Cod liver oil (n-3 fatty acids) as an non-steroidal anti-inflammatory drug sparing agent in rheumatoid arthritis

Cod liver oil (n-3 fatty acids) as an non-steroidal anti-inflammatory drug sparing agent in rheumatoid arthritis.

Dose-dependant gastrointestinal and cardiovascular side-effects limit the use of NSAIDs in the management of RA. The n-3 essential fatty acids (EFAs) have previously demonstrated some anti-inflammatory and NSAID-sparing properties. The objective of this study was to determine whether cod liver oil supplementation helps reduce daily NSAID requirement of patients with RA.

METHODS: Dual-centre, double-blind placebo-controlled randomized study of 9 months' duration. Ninety-seven patients with RA were randomized to take either 10 g of cod liver oil containing 2.2 g of n-3 EFAs or air-filled identical placebo capsules. Documentation of NSAID daily requirement, clinical and laboratory parameters of RA disease activity and safety checks were done at 0, 4, 12, 24 and 36 weeks. At 12 weeks, patients were instructed to gradually reduce, and if possible, stop their NSAID intake. Relative reduction of daily NSAID requirement by >30% after 9 months was the primary outcome measure.

RESULTS: Fifty-eight patients (60%) completed the study. Out of 49 patients 19 (39%) in the cod liver oil group and out of 48 patients 5 (10%) in the placebo group were able to reduce their daily NSAID requirement by >30% (P = 0.002, chi-squared test). No differences between the groups were observed in the clinical parameters of RA disease activity or in the side-effects observed.

CONCLUSIONS: This study suggests that cod liver oil supplements containing n-3 fatty acids can be used as NSAID-sparing agents in RA patients.

Печень трески (n-3 жирных кислот) как нестероидные противовоспалительные препараты щадя агента при ревматоидном артрите.
Доза зависит от желудочно-кишечных и сердечно-сосудистые побочные эффекты ограничить применение НПВС в управлении РА. N-3 жирными кислотами), ранее продемонстрировал некоторые противовоспалительные и НПВП-щадящие свойства. Целью этого исследования было определить, является ли печень трески добавок помогает сократить ежедневные НПВП требование пациентов с РА.
МЕТОДЫ:Dual-центр, двойное слепое плацебо-контролируемое рандомизированное исследование 9 месяцев. Девяносто семь пациентов с РА были рандомизированы либо принимать по 10 г печени трески, содержащего 2,2 g n-3 EFAs или заполненных воздухом, идентичные капсулы плацебо. Документация НПВП суточной потребности, клинических и лабораторных параметров РА активности заболевания и безопасности, проверки были проведены на 0, 4, 12, 24 и 36 недель. В 12 недель, пациентов было поручено постепенно сокращать, и, если возможно, остановить их НПВП потребления. Относительное уменьшение суточного НПВП требование более чем на 30% по итогам 9 месяцев было основным критерием оценки.
РЕЗУЛЬТАТЫ:Пятьдесят восемь пациентов (60%) завершили исследование. Из 49 пациентов, 19 (39%) в печени трески группу, и из 48 пациентов 5 (10%) в группе плацебо смогли снизить свои ежедневные НПВП требование более чем на 30% (Р = 0,002, хи-квадрат). Никаких различий между группами наблюдались в клинических параметров РА активности заболевания или побочных эффектов отмечено не было.
ВЫВОДЫ:В этом исследовании, предполагает, что печень трески добавок, содержащих n-3 жирных кислот может быть использован в качестве НПВП-щадящие вещества у пациентов с РА.
Pain. 2007 May;129(1-2):210-23. Epub 2007 Mar 1.

A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain.

Between 40% and 60% of Americans use complementary and alternative medicine to manage medical conditions, prevent disease, and promote health and well-being. Omega-3 polyunsaturated fatty acids (omega-3 PUFAs) have been used to treat joint pain associated with several inflammatory conditions. We conducted a meta-analysis of 17 randomized, controlled trials assessing the pain relieving effects of omega-3 PUFAs in patients with rheumatoid arthritis or joint pain secondary to inflammatory bowel disease and dysmenorrhea. Meta-analysis was conducted with Cochrane Review Manager 4.2.8. for six separate outcomes using standardized mean differences (SMDs) as a measure of effect size: (1) patient assessed pain, (2) physician assessed pain, (3) duration of morning stiffness, (4) number of painful and/or tender joints, (5) Ritchie articular index, and (6) nonselective nonsteroidal anti-inflammatory drug consumption. Supplementation with omega-3 PUFAs for 3-4 months reduces patient reported joint pain intensity (SMD: -0.26; 95% CI: -0.49 to -0.03, p=0.03), minutes of morning stiffness (SMD: -0.43; 95% CI: -0.72 to -0.15, p=0.003), number of painful and/or tender joints (SMD: -0.29; 95% CI: -0.48 to -0.10, p=0.003), and NSAID consumption (SMD: -0.40; 95% CI: -0.72 to -0.08, p=0.01). Significant effects were not detected for physician assessed pain (SMD: -0.14; 95% CI: -0.49 to 0.22, p=0.45) or Ritchie articular index (SMD: 0.15; 95% CI: -0.19 to 0.49, p=0.40) at 3-4 months. The results suggest that omega-3 PUFAs are an attractive adjunctive treatment for joint pain associated with rheumatoid arthritis, inflammatory bowel disease, and dysmenorrhea.