鱼油对类风湿关节炎有益

ranchgirl

鱼油对类风湿关节炎有益。

一个随机研究发现，在早期类风湿关节炎治疗中，在常规的改变病情的靶向治疗方案中补充高剂量鱼油可改善其预后。

根据澳大利亚阿德雷德大学的Susanna M. Proudman博士及其同事，在接受鱼油联合包括甲氨蝶呤、柳氮磺吡啶和羟氯喹三联疗法治疗的患者中，1年期间治疗失败的可能性低于仅接受三联疗法到的患者（HR 0.28,95%CI 0.12-0.63，P=0.002）。研究者在风湿病年会上在线报道说，此外，鱼油治疗组与对照组相比，缓解率明显更高。研究者观察到，鱼油除了对RA的关节疾病有益外，也可能改善RA增加的心血管疾病风险，包括心血管病死亡率风险的增加，其中心脏性猝死的风险增加2倍。

先前的研究及荟萃分析表明，鱼油含有ω-3脂肪酸EPA和DHA，可改善RA患者的症状。然而，那些更早期的研究与当前的RA治疗相关性很低，因为那些试验中的患者病程很长，并且改变病情抗风湿药的剂量在整个试验过程中保持不变。而当前的研究主要是在早期开始治疗，即症状出现的第一年，并调整治疗方案以达到疾病活动性低或缓解的特定目标。

Proudman及其同事纳入了140名早期类风湿关节炎患者，并随机分配这些患者接受高剂量(5.5 g/day)或低剂量(0.4 g/day)的鱼油。低剂量组代表对照组，因为在先前的研究中该剂量不会引起临床疗效。最初的三联疗法包括甲氨蝶呤(Trexall) 10mg/周，柳氮磺吡啶(Azulfidine) 500mg/天，羟氯喹(Plaquenil)，2次/天，每次200mg。如果肿胀关节数维持在2个或2个以上，红细胞沉降率或C反应蛋白水平持续升高，或疼痛、疲劳，或早期晨僵持续存在，可以以一种固定的模式增加剂量。不建议使用非甾类抗炎药(NSAIDs)和口服的皮质类固醇。三联方案中需补充来氟米特(Arava)被定义为治疗失败。通过1年的治疗，10.5%使用鱼油治疗的患者和32.1%的对照组患者开始使用来氟米特。在调整了吸烟、基线抗环瓜氨酸肽及共同的抗原表位后(HR 0.24, 95% CI0.10-0.54, P=0.0006)，鱼油治疗组的治疗失败率依然明显低于对照组。
在调整这些因素后，缓解率也明显高于对照组(HR 2.09, 95% CI1.02-4.30, P=0.04)。只有对照组的1名患者在治疗1年时开始使用生物制剂。

根据修订的健康评估量表测量的日常活动，2个治疗组均有大幅度改善。试验期间，2组中需要类固醇治疗的患者数量无明显差异，而且平均的甲氨蝶呤剂量也无差异。基线期，鱼油治疗组有38%的患者，对照组有34%的患者正使用NSAIDS，但是在1年时，只有对照组的1名患者依然服用NSAIDS。2组中出现严重不良事件的患者比例相似，鱼油组为11.6%，对照组为3.8% (P=0.13)。研究者观察到，尽管鱼油组出现严重不良事件更频繁，但是无证据表明其与鱼油使用有关联。据报道，仅有1名伴有缺血性心脏病和心房颤动的患者出现一些心脏事件，一名以氯吡格雷治疗血压不受控制，并在5个月前已经停止使用鱼油的患者出现脑出血。

Proudman及其同事指出：“在使用现代的DMARD治疗RA的情况下，该研究设计使鱼油的效果可以被评估。”他们解释说，因为ω-3脂肪酸可以抑制炎症介质和多肽类，包括前列腺素E2和白细胞三烯B4，及肿瘤坏死因子α，所有这些均是目前治疗的靶标，所以鱼油对RA有益在生物学上是有道理的。他们也指出，通过1年的治疗，仅有1名患者需要生物学治疗，这表明使用鱼油联合常规的三联疗法具有潜在的节约成本的效能，因为其至少延迟了需要生物学治疗的进程。他们总结说：“在试验完成后，仅对这种治疗方案作微小的调整，其依然是繁忙诊所的标准治疗方案，进一步强调了其在真实的实践机构的可行性。”

novice_trader

我自己正在用魚油治療風濕。不過，據説吃魚油本身沒有太多用處，但直接吃魚，特別是三文魚，卻有一點效果。可能不止魚油，魚肉中其它未知元素可能也有作用。

ranchgirl

原文链接：http://www.medpagetoday.com/Rheumatology/Arthritis/42007

Fish Oil Shows Benefits in RA

High-dose fish oil added to a "treat to target" regiman of conventional disease-modifying treatment in early rheumatoid arthritis (RA) was associated with improved outcomes, a randomized study found.

