Juvenile arthritis is a term used to describe arthritis in children but a number of diseases are included in this category.
It comprises a number of autoimmune and inflammatory conditions that could affect children below the age of 16.
The major symptoms include pain, swelling, and redness.
Sometimes it may affect the muscles and not joints. Juvenile arthritis can affect other organs such as eyes, stomach, and skin.
It is an autoimmune disorder in which the immune system starts attacking the body’s tissue as a foreign body. There are many types of juvenile arthritis: the most common one is juvenile idiopathic arthritis.
JIA has several subtypes and involves swelling of the joint that lasts for more than 6 weeks.
Other types include juvenile lupus, juvenile scleroderma, Kawasaki disease, etc. Genetic defects are held primarily responsible for juvenile arthritis.
The primary goal of the treatment is to reduce inflammation.
Non-steroidal anti-inflammatory drugs, steroids, disease modifying anti-rheumatic drugs etc are administered. Assistive devices, regular exercise, and change in diet are recommended.
Not many alternative therapies have been researched upon in relation to juvenile arthritis but one that is gaining importance recently is the use of omega 3 fatty acids.
What are omega 3 fatty acids?
Omega 3 fatty acids are healthy polyunsaturated fatty acids that are essential to our health.
EPA (Eicosapentaenoic acid) and DHA (docosahexaenoic acid) are the main omega 3 fatty acids.
There are a part of cell membranes and lead to the formation of various lipid mediators which could beneficial in preventing various diseases.
EPA and DHA are required for fetal development.
EPA and DHA are best obtained from water plants and marine animals. ALA a precursor to EPA is found in plant oils but research suggests that it is not efficiently converted to EPA and DHA in the body.
Therefore seafood sources such as fish and fish oil are considered as prime sources of EPA and DHA.
Omega 3 fatty acids are found to be beneficial in fetal development, heart diseases, inflammatory conditions, Alzheimer’s disease, and cancer.
5 Benefits Of Omega 3 Fatty acids in Juvenile Arthritis
Quite a bit of research has been done on the role of omega 3 fatty acids in inflammation, autoimmune disorders, and juvenile arthritis.
1. Omega 3 is therapeutic in juvenile arthritis
Review studies suggest that omega 3 fatty acid supplementation is therapeutic in arthritic conditions like rheumatoid arthritis.
A study published in Clinical Rheumatology, 2012 demonstrates that omega 3 fatty acids supplements improve symptoms of juvenile arthritis.
27 JIA (Juvenile Idiopathic Arthritis) patients were recruited for this study and were given 2g omega 3 fatty acids per day for 12 weeks.
With the treatment of significant improvement in the number of joints affected, the number of joints swollen and disease score was observed.
Reduction in levels of inflammatory mediators such as TNF-alpha and IL-1 was observed.
The response criteria improved in 92.59% of the patients. Supplementation with omega 3 reduced inflammation to the extent that the patients reduced intake of non-steroidal anti-inflammatory drugs and thus experienced lesser side effects.
Researchers concluded that omega 3 fatty acids could serve as an adjuvant therapy to conventional treatment in juvenile arthritis.
Another study reported that dietary omega 3 fatty acids brought about a reduction in C reactive protein indicating reduced inflammation.
Lee et.al suggest that high doses of omega 3 fatty acids are therapeutic in rheumatoid arthritis in adults.
What does this mean? 2g omega 3 fatty acids per day are found to reduce inflammation and swelling in juvenile arthritis and improve symptoms associated with it within 3 months.
2. They combat inflammation
Omega 3 fatty acids obtained from marine sources reduce inflammation in the following manner :
- Prevent the production of inflammatory mediators and inhibit migration of immune cells
- Lead to the production of agents that have reduced inflammatory action
- Lead to the production of anti-inflammatory and inflammation resolving agents
- Reduced expression of inflammatory genes
- Inhibit activation of pro-inflammatory protein nuclear factor kappa B
These properties of omega 3 fatty acids are of relevance to many inflammatory and degenerative disorders such as rheumatoid arthritis, inflammatory bowel disease, Alzheimer’s, etc.
A clinical trial was conducted where the long term effect of omega 3 fatty acid supplementation on inflammation in children was studied.
The control group received only 1g canola oil while the treatment group received 300mg omega 3 fatty acid and 700mg canola oil.
The production of inflammatory and anti-inflammatory agents was seen in both groups but the ratio was less in omega 3 fatty acid treated group.
What does this mean? Omega 3 fatty acid supplementation reduces production of inflammatory mediators by interfering in inflammatory reactions and stimulates production of anti-inflammatory agents.
