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Fish oils benefit rheumatoid arthritis patients
BOSTON, MASSACHUSETTS. Many small studies have concluded that fish oil supplementation leads to a marked improvement in rheumatoid arthritis symptoms. However, precisely because these studies have been small their publication has not had a major impact on the medical treatment of arthritis. A team of researchers from the Harvard Medical School has now combined and analyzed the results of these smaller studies. Their meta-analysis covered 10 double-blind, randomized, placebo-controlled studies aimed at determining the effect of fish oil supplementation on 8 measures of arthritis severity including the number of tender joints, number of swollen joints, extent of morning stiffness, grip strength, erythrocyte sedimentation rates, and overall global assessment of disease severity. The studies involved a total of 368 participants who took fish oil supplements for at least three months. The meta-analysis revealed a highly significant decrease in the number of tender joints and a significant shortening in the duration of morning stiffness among patients supplementing with fish oils. No statistically significant changes were observed for the other measured indicators of disease severity.

Fortin, Paul R., et al. Validation of a meta-analysis: the effects of fish oil in rheumatoid arthritis. Journal of Clinical Epidemiology, Vol. 48, 1995, pp. 1379-90

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 oil 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 oil 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


Fish oils alleviate rheumatoid arthritis symptoms
ALBANY, NEW YORK. Rheumatoid arthritis is believed to involve an overactivity of certain inflammatory agents derived from arachidonic acid. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the main components of fish oils, are known to inhibit the formation of these inflammatory agents. Research has shown that fish oil supplementation is beneficial in alleviating the symptoms of several inflammatory diseases.

Researchers at the Albany Medical College and the State University of New York now report that fish oils are quite effective in relieving the symptoms of rheumatoid arthritis. Their study involved 33 arthritis patients (25 women and 8 men) aged between 23 and 74 years who had suffered from arthritis for more than 3 years. Half the patients were assigned to supplement daily with 15 fish oil capsules (containing a total of 2.7 grams EPA and 1.8 grams DHA) while the other half received 15 placebo capsules every day (containing olive oil). After 14 weeks of supplementation and a 4-week wash-out period during which everyone took placebo capsules the group on fish oil switched to placebos and vice versa for a further 14 weeks. After 14 weeks on fish oil there was a very noticeable decrease in the average number of tender joints among the patients (from 9 to 5.5) and a 2.5-hour increase in the time to the first onset of fatigue after getting up in the morning. Although not statistically significant a trend to a shorter duration of morning stiffness and fewer swollen joints were also observed.

The researchers conclude that fish oil supplementation relieves arthritis symptoms, but point out that at least 12 weeks of fish oil ingestion is required before the benefits are felt.

Kremer, Joel M., et al. Fish-oil fatty acid supplementation in active rheumatoid arthritis: A double-blinded, controlled, crossover study. Annals of Internal Medicine, Vol. 106, April 1987, pp. 497-503

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Barb

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