Written by Marcia J.Egles, MD. In a randomized controlled trial, patients given 10ml of fish oil in conjunction with standard drug therapy saw significant improvement in symptoms of rheumatoid arthritis.
Rheumatoid arthritis is a severe, chronic inflammatory disease affecting over one million Americans. The disease attacks joints and other body tissues causing significant pain, disability, deformity and decreases in life expectancy. The medical treatment of rheumatoid arthritis, especially for those with early disease, has significantly improved in recent years. Though the disease cannot be cured, for some patients it can be controlled by aggressive treatment with “disease modifying anti-rheumatic drugs” referred to as DMARDs. A recent study from Australia reports additional improvements to treatment outcomes for recent onset rheumatoid arthritis patients who received fish oil along with standard DMARDS treatment (1).
Fish oil dietary supplements are rich in the omega-3 fatty acids EPA (eicosapentaenoic acid) and DHA ( docasahexaenoic acid). These omega-3 fatty acids can suppress the body’s synthesis of factors which can cause inflammation (such as proinflammatory eicosanoids, prostaglandin E2 and leukotriene B4)(2). Prior studies have suggested that some long-established rheumatoid arthritis patients may benefit from fish oil supplements for the reduction of pain and morning stiffness (3,4), but their use with DMARDs in early disease treatment had not yet been investigated. This recent study(1) looks at the addition of dietary fish oil to established DMARD treatment protocols for patients with recent onset rheumatoid arthritis.
The 52 week-long study was a randomized, double-blind controlled trial with 140 adults who had the onset of rheumatoid arthritis within the previous twelve months and had not been treated yet with DMARDs. Participants were randomly allotted 2:1 to receive high-dose or low dose fish oil. Low dose fish oil was included in the control to provide a “fishy” odor to the control oil and thereby permit the “blinding” of the participants and the clinicians.
Subjects in the high dose group received 10 ml per day of fish oil concentrate providing 5500 mg per day of EPA plus DHA for the duration of the study. The control group received 10ml per day of a mixture of two parts sunola oil with one part capelin fish oil. This mixture provided 400 mg per day of EPA plus DHA. The group getting 400 mg of EPA plus DHA is not a normal placebo group, but the AI (Acceptable Intake level set by the USA FDA) is 1600 mg for men and 1100 mg for women.)
The patients in both groups were treated according to similar protocols with DMARDs. According to the study’s protocol, the treatments drugs and dosages might vary with the improvement or deterioration of the individual patient. Each patient received assessment every 3 weeks for twelve weeks by a rheumatologist who evaluated the patient and adjusted the medications. After twelve weeks the patients were assessed every 6 weeks. ( The DMARD treatment drugs used are known as “triple DMARD” consisting of methotrexate with folic acid, suphasalazine, and hydroxychloroquine. Steroids and non-steroidal anti-inflammatory drugs were also included as needed.)
By the end of the 52 weeks, more patients in the high fish oil group had successful DMARD therapy outcomes. Nine of 86 patients (10.5%) in the fish oil group had inadequate DMARD responses, and, according to protocol, were switched to a different treatment with the drug leflunomide. In the control group, 31%, or 17 of 53 patients, failed DMARD and likewise started leflunomide. ( For time-to-event analysis, HR =0.28, 95% CI 0.12 to 0.63;p=0.002). Additionally, for those subjects who experienced satisfactory responses to DMARD treatment, the period of time to disease remission was shorter, resulting in less drug use for those in the fish oil group as compared to the control.
The researchers concluded that the addition of fish oil to the standard aggressive DMARD treatment for early rheumatoid arthritis may provide a benefit to patients. Not only may it allow for less aggressive treatment with disease-modifying antirheumatic drugs, but it may also have cardiovascular benefits from omega-3 oils (1). This is the first study of its kind and will need to be verified by future research.
Source: Fish oil in recent onset rheumatoid arthritis: a randomized,double-blind controlled trial within algorithm-based drug use
© 2013, BMJ Publishing Group Ltd and the European League Against Rheumatism
Posted February 27, 2014.
Marcia Egles, MD, graduated from Vanderbilt University School of Medicine in 1986. She completed her residency in Internal Medicine at St. Louis University Hospital. Dr. Egles is certified in Internal Medicine and is a member of the American College of Physicians. She resides in Avon, IN with her husband and two sons.
References:
- Proudman, Susanna M et al. Fish oil in recent onset rheumatoid arthritis: a randomized,double-blind controlled trial within algorithm-based drug use. Ann Rhem Dis 2013: 0:1-72.
- James,MJ Gibson RA, et al. Dietary polyunsaturated fatty acids and inflammatory mediator production. Am J Clin Nutr 2000: 71(Suppl):343S-8S.
- Fortin PR, Lew RA, Liang MH, et al. Validation of a meta-analysis: the effects of fish oil in rheumatoid arthritis. J Clin Epidemiol 1995;48:1379–90.
- Cleland LG, James MJ, Proudman SM. Fish oil: what the prescriber needs to know. Arthritis Res Ther 2006;8:202.
