Could Omega 3 Fatty Acids Preserve Muscle Health in Rheumatoid Arthritis?

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by a high prevalence of death due to cardiometabolic diseases. As observed during the aging process, several comorbidities, such as cardiovascular disorders (CVD), insulin resistance, metabolic syndrome and sarcopenia, are frequently associated to RA. These abnormalities could be closely linked to alterations in lipid metabolism. Indeed, RA patients exhibit a lipid paradox, defined by reduced levels of total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol whereas the CVD risk is increased. Moreover, the accumulation of toxic lipid mediators (i.e., lipotoxicity) in skeletal muscles can induce mitochondrial dysfunctions and insulin resistance, which are both crucial determinants of CVD and sarcopenia. The prevention or reversion of these biological perturbations in RA patients could contribute to the maintenance of muscle health and thus be protective against the increased risk for cardiometabolic diseases, dysmobility and mortality. Yet, several studies have shown that omega 3 fatty acids (FA) could prevent the development of RA, improve muscle metabolism and limit muscle atrophy in obese and insulin-resistant subjects. Thereby, dietary supplementation with omega 3 FA should be a promising strategy to counteract muscle lipotoxicity and for the prevention of comorbidities in RA patients.

Habitual fish intake negatively correlates with prevalence of frailty among patients with rheumatoid arthritis

“…Serum levels of n-3 PUFA parallel dietary fish consumption 25 , 26 and correlate with a 27% reduction in all-cause mortality risk of elderly 27 . Marine-derived n-3 PUFAs also have anti-inflammatory effects on RA progression 28 . In prospective, double-blind, randomized controlled studies by Kremer et al 29 , 30 , dietary supplementation of n-3 PUFAs dose-dependently decreases RA activity parameters (tender joint count, swollen joint count and duration of morning stiffness) and serum levels of IL-1β.…”

Insights in the Role of Lipids, Oxidative Stress and Inflammation in Rheumatoid Arthritis Unveiled by New Trends in Lipidomic Investigations

“…RA patients have an increased risk for developing insulin resistance, which is influenced by RF seropositivity, higher disease activity, prednisone use, and visceral and thigh intermuscular adiposity [ 24 , 28 ]. The increased accumulation of toxic lipid mediators and consequent lipotoxicity in skeletal muscles may also stimulate mitochondrial dysfunction, that, together with insulin resistance, contribute to cardiovascular disorders and sarcopenia [ 29 ]. Insulin resistance, cardiovascular disorders, and sarcopenia, associated with an increased intramuscular fat compared to healthy subjects, are frequently associated with RA [ 30 ].…”

Dietary Interventions with or without Omega-3 Supplementation for the Management of Rheumatoid Arthritis: A Systematic Review

“…Grip strength significantly improved following a diet high in PUFAs and supplemented with fish oil providing 1.6 g EPA and 1.1 g DHA per day for 4 weeks (116 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) to 136 (12-88) mmHg); (p < 001) [43]. Similarly, in Kavanagh et al's study, a 4-week elemental diet followed by reintroduction of food significantly improved grip strength (140.2 ± 96 to 155.9 ± 98.3 mmHg) (p = 0.008) [36].…”

“…Omega-3 PUFAs regulate signaling pathways of anti-oxidants and alter inflammatory pathways by competing with omega-6 PUFAs which are transformed to pro-inflammatory eicosanoids [18]. Omega-3 PUFAs are the most studied supplements in RA with several clinical trials conducted among adults over the years [19,20]. A recently published systematic review [21] concluded that supplementation with omega-3 PUFAs led to substantial improvements in the duration of early morning stiffness (EMS), pain levels, erythrocyte sedimentation rate (ESR), physical function, grip strength, joint tenderness and levels of leukotriene B4 (LTB4).…”