Sardines and supplements: fish oils help treat early rheumatoid arthritis

This study examined the effects of high-dose fish oil in the treatment of early rheumatoid arthritis.

The goal of modern rheumatoid arthritis treatment is clinical remission (a decrease in or disappearance of signs and symptoms of disease). Guidelines recommend using standardized measures of disease activity and adjustments in medication until low disease activity is achieved.

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are “good fats” found in fish oils. They can suppress the synthesis of some inflammatory markers and therefore might decrease inflammation in rheumatoid arthritis patients. Initial studies have shown that fish oils can decrease pain, morning stiffness, the number of painful and/or tender joints, and the use of painkillers. However, the benefits of fish oil at achieving remission in patients with early rheumatoid arthritis has not been analyzed.

This study included 140 patients with early arthritis (less than 12 months) who were beginning standard treatment for arthritis. Standard therapy for all 140 patients included methotrexate (Trexall, Rheumatrex), sulphasalazine (Azulfidine), and hydroxychloroquine (Plaquenil), and doses were adjusted as needed.  In addition to their treatment 87 patients received a high-dose fish oil supplement daily (average daily intake was 3.7g of EPA plus DHA) and 53 patients received a low-dose fish oil supplement daily (average daily intake was 0.36g of EPA plus DHA). Participants were assessed every 3 weeks until week 12 and then every 6 weeks for 1 year. If standard therapy failed patients began treatment with leflunomide (Arava).

Standard therapy had a higher success rate in the high-dose fish oil group. After 1 year, 9 (10.5%) patients in the high-dose group and 17 (32.1%) patients in the low-dose group had commenced leflunomide.

There was no difference in the rate of corticosteroid (prednisolone [Flo–Pred, Pediapred]) use or the average dose used between the two groups. There was also no difference in the average dose of methotrexate used between the two groups. However, the chance of achieving remission was 2.09 times higher in the high-dose fish oil group than in the low-dose fish oil group.

There was a similar proportion of adverse events experienced by both groups. 3.8% of patients in the low-dose fish oil group and 11.6% of patients in the high-dose group experienced a serious adverse.

The authors concluded that fish oil supplements were associated with benefits additional to those achieved by standard therapy for rheumatoid arthritis.