CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Clinical pathology abstracts editor: Deborah Sesok-Pizzini, MD, MBA, associate professor, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and medical director, Blood Bank and Transfusion Medicine, Children’s Hospital of Philadelphia.
Effects of fish oil in recent-onset rheumatoid arthritis: a patient study
The omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaneonic acid (DHA), which are found in fish oil, can suppress synthesis of the omega-6 proinflammatory eicosanoids prostaglandin E2 and leukotriene B4. The effects of fish oil as a dietary supplement in rheumatoid arthritis have been studied in randomized, controlled trials for patient-assessed pain, morning stiffness, number of painful or tender joints, and non-steroidal anti-inflammatory drug consumption. The authors conducted a study to examine the effects of high- versus low-dose fish oil in early rheumatoid arthritis in the context of a treat-to-target protocol of combination disease-modifying anti-rheumatic drugs (DMARDs). Patients who had rheumatoid arthritis for less than 12 months and were DMARD naïve were enrolled and randomized 2:1 to fish oil at a high dose or low dose (control group). These groups were given 5.5 or 0.4 g/day of the omega-3 fats. All patients received methotrexate, sulphasalazine, and hydroxychloroquine. DMARD doses were adjusted according to an algorithm based on disease activity. The primary outcome measure was failure of triple DMARD therapy. Results showed that the failure of triple DMARD therapy was lower (hazard ratio=0.28 unadjusted and 0.24 adjusted) for smoking history, shared epitope, and baseline anti-cyclic citrullinated peptide. Furthermore, the rate of remission was significantly greater in the fish oil group compared with the control group. No differences between groups were noted with regard to methotrexate dose, DAS28-erythrocyte sedimentation rate, modified health assessment questionnaire, or adverse events. The authors concluded that these results show that fish oil is associated with benefits additional to those achieved by combination treat-to-target DMARDs with similar methotrexate use in early rheumatoid arthritis. These results indicate that fish oil has benefits for increased rates of remission and decreased drug use.
Proudman SM, James MJ, Spargo LD, et al. Fish oil in recent onset rheumatoid arthritis: a randomized, double-blind controlled trial within algorithm-based drug use [published online ahead of print Sept. 30, 2013]. Ann Rheum Dis. doi:10.1136/annrheumdis-2013-204145.
Correspondence: Susanna M. Proudman at sproudman@internode.on.net