MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

As I have said on several occasions before: I am constantly on the lookout for new rigorous science that supports the claims of alternative medicine. Thus I was delighted to find a recent and potentially important article with some positive evidence.

Fish oil has been studied extensively in terms of its effects on health. We know that it has powerful anti-inflammatory properties and might thus benefit a wide range of conditions. However, the effects of FO in rheumatoid arthritis (RA) have not been examined in the context of contemporary treatment of early RA.

A new study has tried to fill this gap by examining the effects of high versus low dose FO in early RA employing a ‘treat-to-target’ protocol of combination disease-modifying anti-rheumatic drugs (DMARDs).

Patients with RA <12 months’ duration and who were DMARD-naïve were enrolled and randomised 2:1 to FO at a high dose or low dose (for masking). These groups, designated FO and control, were given 5.5 or 0.4 g/day, respectively, of the omega-3 fats, eicosapentaenoic acid + docosahexaenoic acid. All patients received methotrexate (MTX), sulphasalazine and hydroxychloroquine, and DMARD doses were adjusted according to an algorithm taking disease activity and toxicity into account. DAS28-erythrocyte sedimentation rate, modified Health Assessment Questionnaire (mHAQ) and remission were assessed three monthly. The primary outcome measure was failure of triple DMARD therapy.

In the FO group, failure of triple DMARD therapy was lower (HR=0.28 (95% CI 0.12 to 0.63; p=0.002) unadjusted and 0.24 (95% CI 0.10 to 0.54; p=0.0006) following adjustment for smoking history, shared epitope and baseline anti–cyclic citrullinated peptide. The rate of first American College of Rheumatology (ACR) remission was significantly greater in the FO compared with the control group (HRs=2.17 (95% CI 1.07 to 4.42; p=0.03) unadjusted and 2.09 (95% CI 1.02 to 4.30; p=0.04) adjusted). There were no differences between groups in MTX dose, DAS28 or mHAQ scores, or adverse events.

The authors concluded that FO was associated with benefits additional to those achieved by combination ‘treat-to-target’ DMARDs with similar MTX use. These included reduced triple DMARD failure and a higher rate of ACR remission.

So here we have a dietary supplement that actually might generate more good than harm! There is a mountain of data of good research on the subject. We understand the mechanism of action and we have encouraging clinical evidence. Some people might still say that we do not need to take supplements in order to benefit from the health effects of FO, consuming fatty fish regularly might have the same effects. This is true, of course, but the amount of fish that one would need to eat every day would probably be too large for most people’s taste.

The drawback (from the perspective of alternative medicine) in all this is, of course, that some experts might deny that FO has much to do with alternative medicine. Again: what do we call alternative medicine that works? We call it MEDICINE! And perhaps FO is an excellent example of exactly that.

6 Responses to Fish oil supplementation may be useful for rheumatoid arthritis

  • I have to confess that I can’t make much sense of the lingo in this summary, but I trust that the conclusion is valid. My granddaughter has RA and was told to try fish oil at one point. She, being my granddaughter and all, was skeptical. She changed doctors fearing that the one who advised this was woo-inclined. She is doing well on serious drugs (Humera), but I wonder if she should look into this further.

    If you take very high doses of a 9supplement, isn’t that a drug?

  • I still remain skeptical of this study. Can you tell me how many patients were included?

    I don’t generally jump on the supplement bandwagon until I see at least, preferably more, systematic reviews. This is a one -off study that doesn’t give use sufficient information.

    I’m also concerned that the study doesn’t compare itself to standards of care that have become almost miraculous. Like one of the commenters above, Humira is wonderful against a lot of autoimmune diseases like RA.

    I have a rule that before I buy into something, there should be biological plausibility. I didn’t realize that there might be some.

    I’m skeptical, but certainly not at the homeopathy=water level. But this is interesting.

  • It is terribly bad for fish, of course, and given that expert opion is that the oceans will be fished out by 2048, and that research now shows that fish feel pain (duh!), perhaps it might be an idea to stop ploughing resources into something which has to come to an end, and start looking for humane, sustainable alternatives?

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