Belch J J, Ansell D, Madhok R, O'Dowd A, Sturrock R D
Centre for Rheumatic Diseases, University Department of Medicine, Royal Infirmary.
Ann Rheum Dis. 1988 Feb;47(2):96-104. doi: 10.1136/ard.47.2.96.
In rheumatoid arthritis (RA) benefit from non-steroidal anti-inflammatory drugs (NSAIDs) is mediated through inhibition of the cyclo-oxygenase enzyme, thereby decreasing production of the 2 series prostaglandins (PGs). The lipoxygenase enzyme is intact, however, allowing leucotriene (LT) production, e.g., LTB4 (an inflammatory mediator). Treatment with evening primrose oil (EPO) which contains gamma-linolenic acid (GLA) leads to production of the 1 series PGs, e.g., PGE1, which has less inflammatory effects. Also LT production is inhibited. Eicosapentaenoic acid (EPA, fish oil) treatment provides a substrate for PGs and LTs, which are also less inflammatory. In this study 16 patients with RA were given 540 mg GLA/day (EPO), 15 patients 240 mg EPA and 450 mg GLA/day (EPO/fish oil), and 18 patients an inert oil (placebo). The aim of this study was to determine if EPO or EPO/fish oil could replace NSAID treatment in RA. The initial 12 month treatment period was followed by three months of placebo for all groups. Results at 12 months showed a significant subjective improvement for EPO and EPO/fish oil compared with placebo. In addition, by 12 months the patients receiving EPO and EPO/fish oil had significantly reduced their NSAIDs. After 3 months of placebo those receiving active treatment had relapsed. Despite the decrease in NSAIDs, measures of disease activity did not worsen. It is suggested that EPO and EPO/fish oil produce a subjective improvement and allow some patients to reduce or stop treatment with NSAIDs. There is, however, no evidence that they act as disease modifying agents.
在类风湿性关节炎（RA）中，非甾体抗炎药（NSAIDs）的益处是通过抑制环氧化酶来介导的，从而减少2系列前列腺素（PGs）的产生。然而，脂氧合酶是完整的，这使得白三烯（LT）能够产生，例如白三烯B4（一种炎症介质）。用含有γ-亚麻酸（GLA）的月见草油（EPO）进行治疗会导致1系列PGs的产生，例如前列腺素E1，其具有较小的炎症作用。同时，LT的产生也受到抑制。二十碳五烯酸（EPA，鱼油）治疗为PGs和LTs提供了一种底物，这些物质的炎症性也较小。在这项研究中，16例RA患者每天服用540毫克GLA（EPO），15例患者每天服用240毫克EPA和450毫克GLA（EPO/鱼油），18例患者服用惰性油（安慰剂）。本研究的目的是确定EPO或EPO/鱼油是否可以替代RA患者的NSAIDs治疗。初始的12个月治疗期之后，所有组都接受了3个月的安慰剂治疗。12个月时的结果显示，与安慰剂相比，EPO和EPO/鱼油组在主观上有显著改善。此外，到12个月时，接受EPO和EPO/鱼油治疗的患者显著减少了NSAIDs的用量。在3个月的安慰剂治疗后，接受积极治疗的患者病情复发。尽管NSAIDs用量减少，但疾病活动度指标并未恶化。有人认为，EPO和EPO/鱼油能产生主观改善，并使一些患者减少或停止使用NSAIDs治疗。然而，没有证据表明它们具有改善病情的作用。
