DUNDEE, UK— Rheumatoid arthritis (RA) patients who take fish oil supplements can slash their need for nonsteroidal anti-inflammatory drugs (NSAIDs), according to a new study that appears on-line ahead of print in the journal Rheumatology.1

“Fish oil supplementation should be considered in RA patients to help them reduce their NSAID intake in order to attenuate the risks of gastrointestinal and cardiovascular adverse events associated with these drugs.”—Bernat Galarraga, MD
“Fish oil supplementation should be considered in RA patients to help them reduce their NSAID intake in order to attenuate the risks of gastrointestinal and cardiovascular adverse events associated with these drugs,” said lead author Bernat Galarraga, MD, of the University of Dundee in Dundee, UK.

The researchers recommend consuming 2.2 grams a day of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The supplement used in the study was the Seven Seas Marine Oil 1 (SSMO1). Patients took 10 grams of SSM01 a day, 10 capsules. The supplement contains blends of cod liver and fish oil containing 150 mg of EPA, 70 mg of DHA, 80 micrograms of vitamin A, 0.5 micrograms of vitamin D. and 2.0 international units of vitamin E.

“We have demonstrated that oral supplements of 2.2 grams a day of EPA and DHA reduce the daily intake of NSAIDs by more than a third in almost 40% of patients with RA, without any worsening of their disease activity,” Dr. Galarraga reported

The placebo-controlled study included 97 RA patients randomized to either the fish oil capsules or placebo. By 12 weeks, patients were instructed to gradually reduce and, if possible, stop their NSAID intake.

Overall, 39% of 49 patients in the fish oil group and out of 10% of 48 patients in the placebo group were able to reduce their daily NSAID requirement by >30%. There were no differences between the groups in the clinical parameters of RA disease activity or in the side effects.
There was a significant reduction in the visual analog scale for pain among those patients who took the fish oil supplements.

The new study did have a high withdrawal rate, mainly due to patients' unwillingness to take 10 large capsules each day along with their regular medication, the authors point out.

cod fish
The Atlantic cod Gadus morhua. Cold liver oil and other fish oil can help reduce the need for NSAIDs in rheumatoid arthritis.

Translating research into practice: back to basics for baby boomers

“Most baby boomers grew up taking a tablespoon of cod liver oil. It's nice to see we are getting back to that tradition,” commented Carolyn Dean, MD, ND, a naturopathic physician and author in City Island, NY. However, Dr. Dean emphasized the importance of choosing “a mercury-free brand of fish oil, due to the high levels of mercury contamination in some fish.”

References
1. Galarraga B, Ho M, Youssef HM, et al. Cod liver oil (b-3 fatty acids) as a non-steroidal anti-inflammatory drug sparing agent in rheumatoid arthritis. Rheumatology. [published online ahead of print March 24, 2008]. 2008; doi:10.1093/rheumatology/ken024.