Fat Manipulation in the Treatment of Rheumatoid Arthritis: A Review

Objective: To review the rationale and status of fat manipulation through dietary supplementation in patients with rheumatoid arthritis (RA). Method: Studies of unsaturated fatty acid supplementation in rheumatoid arthritis are reviewed, and the potential for use as a therapeutic paradigm is evaluated. Results: There is consistent evidence that (n-3) fatty acid supplementation in double blind randomized clinical studies provides a beneficial effect in RA. The evidence is not quite as consistent for (n-6) fatty acid supplementation. Population studies suggest that (n-9) fatty acids incorporated in olive oil and regular fish eating populations reduce the incidence of RA. Mechanisms involve the modulation of mediators of inflammation, cytokine synthesis and cell communication. This modu-latory effect may result from the suppression of (n-6) derived eicosa-noid production and cytokine production. Conclusion: Biochemically, the effects of fat manipulation and anti-inflammatory pharmaceuticals may overlap, suggesting a synergistic potential between dietary fat choice and drug therapy. There is a need to assess the nutritional status, the fat composition of the background diet and the issue of drug therapy of rheumatoid arthritis patients, prior to supplementation studies to obtain a more consistent response.