Does Taking Fish Oil Help Rheumatoid Arthritis?

May 10, 2011

Kremer JM & colleagues from Albany Medical College, New York conducted one of the earliest studies of fish oil in Rheumatoid arthritis patients in 1995. They administered fish oil to one group of patients & corn oil to the other group after stopping their analgesics. Patients on fish oil showed significant improvement in their arthritis. Numerous studies since then have shown a beneficial effect of fish oils in RA.

I’m sure you would be quite curious to know how fish oils can reduce the joint inflammation in RA. Let us understand the mechanism of inflammation at the cellular level for the same. The cell membrane is made up of polyunsaturated fatty acids (PUFA) containing phospholipids. Inflammatory chemicals are generated from these PUFAs.

There are two major types of PUFAs; omega -6 PUFA & the omega -3 PUFA. The omega-6 PUFA related arachidonic acid is the major substrate for inflammatory chemicals. This arachidonic acid is converted by cox-2 enzyme into the inflammatory chemicals. Cox-2 blocker medicines like celecoxib/ rofecoxib reduce inflammation by blocking this enzyme.

The other PUFA present in the cell membrane is the omega -3 PUFA Eicosapentaenoic Acid (similar to arachidonic acid of omega -6 PUFA). This is again converted by cox-2 enzyme into inflammatory chemicals. However, these are not as potent as the arachidonic acid related chemicals. In fact, some of the chemicals generated have anti-inflammatory effects.
Fish oils for Rheumatoid arthritis
Thus, if one can replace the omega -6 Arachidonic Acid from the cell membrane by the omega -3 Eicosapentaenoic Acid; this may actually help reduce inflammation in the joints. This can be achieved by increasing the omega -3 PUFAs in the diet.

Fish oil is derived form cold water fish like mackerel, salmon, tuna, herring, halibut, cod & contains long chain omega -3 PUFAs. When taken orally, it does replace omega -6 Arachidonic Acid from the cell membrane. Multiple studies in RA patients have shown decreased generation of inflammatory cytokines with oral fish oils. Most of the studies have shown beneficial effects of fish oils on joint inflammation in RA.

Precautions:
1. Fish oils cannot replace DMARDs. They can only be used as a supplement.
2. Look for fish oil brands that do not contain mercury.
3. Fish oils may increase the risk of bleeding when taken with blood thinner medications.
4. Please discuss your prescription with your Rheumatologist before starting fish oils.

References:
1. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Clinical and immune correlates. Arthritis Rheum. 1995 Aug;38(8):1107-14. Kremer JM, Lawrence DA & colleagues
2. Polyunsaturated Fatty Acids and Inflammation: Therapeutic Potential inRheumatoid Arthritis. Philip C. Calder Current Rheumatology Reviews, 2009, 5, 214-225
3. Long-chain polyunsaturated fatty acids and inflammation. Philip C. Calder Scandinavian Journal of Food and Nutrition 2006; 50 (S2): 54 _61


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