Fish oil may replace NSAIDs in some RA patients

ALBANY, NEW YORK. There is considerable evidence that fish oil supplementation can alleviate the symptoms of rheumatoid arthritis (RA). What is less clear is how much is required and whether fish oils are effective enough to eliminate the need for non-steroidal anti-inflammatory drugs (NSAIDs). Researchers at the Albany Medical College have released the results of a study which throws light on both of these questions.

The double-blind, placebo-controlled study involved 66 patients with active RA as indicated by the presence of at least 3 of the following symptoms:

  • 6 or more tender joints;
  • 3 or more swollen joints;
  • 30 minutes or more of morning stiffness;
  • a sedimentation rate of 28 mm/hour or higher.

The patients were weaned off their current anti-inflammatory medications and were then started on the NSAID diclofenac (75 mg twice a day). After 2 weeks they were randomized into 2 groups receiving 130 mg/kg per day of either fish oil (EPA+DHA ethyl esters) or corn oil (an omega-6 fatty acid). The daily dose of fish oil corresponds to about 9 grams/day for a person weighing 70 kg. After 18 or 22 weeks the diclofenac was replaced by a placebo and the fish and corn oil supplementation continued for another 8 weeks after which all patients were switched to the corn oil plus diclofenac placebo until the end of the study at week 48.

The researchers found that the fish group achieved a significant lessening of their symptoms from the start of supplementation and until the replacement of diclofenac with the placebo. No statistically significant benefits were observed in the corn oil group. Several patients in the fish group maintained their improved status even after diclofenac withdrawal. The researchers conclude that some RA patients using fish oil supplementation may be able to discontinue NSAIDs without experiencing a flare-up of their disease. They also noted that the benefits achieved from supplementing with 9 grams/day of fish oil were no greater than those observed in other studies using only 3 to 6 grams/day.
Kremer, Joel M., et al. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Arthritis & Rheumatism, Vol. 38, August 1995, pp. 1107-14

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