Background/Purpose: A comprehensive metabolomic screen comparing sera from patients with systemic lupus erythematosus (SLE) to healthy controls (HC) indicated a relative deficiency in omega-3 fatty acids. A randomized clinical trial of fish oil supplements in patients with SLE was undertaken. This study noted improvements in the fish oil treatment group when compared to a parallel placebo group in quality of life, global disease activity, erythrocyte sedimentation rate (ESR), and the cytokines Interleukin (IL)-12 and IL-13. A follow-up study was performed to verify that serum lipid profiles were impacted by oral fish oil supplementation and to correlate alterations of serum omega-3 fatty acid levels with the clinical improvements noted in the trial.

Methods: Fifty SLE patients were recruited, 25 supplemented with fish oil (FO) and 25 with olive oil placebo. At baseline and after 6 months of FO supplementation, Short Form-36 (SF-36), SLE Disease Activity Index (SLEDAI), Physician Global Assessment (PGA), and serum free fatty acid (FFA) profiles were completed. Demographic information and clinical laboratory data were collected from the electronic medical record. Liquid-liquid extraction was performed to isolate the FFA from all available serum samples. Quantification of FFA levels was determined by gas chromatography/ mass spectrometry. Data analysis utilized non-parametric statistical testing, Mann-Whitney to compare groups and Spearman for correlation.

Results: Eighteen fish oil and fourteen placebo patients completed the study. Baseline FFA levels and demographics did not differ significantly between the two groups. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) levels (ng/ul) were converted to percent of total FFA for normalization. The median change in EPA level in the fish oil group was 0.037 [IQR 0.0013– 0.039] compared to -0.0084 [-0.035 – 0.029] in the placebo group, yielding a significant difference between groups (p=0.022). The median change in DHA level in the fish oil group was 0.10 [-0.21 – 1.16] compared to -0.022 [-0.075 – 0.023] in the placebo group, also significant (p=0.013). The change in EPA and DHA levels were compared to change in SF-36 parameters, ESR, SLEDAI, IL-13, and IL-12. Increase in EPA correlated with improvement of SF-36 Pain (r=0.48, p=0.0053) and reduction of ESR level (r=-0.41, p=0.021). Increase in DHA level correlated with reduction of ESR level (r=-0.30, p=0.099) and increase in IL-13 level (r=0.30, p=0.099).

Conclusion: A placebo-controlled clinical trial of fish oil supplements in SLE patients verified the ability to change important serum omega-3 fatty acid levels by dietary intervention. Serum from both treatment and placebo patients completing the trial had comparable fatty acid profiles at baseline, and achieved a significant increase in EPA, DHA, and PUFA levels with oral supplementation of fish oil. Patients with SLE may potentially have reduced EPA and DHA levels due to dietary intake and/or increased metabolism. Oral supplementation can overcome this deficit. Additionally, benefits noted in quality of life, specifically pain, and inflammation may be partially explained by the increases in DHA and EPA levels.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/dietary-fish-oil-supplementation-raises-serum-essential-fatty-acid-concentrations-in-patients-with-systemic-lupus-erythematosus-and-correlates-with-improvements-in-inflammation-and-pain/