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Natural Arthritis Relief With Omega-3 Fatty Acids

September 2006

Recently, alarming studies documenting the potentially deadly side effects of prescription anti-arthritis drugs such as Vioxx® and Celebrex® have forced many to relinquish these medications. The result has been a frantic scramble among scientists and arthritis sufferers alike to find safe, effective agents that reduce inflammation and relieve arthritis pain.

Fortunately, groundbreaking research has uncovered new substances derived from the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) that resolve and protect against inflammation. These newly discovered substances, aptly called resolvins and protectins, may help provide arthritis relief without the side effects of conventional arthritis drugs.

Arthritis: A Family of Diseases Linked by Inflammation

Arthritis is not a single disorder, but rather a family of diseases, the most common of which are osteoarthritis and rheumatoid arthritis.

Osteoarthritis is considered the “wear and tear” arthritis, in which the cartilage that cushions our joints deteriorates, producing pain and discomfort. The most common type of joint disease, osteoarthritis is often associated with aging and exacerbated by obesity. By contrast, rheumatoid arthritis is an autoimmune disease in which the immune system mistakenly attacks the body’s own tissues, resulting in joint inflammation and tissue destruction. Both forms of arthritis are characterized by tenderness, stiffness, and inflammation in the joints. This pain can become severe, limiting mobility and adversely affecting one’s quality of life.1

Omega-3s Help Relieve Osteoarthritis Pain

Omega-3 fatty acids show promise in relieving the pain of osteoarthritis. In a preliminary study, individuals who supplemented with the omega-3 fatty acid EPA for six months reported less arthritis pain compared to people who did not supplement.2 This suggests that omega-3 fats could help restore mobility and quality of life to those who whose daily activities may be limited by arthritis pain.

In the laboratory, researchers have noted that adding omega-3 fatty acids to cartilage cells decreases their susceptibility to inflammation and degradation, such as occurs with osteoarthritis.3,4 Omega-3 fatty acids may thus guard against the degenerative joint destruction that accompanies osteoarthritis.

Powerful Pain Relief for Rheumatoid Arthritis

Abundant evidence suggests that omega-3s benefit people suffering from rheumatoid arthritis. Numerous studies document the rheumatoid arthritis-relieving effects of fish oil.5-10 The most commonly observed benefit is a decrease in swollen, painful joints,8 but improvements in morning stiffness, pain index, and grip strength are also reported.5,7 Several studies suggest that a minimum of 3 grams of omega-3 fatty acids daily for three months is needed to produce benefits.5-10

Earlier this year, scientists reported that omega-3 fatty acids administered intravenously quickly relieve rheumatoid arthritis pain. Patients with active rheumatoid arthritis received fish oil intravenously, in addition to standard prescription therapies. After just one week of once-a-day therapy, more than half of the patients experienced significant improvement in their symptoms. The therapy was well tolerated, and the research team recommended further investigation into the intravenous use of omega-3 fatty acids as a therapeutic option for rheumatoid arthritis patients.11

In a recent study from Brazil, rheumatoid arthritis patients reported markedly improved symptoms within three months by taking a daily dose of 3 grams of omega-3 fatty acids from fish oil. The patients experienced improvements in grip strength, pain intensity, ability to move easily, and fatigue. Interestingly, patients who also added olive oil to their daily regimen of fish oil supplements experienced even greater improvements in their symptoms, as determined by both self-reported and objective assessments of disease activity. The benefits of supplementation were even more pronounced after six months of therapy.12 This synergistic effect between olive oil and fish oil was reported in an earlier study by US researchers, who documented a significant decrease in production of inflammatory cytokines, as well as relief of rheumatoid arthritis symptoms, in patients who received fish oil and olive oil.13

Regular consumption of omega-3 fats from fish oil could help rheumatoid arthritis sufferers reduce their use of pain-relieving nonsteroidal anti-inflammatory drugs (NSAIDs). Numerous studies have documented that when rheumatoid arthritis patients regularly consume fish oil, they can dramatically lessen their need for NSAIDs.14-16 A substantial number of individuals have experienced ongoing relief from rheumatoid arthritis symptoms with continued fish oil supplementation.15,16

Omega-3s Fight Pain by Quelling Inflammation

Omega-3s may be particularly helpful in managing arthritis because they reduce production of compounds that fuel the fires of inflammation, while increasing the production of biochemicals that limit inflammation.