3. They can be an alternative to painkillers
Vargova et. al conducted a study to assess whether the inclusion of omega 3 fatty acids in diet would reduce daily consumption of non-steroidal anti-inflammatory drugs in children with juvenile arthritis.
In this study, 23 children were assigned to two groups.
One group along with ibuprofen received a diet rich in omega 3 fatty acids while the other group did not receive any such intervention.
The average consumption of ibuprofen was 28.4mg/kg/day and after omega 3 treatment it reduced to 23.4mg/kg/day.
Omega 3 fatty acids reduced consumption of NSAIDs by 17.3%.
In the control group average intake decreased by 6.5% (23.7 to 22.7mg/kg/day).
Though average intake was higher in the first group than control group omega 3 supplementation brought an obvious reduction in dependence on painkillers.
A study in adults proved that omega 3 fatty acids supplements (1.2-2.4g/day) led to discontinuation of NSAIDs for managing discogenic pain.
Metabolites of omega 3 fatty acids are said to have pain relieving property. The edge that omega 3 fatty acids have over conventional painkillers is that they are safe for the stomach and also protect from NSAID induced gastric side effects.
What does this mean? Research suggests that omega 3 fatty acids serve as natural painkillers and reduce the intake of non steroidal anti-inflammatory drugs in juvenile arthritis. They also protect from gastric side effects caused by painkillers.
4. They aid in autoimmune conditions
Animal studies show that fish oil supplementation is therapeutic in autoimmune conditions by bringing down the level of inflammatory mediators and reducing symptoms and severity of the disease.
The ability of omega 3 fatty acids to regulate immune responses in order to turn down inflammation is helpful in the treatment of autoimmune conditions like rheumatoid arthritis, uveitis, lupus, Sjogren's syndrome, and inflammatory bowel disease.
Omega 3 fatty acids are considered an essential part of the diet in favour of healthy immune responses.
What does this mean? Omega 3 fatty acids have found to be helpful in modulating immune responses in autoimmune conditions like rheumatoid arthritis and can be helpful in counteracting spread of inflammation to other organs in juvenile arthritis.
5. Omega 3 fatty acids can help in pediatric metabolic syndrome
Juvenile idiopathic arthritis is highly prevalent in those suffering from metabolic syndrome.
Also, long term use of steroids in juvenile arthritis can increase the risk of developing metabolic syndrome.
Pacifico et. al comment that supplementation of omega 3 fatty acids in children with metabolic syndrome can help by reducing inflammation, cholesterol and treating fatty liver.
What does this mean? Omega 3 fatty acids can help in improving metabolic health in children suffering from juvenile arthritis.
How to take Omega 3 fatty acids in Juvenile Arthritis?
The study demonstrating the effectiveness of omega 3 fatty acid supplementation in juvenile arthritis recommends a dose of 2g/day.
Dietary inclusion of omega 3 rich oils is a safe option except in case of allergy. Fish oil is the first choice since it is the direct source of EPA and DHA.
Among vegetarian choices, there is algal oil which provides a direct source of DHA.
Plant oils provide ALA an omega 3 fatty acid that is a precursor to EPA and DHA and these include flaxseed oil, walnut oil, and soybean oil.
Since the low conversion of ALA to EPA in the body, fish oil is preferred in case of therapeutic effect as per current research.
Inclusion of these oils in the diet is favourable.
Belching is a common side effect with fish oil so its best taken with meals and avoid consuming any liquid immediately after consuming fish oil.
In case of supplements, check for the content of EPA and DHA in the supplement and in case of fish oil supplements check for brands free from heavy metal contamination.
Precautions
Doses higher than 3g could lead to increased bleeding risk.
Omega 3 fatty acids could have drug interactions with blood-thinning medicines, diabetes medicines, NSAIDs, cyclosporin, cholesterol-lowering drugs and steroids.
In case of fish oil you have to have to check for a brand free from heavy metal contamination.
Gastric discomfort is possible with fish oil; its best taken with meals. Fish oil capsules should be given to children only when prescribed by the doctor.
Conclusion
Omega 3 fatty acid supplementation is proven to be beneficial in juvenile arthritis. It helps reduce inflammation and also benefits in reducing symptoms of autoimmune diseases.
Omega 3 fatty acid supplementation can help reduce the intake of non-steroidal anti-inflammatory drugs.
More clinical studies focused on larger study populations and utility of omega 3 fatty acids are warranted.
Including omega 3 fatty acids in diet can be helpful in juvenile arthritis. If opting for supplements, consult a doctor prior.