Health store items helpful for R.A

Healthfacts, Dec, 1993

Within the last few months, preliminary studies have published results showing that two products commonly available at health food stores can significantly alleviate symptoms of rheumatoid arthritis (R.A.). The first study, published in the September 24 issue of Science, involved collagen protein extracted from chicken breast bones; the second, published in the November 1 issue of Annals of Internal Medicine, involved gammalinolenic acid, which is an essential fatty acid extracted from certain plant seeds, particularly borage and evening primrose. The collagen protein is sold in liquid form, and the gammalinolenic acid (GLA) is sold as capsules, most commonly labeled as oil of evening primrose.

The GLA study was conducted by Lawrence J. Leventhal, M.D., of the University of Pennsylvania, and colleagues from medical centers in Pennsylvania and Massachusetts. The 27 participants had suffered the morning stiffness, tenderness, swelling, and joint pain of R.A. for about nine years. Most continued taking the standard treatment, non-steroidal anti-inflammatory drugs (e.g., ibuprophen), for the six-month duration of the study. The investigators randomly assigned 14 people to received GLA daily, and 13 to receive placebos.

The dosage used in the GLA study was high, 1.4 grams/daily. Dr. Leventhal and colleagues noted that lower doses used in previous studies, 480-540 mg/daily, were either ineffective or merely reduced pain, without an effect on physical conditions.

Significant Improvements

After the study ended, the people who had been taking GLA showed "statistically significant improvement in global assessment by physician, patient assessment of pain using both a five-point scale and visual analog scale, ability to perform vocational tasks, number of tender and swollen joints, and associated tender and swollen joint scores." There was a 36% reduction in the number of tender joints and 28% reduction in swollen joints, but no significant improvement among the people taking the placebos.

The investigators concluded, "Gammalinolenic acid in doses used in this study is a well-tolerated and effective treatment for active R.A.." They reported that the adverse effects reported by the people taking GLA were negligible. (One reported belching and another reported flatulence.)

Any treatment that helps people without causing harm is worth checking out further because most of the drugs used to treat R.A. have serious side effects (see Rx News, page 2). R.A. is a painful inflammatory disorder that often leads to crippling destruction of the joints. The cause is unknown, and since there is no cure, the aim of treatment is symptom alleviation, which is often only partially successful.

Many people cannot tolerate the large doses of Aspirin required to reduce the inflammation of R.A. (experiencing stomach irriatation, ulceration, bleeding), and long-term use of nonsteroidal anti-inflammatory drugs (e.g., Indocin, Clinoril, Naprosyn) can also cause gastrointestinal symptoms (bleeding, ulceration). When these drugs fail to help, physicians will prescribe drugs with more serious side effects such as cortisone-like steriods (prednisone), which cause bone loss and cataract formation.

An anti-cancer drug called methotrexate is used in lower doses than would be used to treat cancer in order to suppress the immune response, but its high toxicity makes it a choice of last resort to prevent joint destruction. (R.A. is an autoimmune disease, which means that the immune system, normally a protective force against virus and bacteria, will for unknown reasons attack proteins in the body's joints.)

GLA demonstrated beneficial immune responses in earlier research conducted by Dr. Leventhal and colleagues. For example, GLA suppresses acute and chronic inflammation, and it also appears to modulate immune responses by triggering the production of suppressor T-cells, which block the other types of T-cells from mounting an attack.

Collagen From Chicken Bones

The other R.A. study, involving collagen (a protein found in the bones) indicates that this treatment also suppresses the immune response without serious side effects.

The new study, which included 59 people with severe R.A. of nine to ten years duration, was conducted by David Trentham, M.D., chief of the division of rheumatology at Beth Israel Hospital in Boston, and his colleagues. Twenty of the participants had disease severe enough to warrant immunosuppressive drugs, usually methotrexate, from which they were withdrawn so they could take part in the study.

The participants were randomly assigned to receive the collagen or an inactive substance (placebo drink); neither the participants nor their physicians knew who was receiving the active treatment. Twenty-eight drank a small amount of collagen extract from chicken bones mixed with their daily morning orange juice, and another 31 drank an indistinguishable placebo mixture.

After three months, the people who drank collagen showed significant improvements not experienced by people in the placebo group, who worsened slightly. There was a 25-30% reduction in observed swelling and pain in their joints. The people taking the collagen also had improved grip strength and could walk more quickly. Four of the people who drank the liquid collagen experienced complete remissions. (R.A. is a disease that waxes and wanes. Furthermore, about 10% of people will experience a spontaneous complete remission within 6-24 months of the onset of symptoms.)