Among patients receiving fish oil in conjunction with triple therapy with methotrexate, sulfasalazine, and hydroxychloroquine, the likelihood of treatment failure at 1 year was lower than for those given triple therapy alone (hazard ratio 0.28, 95% CI 0.12-0.63,P=0.002), according to Susanna M. Proudman, MD, of the University of Adelaide in Australia, and colleagues.

In addition, the rate of remission was significantly greater in the fish oil group than among controls (HR 2.17, 95% CI 1.07-4.42, P=0.03), the researchers reported online in Annals of the Rheumatic Diseases.

"In addition to benefits of fish oil for articular disease in RA, there may be benefits for the increased cardiovascular risk of RA, which include increased risk of cardiovascular mortality, including an almost two-fold increased risk of sudden cardiac death," the researchers observed.

Previous studies and meta-analyses suggested that fish oil, which contains the omega-3 fatty acids eicosapentaenoic (EPA) acid and docosahexaenoic acid (DHA), could have symptomatic benefits for patients with RA.

However, those earlier studies have minimal relevance to contemporary RA management, because patients in those trials had longstanding disease and the dosages of disease-modifying anti-rheumatic drugs (DMARDs) were kept constant through the trials.

Contemporary treatment, however, focuses on starting treatment early, within the first year of symptom onset, and adjusting treatment to meet the specific target of low disease activity or remission.

Proudman and colleagues enrolled 140 patients with early RA, randomly assigning them to receive high-dose (5.5 g/day) or low-dose (0.4 g/day) fish oil (EPA plus DHA). The low-dose group represented controls, as that dosage has not been associated with clinical effects in previous studies.

The initial triple regimen consisted of methotrexate (Trexall), 10 mg per week, sulfasalazine (Azulfidine) 500 mg per day, and hydroxychloroquine (Plaquenil), 200 mg twice per day.

Dosages could be increased in a structured fashion if the swollen joint count remained at two or higher, if the erythrocyte sedimentation rate or C-reactive protein level remained elevated, or if pain, fatigue, or early morning stiffness persisted.

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) and oral corticosteroids was discouraged.

Treatment failure was defined as the need to add leflunomide (Arava) to the triple regimen.

At 1 year, 10.5% of patients taking fish oil and 32.1% of controls had begun taking leflunomide.

The failure rate remained significantly lower for the fish oil group after adjustment for smoking, baseline anti-cyclic citrullinated peptide, and shared epitope (HR 0.24, 95% CI 0.10-0.54, P=0.0006).

The remission rate also was significantly greater after adjusting for those factors (HR 2.09, 95% CI 1.02-4.30, P=0.04).

Only one patient, who was in the control group, had begun taking a biologic agent at 1 year.

Activities of daily living, as measured on the modified Health Assessment Questionnaire, improved "substantially" in both groups. There was no difference in the number of patients who required steroids during the trial, and mean methotrexate doses didn't differ between the groups.

At baseline, 38% of the fish oil group and 34% of controls were taking NSAIDS, but by 1 year, only one patient, in the control group, was still doing so.

The proportion of patients with serious adverse events was similar in the two groups, at 11.6% of the fish oil group and 3.8% of controls (P=0.13).

While serious adverse events occurred more often in the fish oil group, "there was no pattern suggesting a linkage with fish oil use," the researchers observed.

A number of cardiac events were reported by a single patient who had ischemic heart disease and atrial fibrillation, and an intracerebral hemorrhage occurred in a patient with uncontrolled hypertension who was being treated with clopidogrel and had stopped taking the fish oil 5 months earlier.

"The study design has allowed the effects of fish oil to be assessed in the context of modern DMARD treatment for RA," Proudman and colleagues noted.

That fish oil would provide benefits in RA is biologically plausible, they explained, because of the ability of the omega-3 fatty acids to inhibit the release of inflammatory mediators and peptides, including prostaglandin E2 and leukotriene B4, as well as tumor necrosis factor alpha -- all of which are targets of current treatments.

They also pointed out that only one patient had progressed to biologic treatment by 1 year, which suggested a potential for cost-saving with fish oil and conventional triple therapy, in that it may "at least delay progression to biologic therapy."

"That the protocol, with only minor adjustments, has remained standard practice within our busy clinic after completion of the trial, further underlines its applicability to real practice settings," they concluded.

ranchgirl

novice_trader 发表于 2013-11-8 12:55 PM
我自己正在用魚油治療風濕。不過，據説吃魚油本身沒有太多用處，但直接吃魚，特別是三文魚，卻有一 ...

这篇文章不是”据说“。 而是研究报告。。。研究报告有时也会出错，但可能比据说稍微要靠得住一些。。。

novice_trader

ranchgirl 发表于 2013-11-8 03:56 PM
这篇文章不是”据说“。 而是研究报告。。。研究报告有时也会出错，但可能比据说稍微要靠得住一些。。。: ...

謝謝！

ranchgirl

您大概知道：
1）类风湿关节炎 和 风湿关节炎 不是一回事
2）他们是人体免疫系统问题

novice_trader

我知道。我是類風濕，家族遺傳。