Omega-3 fatty acids and arthritis

Narinder Duggal, MD, FRCPC

Omega-3 fatty acids represent a unique group of polyunsaturated essential fatty acids because of their multiple therapeutic effects including anti-inflammatory functions. Omega-3 fatty acids are classified as 'essential' because they cannot be synthesized in the body and therefore must be obtained through diet or supplements. So it is important that our diet includes foods containing omega-3 fatty acids.

Evidence from several clinical studies has consistently shown that omega-3 fatty acids, especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) offer significant therapeutic benefits in the patients with arthritis.¹ Data from these studies support the efficacy of omega-3 fatty acids in reducing pain, reducing the number of tender joints, reducing the duration of morning stiffness, reducing the use of non-steroidal anti-inflammatory drugs (NSAID) and improving physical performance in Rheumatoid Arthritis (RA) patients.^2,3

Omega-3 fatty acids are potent anti-inflammatory agents. A sufficient high intake of omega-3 fatty acids decrease the production of inflammatory mediators, prostaglandins, leukotriene and interleukin-1.^4-6They also give rise to a family of anti-inflammatory mediators termed resolvins.⁷ Due to these anti-inflammatory properties, clinical application of omega-3 fatty acids is indicated in patients with rheumatoid arthritis.⁵

Significant improvement in the clinical symptoms of RA such as, tender joints and morning stiffness has been observed in patients taking fish oil capsules. In a double-blind, placebo-controlled, randomized study, RA patients were given 10g of cod liver oil containing 2.2 g of omega-3 fatty acids. It was found that out of 58 patients, 49 were able to reduce their daily NSAID requirement by more than 30%.⁸Moreover, studies have also shown that some patients, taking fish oil supplements for RA are able to discontinue their NSAID treatment.⁹ Some investigators have reported that a minimum daily dose of 3 g EPA and DHA is necessary to derive the clinical benefits in RA patients.⁴

Some researchers believe that omega-3 fatty acid supplementation along with NSAID’smay provide considerable therapeutic effect in RA patients. The findings of a recent study suggested that the RA patients who were given omega-3 fatty acid supplementation with indomethacin achieved a better improvement in terms of reducing disease activity.¹⁰

The intravenous application of omega-3 fatty acids in patients with active RA, as an add-on therapy proved to be well tolerated and led to the improvement of the disease activity status.¹¹ Recently, a double-blind, randomized, placebo-controlled study investigated the efficacy and safety of intravenous infusion of omega-3 fatty acids. The authors observed infusion therapy of omega-3 fatty acids is well tolerated and can improve clinical symptoms of RA, but subsequent oral administration of omega-3 fatty acids may prolong the beneficial effects of the infusion therapy.¹²

It is believed that an ideal omega-6 to omega-3 fatty acid ratio in humans should be 1:1, whereas in a typical American diet, it is 15:1 to 16.7:1.^13,14 The omega-6 fatty acids are the precursor of prostaglandins, leukotrienes, and related compounds that play important roles in inflammation.^15,16 Higher intake of omega-6 fatty acids than omega-3 promotes the pathogenesis of many diseases including Rheumatoid Arthritis.14 In a placebo controlled, double blind randomized study involving RA patients, whose omega-6 fatty acid intake was less than 10g/d, were supplemented with omega-3 fatty acids at a rate of 40mg/kg body weight. The findings showed a significant improvement in the clinical status of RA patients.¹⁷

In addition to its anti-inflammatory effect, omega-3 fatty acid administration is able to prevent an arthritis-induced decrease in body weight and muscle wasting,¹⁸ per a recent 2009 study. Omega-3 fatty acids are proven to be effective in osteoarthritis (OA) also. Studies have shown that omega-3 fatty acids can alter the pathologic indicators of OA, and they are able to decrease symptoms of this disease.^19,20A clinical trial in which 177 patients with moderate to severe OA, were treated with either glucosamine sulfate or a combination of omega-3 fatty acids with glucosamine sulfate. After a treatment of over 26 weeks, the authors found that OA symptom reduction was greater in patients who were also given omega-3 fatty acids than the patients who received glucosamine sulfate alone.²¹

Increasing omega-3 fatty acids and decreasing omega-6 fatty acid is required to improve the ratio of omega-6/omega-3 fatty acids and has been demonstrated through research to reduce the symptoms of arthritis. Omega-3 fatty acids supplements can also be used as an adjunct to other drug therapy used to treat RA. Synergy Therapeutics Rx offers the highest quality omega-3 fatty acid ‘EPACOR’ containing 660mg of EPA and 340mg of DHA per serving. Ask your physician about adding EPACOR to improve symptoms of arthritis. Purchase EPACOR today.

References:

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3.    Sales C, Oliviero F, Spinella P. [The mediterranean diet model in inflammatory rheumatic diseases]. Reumatismo 2009;61(1):10-4. (PUBMED Abstract)
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