Omega-3 is indicated as an adjunct to diet to reduce very high triglyceride (TG) levels (500 mg/dL) in adult patients. Omega-3
is used for treatment post-myocardial infarction, in addition to other standard therapy, and for treatment of hypertriglyceridaemia (as a supplement to diet) when dietary measures are insufficient to produce an adequate response. Fish oils are a rich source of omega-3 long chain polyunsaturated fatty acids (n-3 LC PUFA). The specific fatty acids, eicosapentaenoic acid and docosahexaenoic acid, are homologues of the n-6 fatty acid, arachidonic acid (AA).
Rheumatoid arthritis (RA) is a debilitating disease and is associated with increased risk of cardiovascular disease and osteoporosis. A review of the published literature identified several studies that examined the use of omega-3 fatty acids in patients with rheumatoid arthritis. Few published literature also showed concomitant use of omega-3 fatty acids and NSAIDs. These studies are presented here.
Omega-3 PUFAs are shown to alleviate pain in patients with rheumatoid arthritis, inflammatory bowel disease and in a number of other painful conditions. This is attributed to the inhibition of pro-inflammatory eicosanoid and cytokine production by peripheral tissues. Rennie et al reviews the scientific evidence for the role of diet and nutrient
supplementation in the management of RA, by alleviating symptoms, decreasing progression of the disease or by reducing the reliance on, or combating the side-effects of, NSAIDs. Supplementation with long-chain n-3 polyunsaturated fatty acids (PUFA) consistently demonstrates an improvement in symptoms and a reduction in NSAID usage. The present evidence suggests that RA patients should consume a balanced diet rich in long-chain n-3 PUFA and antioxidants.
More randomized long-term studies are needed to provide evidence for the benefits of specific nutritional supplementation and to determine optimum intake, particularly for n-3 PUFA and antioxidants. Over 15
clinical trials and 2 meta-analyses favor the use of fish oil in patients with rheumatoid arthritis (RA). Fish oil supplementation consistently shows modest clinical improvement and reduction of nonsteroidal anti-inflammatory drug (NSAID) use in randomized clinical trials. One trial compared approximately 2.8 g of fish oil versus placebo in 64 patients with stable RA. In 3 months, the fish oil group showed significant reduction of NSAID use compared with placebo. This effect peaked at 12 months and was not associated with any clinical deterioration (LOE-2). A double-blind placebo-controlled trial showed that fish oil supplementation of 130 mg/kg/day decreased the number of tender joints, duration of morning stiffness, pain, and global arthritis activity versus placebo (LOE-2). Reduction of tumor necrosis factor, interleukin levels, and other anti-inflammatory mediators has been hypothesized as the main effect of omega-3 FA in RA. However, others recognize the importance and synergistic effects of a higher intake of omega-3 FA in conjunction with lower dietary intake of omega-6 FA. A double-blind placebo controlled trial using lower doses of fish oil (40 mg/kg; average, 2.3 g) in a background of low dietary omega-6 showed clinical improvement compared with placebo over 15 weeks ( P < .02) (LOE-2). Clinical improvements were similar to studies using higher doses. Another recent randomized controlled trial showed clinical benefits, reduction of NSAID, and corticosteroid use with low-dose fish oil supplementation (30 mg/kg; average, 2 g) in patients with diets low in omega-6 FA. Effects were significant at 3 months and peaked at 6 to 8 months (LOE-1). Another double-blind, randomized study compared daily supplementations with either 2.6 gm of omega 3, or 1.3 gm of omega 3 + 3 gm of olive oil, or 6 gm of olive oil. Significant improvement in the patient's global evaluation and in the physician's assessment of pain was observed only in those taking 2.6 gm/day of ega 3. The proportions of patients who improved and of those who were able to reduce their concomitant antirheumatic medications were significantly greater with 2.6 gm/day of omega 3. This concludes that daily supplementation with 2.6 gm of omega 3 results in significant clinical benefit and may reduce the need for concomitant antirheumatic medication.