Much of the research involving omega-3 fish oils in people with rheumatoid arthritis was carried out before the development of modern, disease-modifying anti-rheumatic drugs (DMARDs). These early studies showed that, in rheumatoid arthritis, taking high dose fish oil supplements (above 2.7g per day) helped to reduce pain, morning stiffness and the number of painful and tender joints. Fish oil supplements also reduced the need for non-steroidal anti-inflammatory painkillers after a delay of 2 to 3 months for the effects of the omega-3s to kick in.
Australian rheumatologists therefore investigated whether fish oils were of any benefit for people with recent-onset rheumatoid arthritis who were starting modern DMARD triple-therapy medication.
Fish oils for rheumatoid arthritis
140 volunteers with rheumatoid arthritis were asked to take either 10ml high dose fish oil (5.5g EPA + DHA per day) or a control oil containing a small amount of fish oil (400mg EPA + DHA) to produce a similar ‘fishy’ odour. This ensured that neither the participants nor the doctors knew which patient was on which supplement (a double-blind, randomised, controlled trial).
After 12 months, people with rheumatoid arthritis who were taking the high dose fish oils were 76% more likely to have responded to their triple DMARD therapy (after adjusting for other factors such as smoking) than those on the control oil.
Only 10.5% of those in the high dose fish oil group ‘failed’ triple therapy and moved on to more intensive rheumatoid arthritis treatment with an immunosuppressive drug called leflunomide, compared to one-third (32.1%) of those taking the control oil.
The rate of remission in the high-dose fish oil group was double that seen in those on the control oil. A similar number (around 12%) withdrew from each group suggesting that the treatment was well tolerated.
EPA and DHA appear to work by reducing the production of immune factors that cause inflammation in the body. As well as reducing joint inflammation, omega-3 fish oils may also help to reduce the risk of heart disease in people with rheumatoid arthritis, whose risk is almost double that seen in the general population.
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