Objective Many rheumatologists are inundated with questions about what “natural remedies” and “anti-autoimmune diets” exist for decreasing Systemic Lupus Erythematosus (SLE) disease activity. Over the last three decades, there has been an abundance of data from several different trials about omega-3 fatty acids sourced from fish oil, but the findings have been contradictory. This review seeks to present this data so that evidence-based recommendations can be given to patients, supporting the use of an adjuvant regimen with their present immunosuppression. Methods A literature search was conducted using the PubMed, Google Scholar, MEDLINE, and Scopus electronic databases to retrieve relevant articles for this review. Trials conducted on human subjects with SLE with full publications in English were included from 1 January 1980 to 1 April 2021. The impact of fish oil-derived omega-3 fatty acid supplementation on specific clinical features, the innate and adaptive immune response, biomarkers, and disease activity measures were assessed. The initial search yielded 7519 articles, but only 13 met our criteria and were eligible for this review. Results Data from thirteen articles were assessed. Ten trials assessed disease activity as an outcome, with eight trials demonstrating an improvement in patients in the omega-3 fatty acid group as assessed by a validated clinical tool or individual patient criteria. There was a significant improvement in Systemic Lupus Activity Measure-Revised (SLAM-R) scores at week 12 ( p = .009) and week 24 ( p < .001). Additionally, a reduction of urinary 8-isoprostane, a non-invasive marker of disease activity, was observed. There was no treatment benefit seen with respect to renal parameters such as serum creatinine or 24-hour urine protein; or systemic parameters such as C3, C4, or anti-double stranded DNA (anti-dsDNA) levels regardless of the dose of the omega-3 LUPUS fatty acids or duration of the trial. Conclusion While there is conflicting evidence about the benefits of omega-3 fatty acid supplementation on SLE disease activity, specific measures have demonstrated benefits. Current data show that there is a potential benefit on disease activity as demonstrated by SLAM-R, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and British Isles Lupus Assessment Group (BILAG) scores and plasma membrane arachidonic acid composition and urinary 8-isoprostane levels, with minimal adverse events.

The mean and median ages of diagnosis of multiple myeloma range from 70 to 73 years old, with 63% of patients being over the age of 65. Phase 3 clinical trials are designed to study efficacy in the target disease population and are meant to have the most representative subject pool. The purpose of this review is to identify the age demographic of subjects participating in interventional phase 3 clinical trials that aim to treat multiple myeloma and to determine if they encompass the true age demographic of the disease. To complete this review, a search of phase 3 multiple myeloma research trials with reported results was conducted on clinicaltrials.gov, a national, publicly available resource listing clinical trials. Reported mean or median ages of subjects were identified for each trial, and adjusted averages of these values were calculated. Data from 81 clinical trials were assessed, with 42 trials reporting an average mean age of 65.78 years and 15 trials reporting an average median age of 63.29 years. Based on these results, it was determined that the clinical trials reported in this study enrolled patients that were younger than the true age demographic of the disease. There is an unmet need in research in the older population of patients with multiple myeloma, and this may hinder the generalizability and utility of clinical trial results.

Objective Curcumin is the active ingredient in the curry spice turmeric. It has anti-inflammatory properties due to the inhibition of transcription factors and inflammatory mediators such as nuclear factor- κβ (NF- κβ), cyclooxygenase-2 (COX2), lipoxygenase (LOX), tumor necrosis factoralpha (TNF-alpha), and interleukin-1 (IL-1) and 6 (IL-6). This review examines the literature regarding the efficacy of curcumin on systemic lupus erythematosus disease activity. Methods A search was conducted following guidelines in the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) using the PubMed, Google Scholar, Scopus, and MEDLINE electronic databases to retrieve relevant studies assessing the impact of curcumin supplementation on SLE. Results The initial search yielded three double-blind, placebo-controlled, randomized clinical trials, three human in vitro studies, and seven mouse-model studies. In human trials, curcumin decreased 24-h and spot proteinuria, but the trials were small, ranging from 14 to 39 patients, with varied curcumin doses and different study durations ranging from 4 to 12 weeks. There was no change in C3, dsDNA, or the Systemic Lupus Erythematosus Disease Activity (SLEDAI) scores even in the longer trials. The mouse-model trials yielded more data. NF- κβ activation was suppressed along with inducible nitric oxide synthase (NOS) species expression when 1 mg/kg/day of curcumin was administered for 14 weeks, leading to significant decreases in dsDNA, proteinuria, renal inflammation, and IgG subclasses. Another study suggested that curcumin reduced B cell-activating factor (BAFF) when used for up to 8 weeks at 50 mg/kg/day. A reduction in pro-inflammatory Th1 and Th17 percentages, IL-6 and anti-nuclear antibody (ANA) levels were reported. The doses used in the murine models were much higher than those used in human trials, with 12.5 mg–200 mg/kg/day used for over 16 weeks; highlighting that the optimal time for an immunological effect to be observed may require 12–16 weeks of curcumin use. Conclusion Despite the wide use of curcumin in everyday life, its molecular and anti-inflammatory use has only been partially explored. Current data show a potential benefit on disease activity. Still, no uniform dose can be advised because long-duration, large-scale randomized trials using defined dosing are needed in different subsets of SLE, including lupus nephritis patients.