disease activity (DAS28 > 5.1), and less corticosteroid treatment. High serum omega-6 fatty acid profile was associated with increased BMI, ACPA positivity, high C-reactive protein (CRP) level and disease activity, erosive disease, low educational level, and smoking. High serum omega 7- 9 fatty acid pattern was associated with Caucasian ethnicity, smoking, and high BMI. In multivariate analysis of high pattern omega-3 fatty acid profile with baseline disease activity, data showed that high omega-3 fatty acid scores were associated with reduced odds of increased disease activity. However, when CRP levels were included in the analysis, no association was observed. Multivariate analysis at six months showed that both omega-3 and omega-6 were associated with reduced odds of high disease activity even after including CRP levels in the model.

Overall, high serum omega-3 fatty acids were associated with lower disease activity and inflammation at baseline and 6 months follow-up. Serum omega 7-9 was not associated with disease activity at baseline or 6-month follow-up. High serum omega-6 fatty acids were associated with increased disease activity and inflammation at baseline but reduced odds of increased disease activity at 6 months. Researchers proposed the contradictory result of omega-6 may be explained by gamma – linoleic acid (an omega-6 fatty acid with anti-inflammatory properties)7. Further research will be needed to verify these findings.

Chrystal Moulton BA, PMP, is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Indianapolis, IN.

References:

  1. Sigaux J, Bellicha A, Buscail C, et al. Serum Fatty Acid Profiles Are Associated with Disease Activity in Early Rheumatoid Arthritis: Results from the ESPOIR Cohort. Nutrients. Jul 19 2022;14(14)doi:10.3390/nu14142947
  2. Stolt P, Yahya A, Bengtsson C, et al. Silica exposure among male current smokers is associated with a high risk of developing ACPA-positive rheumatoid arthritis. Ann Rheum Dis. Jun 2010;69(6):1072-6. doi:10.1136/ard.2009.114694
  3. Semerano L, Julia C, Aitisha O, Boissier MC. Nutrition and chronic inflammatory rheumatic disease. Joint Bone Spine. Oct 2017;84(5):547-552. doi:10.1016/j.jbspin.2016.10.003
  4. Daien C, Czernichow S, Letarouilly JG, et al. Dietary recommendations of the French Society for Rheumatology for patients with chronic inflammatory rheumatic diseases. Joint Bone Spine. Mar 2022;89(2):105319. doi:10.1016/j.jbspin.2021.105319
  5. Benito-Garcia E, Feskanich D, Hu FB, Mandl LA, Karlson EW. Protein, iron, and meat consumption and risk for rheumatoid arthritis: a prospective cohort study. Arthritis Res Ther. 2007;9(1):R16. doi:10.1186/ar2123
  6. Combe B, Benessiano J, Berenbaum F, et al. The ESPOIR cohort: a ten-year follow-up of early arthritis in France: methodology and baseline characteristics of the 813 included patients. Joint Bone Spine. Oct 2007;74(5):440-5. doi:10.1016/j.jbspin.2007.06.001
  7. de Pablo P, Romaguera D, Fisk HL, et al. High erythrocyte levels of the n-6 polyunsaturated fatty acid linoleic acid are associated with lower risk of subsequent rheumatoid arthritis in a southern European nested case-control study. Ann Rheum Dis. Jul 2018;77(7):981-987. doi:10.1136/annrheumdis-2017-212274