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Br J Nutr. 2015 Sep 28;114(6):885-90. doi: 10.1017/S0007114515002718. Epub 2015 Aug 18.

Plasma n-3 fatty acids and clinical outcomes in recent-onset rheumatoid arthritis.

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1Rheumatology Unit,Royal Adelaide Hospital,Adelaide,SA 5000,Australia.
3Public Health (TRS),University of Adelaide,Adelaide,SA 5000,Australia.


A randomised controlled trial (RCT) of high-dose v. low-dose fish oil in recent-onset rheumatoid arthritis (RA) demonstrated that the group allocated to high-dose fish oil had increased remission and decreased failure of disease-modifying anti-rheumatic drug (DMARD) therapy. This study examines the relationships between plasma phospholipid levels of the n-3 fatty acids in fish oil, EPA and DHA, and remission and DMARD use in recent-onset RA. EPA and DHA were measured in blood samples from both groups of the RCT. The data were analysed as a single cohort, and Cox proportional hazards models were used to examine relationships between plasma phospholipid (PL) EPA and DHA and various outcome measures. When analysed as a single cohort, plasma PL EPA was related to time to remission, with a one unit increase in EPA (1% total fatty acids) associated with a 12% increase in the probability of remission at any time during the study period (hazard ratio (HR)=1.12; 95% CI 1.02, 1.23; P=0.02). Adjustment for smoking, anti-cyclic citrullinated peptide antibodies and 'shared epitope' HLA-DR allele status did not change the HR. Plasma PL EPA, adjusted for the same variables, was negatively related to time to DMARD failure (HR=0.85; 95% CI 0.72, 0.99; P=0.047). The HR for DHA and time to remission or DMARD failure were similar in magnitude to those for EPA, but not statistically significant. Biomarkers of n-3 status, such as plasma PL EPA, have the potential to predict clinical outcomes relevant to standard drug treatment of RA patients.


ACR American College of Rheumatology; Arthritis; DAS28 Disease Activity Score; DMARD disease-modifying anti-rheumatic drug; Docosahexaenoic acid; Eicosapentaenoic acid; Fish oil; HR hazard ratio; Nutritional immunology; PL phospholipid; RA rheumatoid arthritis; RCT randomised controlled trial

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