Fish Oil May Boost Remission Chances in Early RA

Proudman SM, James MJ, Spargo LD, et al Fish oil in recent onset rheumatoid arthritis: a randomised, double-blind controlled trial within algorithm-based drug use , Ann Rheum Dis. (2013) doi: 10.1136/annrheumdis-2013-204145. First published online September 30, 2013

Adding high-dose fish oil to conventional disease modifying antirheumatic drugs (DMARDs) for early rheumatoid arthritis (RA) patients leads to a greater remission rate and reduces the chance of treatment failure at one year, according to a randomized clinical trial from Australia.

Fish oil, consisting of the omega-3 fats eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), dampens inflammatory mediators targeted by current RA treatments, including prostaglandin E2, leukotriene B4, and tumor necrosis factor alpha (TNF-α). Previous clinical trials have shown that EPA/DHA supplementation reduces pain, morning stiffness and painful/tender joints

The current trial demonstrates the benefits for fish oil in real-world clinical practice. It randomized 140 early RA patients to high-dose EPA/DHA (5.5 g/day). Patients taking only0.4 g/day of the supplement acted as controls. Women in their mid-50s on a common “triple therapy” of conventional DMARDs made up the majority of the cohort.

Triple therapy consisted of 10 mg oral methotrexate (MTX) weekly, 500 mg of sulfasalazine (Azulfidine) daily, and 200 mg hydroxychloroquine (Plaquenil) twice daily. (This is a standard regimen for achieving treat-to-target goals of low disease activity or remission in early RA.

Those on high dose fish oil (n=86) showed a significantly higher rate of remission than controls (n=53), and a lesser rate of treatment failure (even when adjusted for disease activity and toxicity).

Approximately 40% of patients who took fish oil reached ACR remission by one year. Only half as many controls achieved that goal.  In addition, only 10.5% of the fish oil group (n=9) started the DMARD leflunomide (Arava), indicating failure of triple treatment, versus 32.1% (n=17) of controls.  One person in the control group needed a biologic after one year.

Both groups show decreased disease activity (all had early RA and were DMARD-nave). Daily function, measured by  a modified Health Assessment Questionnaire, improved more during in the first three months of treatment in the fish oil group than among controls.

Similar rates of adverse and serious adverse events were seen in both groups, but compliance was lower in the fish oil group, presumably reflecting decreased tolerance to fish oil concentrate, the authors say.