High-dose fish oil could be a beneficial addition to conventional medications in recent-onset rheumatoid arthritis, Australian research suggests.
A randomised trial found success rates of first-line triple drug therapy were boosted by adding daily high-dose fish oil.
Patients also achieved remission faster when taking adjunctive high-dose fish oil, compared with a control group given a lower dose, the Royal Adelaide Hospital study found.
The study involved 140 patients with rheumatoid arthritis of less than a year’s duration, who were being treated with “contemporary best-practice therapy”.
This comprised triple therapy with the disease-modifying anti-rheumatic drugs (DMARDs) methotrexate, hydroxychloroquine and sufasalazine, given according to a predefined protocol.
After one year, triple therapy had failed in just 10.5% of patients taking additional high-dose fish oil, compared with 32% of those taking low-dose fish oil. Treatment failure was defined as requiring progression to a fourth agent, leflunomide.
“The beneficial effects of fish oil in rheumatoid arthritis have biological plausibility,” said the researchers, led by Professor Susanna Proudman.
“Eicosapentaenoic acid and/or docosahexaenoic acid can inhibit production of the pro-inflammatory lipid mediators, prostaglandin E2 and leukotriene B4, and peptide mediators, tumour necrosis factor-alpha and interleukin-1ß. These actions encompass the same molecular targets as NSAIDs and the TNF blockers, respectively.”
Omega-3 fatty acids have long been reported to improve rheumatoid arthritis symptoms, but earlier trials had not reflected “real-world” DMARD use, the researchers said.