Psoriatic arthritis is a chronic inflammatory condition characterised by inflammation of skin and joints. Psoriasis presents with red patchy scaly skin and itching. It affects elbow, knees, genital areas, navel and ears.
Psoriasis precedes arthritis in 80% of the cases. But in around 15% of the cases, arthritis may occur prior to psoriasis.
Psoriatic arthritis is a systemic rheumatic disease that may even cause inflammation in other body organs and tissues.
Genetic factors, immune system dysfunction and environmental factors are responsible for occurrence of this disease. The symptoms include:
- Itching and inflamed skin
- Swollen fingers and toes
- Foot and lower back pain
- Stiffness and swelling in joints
- Pitting and ridge in nails
- Inflammation in other organs and related symptoms
Treatment options include painkillers, anti-rheumatic drugs, biological response modifiers etc. Psoriatic arthritis develops in 6-42% of the individuals suffering from psoriasis.
How does borage oil benefit in psoriatic arthritis?
Borage oil is a rich source of Gamma Linolenic acid. GLA is an omega 6 fatty acid ( a polyunsaturated fatty acid) that keeps joints and skin healthy. It works as anti-inflammatory agent by serving as a precursor to development of biological agents that play a vital role in inflammation.
Borage oil is also rich in healthy fats, vitamins and minerals and is found to be therapeutic in arthritis, skin diseases, autoimmune conditions etc.
1.It reduces inflammation
Gamma linolenic acid is produced in the body from linoleic acid an essential omega 6 fatty acid. It is further metabolized to form DGLA dihomo gamma linolenic acid which is oxidised by inflammatory enzymes (COX and LOX) to form anti-inflammatory chemicals called eicosanoids.
These eicosanoids comprise of two groups: prostaglandins and leukotrienes. These metabolites affect various genes involved in inflammation and cell death.
Prostaglandins can increase signs of inflammation such as redness, pain, swelling and heat. However in presence of inflammatory cells it inhibits the action of these cells and reduces inflammation.
Leukotrienes also exert anti-inflammatory effect and inhibit the immune cells from migrating and attaching to the site of inflammation. Belch et. al suggest that this mechanism of GLA serves to be therapeutic in treatment of rheumatoid arthritis, psoriatic arthritis, Sjogren syndrome and Raynaud phenomenon.
Johnson et. al have proven that 1.5- 6g/day dietary supplementation of GLA has an anti-inflammatory effect.
In animal model of arthritis, dietary supplementation of borage oil is found to be beneficial in treatment of acute and chronic inflammation by increasing the level of anti-inflammatory agents- prostaglandins and leukotrienes.
Oral administration of GLA reduces joint inflammation in arthritis by reducing the production of inflammatory agent- interleukin-1beta.
What does this mean?
GLA is metabolized in the body to produce anti-inflammatory agents which can help reduce inflammation in psoriatic arthritis.
2.It benefits in arthritic conditions
As mentioned previously, GLA and other polyunsaturated fatty acids lead to production of anti-inflammatory molecules.
Clinical trial reports that supplementation of GLA and other PUFAs has a beneficial effect on chronic inflammatory arthritis.
Tumor necrosis factor-alpha is a protein that plays an important role in inflammation. Borage oil is said to increase the level of prostaglandins which indirectly lower the activity of tumor necrosis factor in arthritic inflammation.
A 24 week long clinical trial was conducted where individuals were given 1.4g/day of borage oil or cotton seed oil as placebo. It was observed that borage oil supplementation reduced tender joints by 36%, the tender joint score by 45%, swollen joint count by 28%, and the swollen joint score by 41%.
No significant improvement was seen in the placebo group.
Another clinical trial demonstrated that 2.8g/day of GLA supplementation for 6 months improved symptoms of rheumatoid arthritis.
Borage oil supplementation is found to reduce inflammation and improve bone health.
What does this mean?
Evidences from clinical trials suggest that GLA or borage oil supplementation is effective in reducing symptoms of arthritis such as joint pain, stiffness and tenderness.
3.It benefits in autoimmune conditions
Dietary omega 6 fatty acids can modulate the immune system to prevent inappropriate immune reactions and also reduce immune mediated inflammation. These have clinical effects on autoimmune inflammatory conditions like rheumatoid arthritis, inflammatory bowel disease etc.
T cells are a type of immune cells that play an important role in tissue damage in arthritis. It has been proven that oral supplementation of borage seed oil (2.4g) helps in reduction of growth and development of T cells which indirectly would reduce tissue damage and inflammation in arthritis.
A study in humans shows that GLA supplementation at 2g/day has a mild effect on immune cells and their function.
What does this mean?
Borage seed oil and GLA can influence immune function which is beneficial in treatment of autoimmune conditions like psoriatic arthritis.
4.It improves skin function
Our skin is made up of lipids- healthy fats that help maintain skin function.
These fats also play a major role in development of skin, inhibition of pro-inflammatory chemicals, accelerating wound healing, elevation of sunburn threshold and even influence development of malignant skin conditions.
Deficiency of these fats can lead to development of skin disorders. Dietary supplementation of borage oil inhibits the production and activity of leukotrienes (inflammatory chemicals) and this can help treat chronic inflammatory skin conditions.
Psoriasis is marked by excessive production and cell death of skin cells which is seen in the form of flaky skin. Animal study demonstrates that GLA present in borage oil can help prevent such flaking and excessive cell death in skin cells.
Oral supplementation of borage oil in women is found to reduce skin irritation, reddening, drying of skin and improvement in skin function in 12 weeks. Milk supplemented with borage oil is also found to improve skin function within 6 weeks.
Eczema is characterised by itching and inflammation of the skin and generally presents as symptoms of many skin disorders. Oral borage oil supplementation is found to be ineffective in treatment of eczema. Topical application of borage oil is proven to be beneficial in reducing redness and itching of skin.
Kawamura et. al reported that GLA containing food can reduce dry skin and itching in those suffering from inflammatory skin conditions.
What does this mean?
GLA in borage oil can reduce the excessive flaking of skin in psoriaisis. Topical application of borage oil can reduce itching and redness occurring in psoriasis.
Borage oil contains 18-26% of GLA. It is available in the form of soft gel or capsules. Doses up to 3g per day of borage oil are found to be safe.
1000-1300mg of borage oil a day will provide you with 240-300mg of GLA. Borage oil can also be used as a flavouring agent in food. Opt for cold pressed borage oil.
Borage oil can be used topically either alone or in combination with cream to soften skin and alleviate skin disorders.
Borage oil may cause nausea and slight gastric discomfort if taken in excess. It can increase the risk of developing seizures; so individuals who are prone to seizures or taking psychiatric medications should avoid it.
It may increase risk of bleeding and hence should be avoided with blood thinning medications. Avoid borage oil supplements if nursing or pregnant.
GLA is said to have possible drug interactions with blood thinning medicines, antibiotics, chemotherapeutic agent, immunosuppressant and psychiatric medications.
Borage oil is a rich source of anti-inflammatory agent Gamma Linolenic acid which helps in suppressing skin and joint inflammation occurring in psoriatic arthritis.
Topical application of borage oil can reduce skin inflammation, flaking of skin, irritation and itching occurring in psoriasis.
Borage oil can serve as a complementary therapy in treating as well as reducing progression of psoriatic arthritis.