New research reveals that EPA and DHA both serve as direct precursors of novel anti-inflammatory compounds aptly named resolvins and protectins.17,18 Groundbreaking work shows that various resolvins from EPA and DHA trigger resolution, or reduction, of inflammation, while protectins derived from DHA offer powerful protection against runaway inflammation.19 Furthermore, consumption of omega-3 fatty acids has been associated with reduced levels of two pro-inflammatory cytokines, tumor necrosis factor-alpha and interleukin-1 beta, in rheumatoid arthritis patients.20 EPA and DHA may thus help alleviate the inflammation that contributes to the pain and disability of arthritis.

Natural, Safe Relief—Without the Risks of Pharmaceuticals

Some physicians now consider fish oil an option preferable to NSAIDs such as ibuprofen or Celebrex® for relief from the inflammation of arthritis. For example, a group of Australian rheumatologists recently noted that fish oil has a number of advantages over NSAIDs. First, fish oil has not been associated with the potentially serious side effects of NSAIDs, such as upper digestive tract upset or upper gastrointestinal tract bleeding.21 (Since fish oil can produce a modest blood thinning effect, people who suffer from an abnormal bleeding tendency or use blood-thinning drugs such as Coumadin® should consult a physician before taking fish oil.22)

Furthermore, omega-3 fatty acids from fish oil benefit cardiovascular health, in contrast to some prescription arthritis medications, such as Bextra® and Vioxx®, that may harm the cardiovascular system.23 Thus, while fish oil works through several mechanisms to reduce risk for cardiovascular events, including cardiac death,24 numerous prescription drugs for arthritis actually increase the risk of cardiovascular events.23 For this reason, some physicians now recommend that their patients take the lowest possible dose, for the shortest possible time, when using NSAIDs to treat arthritis.21 By contrast, many nutritionally oriented physicians are now urging their patients to regularly consume fish oil in order to relieve the inflammation associated with arthritis and safeguard their cardiovascular health.


Growing clinical evidence indicates that supplemental omega-3 fatty acids from fish oil may help relieve the inflammation, pain, and immobility of arthritis. Unlike many commonly used prescription pain relievers, these essential fatty acids are safe and well tolerated.

Clearly, people seeking to prevent or relieve joint inflammation and its associated immobility and pain should consider including the omega-3 fatty acids EPA and DHA in their daily nutritional program.


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2. Stammers T, Sibblad B, Freeling P. Fish oil in osteoarthritis. Lancet. 1989. Aug 26;2(8661):503.

3. Curtis CL, Rees SG, Little CB, et al. Pathological indicators of degradation and inflammation in human osteoarthritic cartilage are abrogated by exposure to n-3 fatty acids. Arthritis Rheum. 2002 Jun;466):1544-53.

4. Curtis CL, Rees SG, Cramp J, et al. Effects of n-3 fatty acids on cartilage metabolism. Proc Nutr Soc. 2002 Aug;61(3):381-9.

5. Hagfors L, Nilsson I, Skoldstam L, Johansson G. Fat intake and composition of fatty acids in serum phospholipids in a randomized, controlled, Mediterranean dietary intervention study on patients with rheumatoid arthritis. Nutr Metab (Lond). 2005 Oct 10;2:26.

6. Volker D, Fitzgerald P, Major G, Gang M. Efficacy of fish oil concentrate in the treatment of rheumatoid arthritis. J Rheumatol. 2000 Oct;27(10):2343-6.

