Rheumatoid arthritis patients may be able to reduce their dose of nonsteroidal anti-inflammatory drugs (NSAIDs) by adding cod liver oil to their daily regimen, according to an article published online on March 24, 2008 in the journal Rheumatology. Cod liver oil contains the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which can help inhibit the production of inflammatory prostaglandins and leukotrienes derived from arachidonic acid (an omega-6 fatty acid), and increase the production of less inflammatory substances.
For the current study, researchers at centers in Dundee and Edinburgh, Scotland enrolled 97 rheumatoid arthritis patients who were being treated with nonsteroidal anti-inflammatory drugs. Participants were randomized to receive a placebo or a daily dose of ten capsules containing 10 grams of cod liver oil (which provided 2.2 grams of omega-3 essential fatty acids plus vitamins A, D, and E) for nine months. The subjects were evaluated for rheumatoid arthritis disease activity and safety at the beginning of the study and at the fourth, twelfth, twenty-fourth and thirty-sixth week.
After 12 weeks, the participants were instructed to gradually reduce their medication usage and to discontinue their drugs if possible. Thirty-nine percent of those who received cod liver oil were able to reduce their NSAID dose by over 30 percent without experiencing a worsening of symptoms, while only 10 percent of those in the placebo group were able to do so. Among those who completed the full nine months fish oil therapy, 59 percent successfully lowered their medication dose. They also experienced a modest improvement in pain symptoms compared with the placebo group by the end of the trial.
To the author’s knowledge, the study is the largest to investigate the effect of omega-3 fatty acids in rheumatoid arthritis. “Fish oil supplementation should be considered in rheumatoid arthritis patients to help them reduce their NSAID intake in order to attenuate the risks of gastrointestinal and cardiovascular adverse events associated with these drugs,” the authors conclude.
Rheumatoid arthritis (RA) is a degenerative autoimmune disease in which the joints are attacked by an abnormal immune response and slowly destroyed. RA is much less common than osteoarthritis (OA), occurring in about 1 percent of the population and affecting women two to three times more frequently than men. The first symptoms typically appear between the ages of 25 and 50, although it can occur at any age, even childhood (juvenile RA). Unlike OA, RA is a systemic disease. It can affect organ systems throughout the body, not just the joints. Problems associated with RA include inflamed blood vessels, heart attack, neuropathy, lung complications, and others.
The omega-3 fatty acids are well-known anti-inflammatories that interfere with the underlying disease progression in RA. Studies have found that fish oil supplements, which are high in the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), can reduce TNF-alpha and interleukin-6. In one human study with 60 patients, groups were randomly assigned to take fish oil supplements or placebo. No other dietary modifications were made. At the end of the study, there were significant differences in the levels of pro-inflammatory cytokines in the patients taking fish oil (Sundrarjun T et al 2004). Another study compared the value of a diet high in omega-3 fatty acids and low in pro-inflammatory arachidonic acid with a normal Western diet (which tends to be pro-inflammatory). At the end of the study, patients on the anti-inflammatory diet experienced a 14 percent decrease in the number of swollen joints, while the patients on the Western diet experienced no change (Adam O et al 2003). These results have been supported by many other human studies demonstrating profound benefits of omega-3 fatty acids, including studies showing that some people can discontinue nonsteroidal anti-inflammatory drug (NSAID) treatment after beginning therapy with fish oil supplements (Kremer JM et al 1995).
Over-the-counter NSAIDs, such as naproxen (Aleve®), ibuprofen, and others, operate by inhibiting the cyclooxygenase enzymes (COX-1 and COX-2), which convert arachidonic acid to pro-inflammatory PGE2. Side effects of over-the-counter NSAIDs include gastrointestinal upset because the COX-1 enzyme is also partly responsible for maintaining the mucosal lining of the stomach.
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