September 10, 2010

Vitamin B6 supplementation lowers inflammation in rheumatoid arthritis patients

The September, 2010 issue of the European Journal of Clinical Nutrition reported a trial conducted by researchers in Taiwan which found an anti-inflammatory benefit for pyridoxine (vitamin B6) supplementation in rheumatoid arthritis patients.

Dr Y-C Huang of Chung Shan Medical University in Taichung and colleagues randomized 35 adults with rheumatoid arthritis to receive 5 milligrams per day folic acid or 5 milligrams folic acid plus 100 milligrams vitamin B6 for 12 weeks. (Seventy-four percent of the participants were being treated with methotrexate, the standard treatment for rheumatoid arthritis, which interferes with folate metabolism.) Blood samples obtained from the subjects at the beginning and end of the study were analyzed for plasma pyridoxal 5'-phosphate (PLP, the active form of vitamin B6), serum folate, immune parameters, and factors involved in inflammation, including C-reactive protein, erythrocyte sedimentation rate, interleukin-6 and tumor necrosis factor-alpha (TNF-a).

At the end of the twelve weeks, interleukin-6 and TNF-a were decreased among those who received supplemental vitamin B6. Higher plasma interleukin-6 levels were related to reduced levels of plasma pyridoxal 5'-phosphate. No significant effect on immune parameters was observed.

In their discussion of the findings, the authors remark that interleukin-6 and TNF-a are abundantly expressed in rheumatoid arthritis patients and have important roles in driving the inflammation and synovial cell proliferation characteristic of the joint destruction that occurs. "As plasma pyridoxal 5'-phosphate acts as a coenzyme for the production of cytokines and other polypeptide mediators during the inflammatory response (Friso et al., 2001), a prolonged pro-inflammatory state may lead to plasma pyridoxal 5'-phosphate depletion and could be expected to be inversely associated with pro-inflammatory cytokines (that is, IL-6 or TNF-a) in patients with rheumatoid arthritis," they explain. They note that a previous study involving 50 milligrams per day vitamin B6 for 30 days failed to suppress proinflammatory cytokines, and remark that the current study's findings indicate that higher doses of the vitamin for longer periods of time may be needed.

"In conclusion, 100 mg/day of vitamin B6 supplementation suppressed pro-inflammatory cytokines (that is, interleukin-6 and TNF-a) in patients with rheumatoid arthritis," the authors write. "Our results provide valuable reference data for clinical practice with regard to the potential beneficial use of vitamin B6 to suppress inflammatory response in rheumatoid arthritis patients."

Rheumatoid arthritis

The earliest signs of rheumatoid arthritis (RA) are tiny injuries to the synovial membrane and an increase in the number of synovial cells. At this point, long before symptoms are experienced, there is evidence of immune cell penetration into the synovial membrane. Over time, the immune response continues to gain momentum and inflict damage on the synovial membrane.

Rheumatoid arthritis symptoms are caused by chemical messengers called cytokines. It is thought that the release of interleukin-1, TNF-alpha, and interleukin-6 into the circulation system may account for systemic symptoms such as malaise and fatigue. In fact, these symptoms, along with weakness and vague musculoskeletal symptoms, are often the first indication of any disease. They may last for weeks or months, during which time a diagnosis may be difficult to make. It is not until specific, joint-related symptoms appear that RA is diagnosed.

The omega-3 fatty acids are well-known anti-inflammatories that interfere with the underlying disease progression in RA. Studies have found that fish oil supplements, which are high in the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), can reduce TNF-alpha and interleukin-6. In one human study with 60 patients, groups were randomly assigned to take fish oil supplements or placebo. No other dietary modifications were made. At the end of the study, there were significant differences in the levels of pro-inflammatory cytokines in the patients taking fish oil (Sundrarjun T et al 2004). Another study compared the value of a diet high in omega-3 fatty acids and low in pro-inflammatory arachidonic acid with a normal Western diet (which tends to be pro-inflammatory). At the end of the study, patients on the anti-inflammatory diet experienced a 14 percent decrease in the number of swollen joints, while the patients on the Western diet experienced no change (Adam O et al 2003). These results have been supported by many other human studies demonstrating profound benefits of omega-3 fatty acids, including studies showing that some people can discontinue nonsteroidal anti-inflammatory drug (NSAID) treatment after beginning therapy with fish oil supplements (Kremer JM et al 1995).

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