7. James MJ, Cleland LG. Dietary n-3 fatty acids and therapy for rheumatoid arthritis. Semin Arthritis Rheum. 1997 Oct;27(2):85-97.

8. Kremer JM. n-3 fatty acid supplements in rheumatoid arthritis. Am J Clin Nutr. 2000 Jan;71(1 Suppl):349S-51S.

9. James MJ, Proudman SM, Cleland LG. Dietary n-3 fats as adjunctive therapy in a prototypic inflammatory disease: issues and obstacles for use in rheumatoid arthritis. Prostaglandins Leukot Essent Fatty Acids. 2003 Jun;68(6):399-405.

10. Fortin PR, Lew RA, Liang MH, et al. Validation of a meta-analysis: the effects of fish oil in rheumatoid arthritis. J Clin Epidemiol. 1995 Nov;48(11):1379-90.

11. Leeb BF, Sautner J, Andel I, Rintelen B. Intravenous application of omega-3 fatty acids in patients with active rheumatoid arthritis. The ORA-1 trial. An open pilot study. Lipids. 2006 Jan;41(1):29-34.

12. Berbert AA, Kondo CR, Alemendra CL, Matsuo T, Dichi I. Supplementation of fish oil and olive oil in patients with rheumatoid arthritis. Nutrition. 2005 Feb;21(2):131-6.

13. Kremer JM, Lawrence DA, Jubiz W, et al. Dietary fish oil and olive oil supplementation in patients with rheumatoid arthritis. Clinical and immunologic effects. Arthritis Rheum. 1990 Jun;33(6):810-20.

14. Belch JJ, Ansell D, Madhok R, O’Doud A, Sturrock RD. Effects of altering dietary essential fatty acids on requirements for non-steroidal anti-inflammatory drugs in patients with rheumatoid arthritis: a double blind placebo controlled study. Ann Rheum Dis. 1988 Feb;47(2):96-104.

15. Lau CS, Morley KD, Belch JJ. Effects of fish oil supplementation on non-steroidal anti-inflammatory drug requirement in patients with mild rheumatoid arthritis—-a double-blind placebo controlled study. Br J Rheumatol. 1993 Nov;32(11):982-9.

16. Kremer JM, Lawrence DA, Petrillo GF, et al. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Clinical and immune correlates. Arthritis Rheum. 1995 Aug;38(8):1107-14.

17. Ariel A, Li PL, Wang W, et al. The docosatriene protectin D1 is produced by TH2 skewing and promotes human T cell apoptosis via lipid raft clustering. J Biol Chem. 2005 Dec 30;280(52):43079-86.

18. Chiang N, Serhan CN. Cell-cell interaction in the transcellular biosynthesis of novel omega-3-derived lipid mediators. Methods Mol Biol. 2006;341:227-50.

19. Serhan CN, Gotlinger K, Hong S, et al. Anti-inflammatory actions of neuroprotectin D1/protectin D1 and its natural stereoisomers: assignments of dihydroxy-containing docosatrienes. J Immunol. 2006 Feb 1;176(3):1848-59.

20. James MJ, Gibson RA, Cleland LG. Dietary polyunsaturated fatty acids and inflammatory mediator production. Am J Clin Nutr. 2000 Jan;71(1 Suppl):343S-8S.

21. Cleland LG, James MJ. Marine oils for antiinflammatory effect— time to take stock. J Rheumatol. 2006 Feb;33(2):207-9.

22. Buckley MS, Goff AD, Knapp WE. Fish oil interaction with warfarin. Ann Pharmacother. 2004 Jan;38(1):50-2.

23. Motsko SP, Rascati KL, Busti AJ, et al. Temporal relationship between use of NSAIDs, including selective COX-2 inhibitors, and cardiovascular risk. Drug Saf. 2006;29(7):621-32.

24. Oh R. Practical applications of fish oil (Omega-3 fatty acids) in primary care. J Am Board Fam Pract. 2005 Jan-Feb;18(1):28-36.