The Fish Foundation

Rheumatoid Arthritis and Long Chain Omega-3 Polyunsaturates

    The first double blind clinical trial to report a positive outcome in omega-3  supplementation studies in RA patients appeared in 1985. Kremer(1985)  reported in the Lancet that rheumatoid arthritis patients showed less morning stiffness, fewer painful and swollen joints after 12 weeks on 10g of Maxepa fish oil daily (3.6g w-3). The same author went on to complete a series of related studies (Kremer,1987; Kremer,1988; Kremer,1990; Kremer 1995)  all of which showed much the same thing, i.e. that when rheumatoid arthritis (RA)  patients supplemented their diets with 3-5g of w-3 daily, (equivalent to 10-20mls of fish oil) for  12 weeks  or more, their arthritic symptoms improved.

Since that first paper, other research groups have explored the impact of fish oils on RA, and all have found more or less the same result, that the pain, stiffness and inflammation of RA is reduced when the long chain omega-3 polyunsaturates are added to the diet.

Belch reported in 1988 that rheumatoid arthritis patients treated with a mixture of  fish oil and evening primrose oil (omega-3 polyunsaturates 0.4g/d  and omega-6 5g/d polyunsaturates) for 12 months showed significantly lower use of non-steroidal anti-inflammatory  drug (NSAID) usage. After stopping the supplementation, painkiller usage remained at a low level for a further 12 weeks in the group receiving the fish oil, before rising to pre-trial levels. 

The same year, Cleland reported their data from a group of 60 RA patients taking 18 fish oil  capsules daily (6.5g w-3) in a double blind trial. They found  a significant drop in the number of tender joints, an increase in grip strength, and  biochemical changes in the w-3 group which were consistent with a lower level of disease activity. The placebo (olive oil) group showed no such changes. 

    The more interesting feature of this paper is that the authors were able to demonstrate a significantly  lower level of an inflammatory substance in the treated patients  compared to those on olive oil. This substance, known as leukotriene LTB4 is a well known cause of inflammatory symptoms, and is thought to be a part of the mechanism which operates in RA, though why it should be elevated is not yet known.

Lower levels of LTB4 were also found in a trial reported by van der Tempel and colleagues in 1980.

In the intervening years  many published studies have appeared  which confirm the results found by Kremer, Belch and Cleland. 

Tulleken et al,1990,  Magaro(1988), Magaro(1992) ,  Lau et al,1993, Lau et al,1995,  and Sperling et al (1997), have all confirmed the original  work. Das(1991)  has systematically reviewed much of the advances in understanding the role of the polyunsaturates in inflammatory conditions such as rheumatoid arthritis.

To sum up, there is no doubt that having long chain omega-3 polyunsaturates in the diet helps to "damp down" the pain, swelling, tenderness and stiffness of joints affected by rheumatoid arthritis.  At the same time, it is necessary to recognise that on their own, the omega-3's  cannot be  considered a cure for every person affected by  rheumatoid arthritis. As part of a treatment regime involving diet and lifestyle, as well as orthodox and perhaps complimentary therapies,  the omega-3 polyunsaturates  offer significant  help in permitting sufferers  to regain some degree of normality. The evidence also shows that usage of potentially damaging pain-killers can be significantly reduced.