Rheumatoid Arthritis: Fish Oil and Symptomatic Benefit

MedicalResearch.com Interview with
A/Prof Susanna M Proudman MB BS (Hons) FRACP
Discipline of Medicine, University of Adelaide
Senior Consultant in Rheumatology
Royal Adelaide Hospital
North Terrace, Adelaide, 5000

MedicalResearch.com: What are the main findings of the study?

Answer: In patients with early DMARD-naïve rheumatoid arthritis (RA), fish oil (delivering an average daily dose of 3.7 g dose of omega-3 fats) was associated with benefits additional to those achieved by combination treat-to-target DMARDs with similar methotrexate use. These included significantly reduced risk of triple DMARD failure, defined as needing the addition of leflunomide, and a higher rate of ACR remission.

Because a structured treatment algorithm that was responsive to disease activity and tolerance was used, drug use could be used as an outcome measure for the effects of fish oil. This is one of the novel features of this study as the study design allows for a RCT to be performed on a background of treat-to-target therapy for early RA.

MedicalResearch.com: Were any of the findings unexpected?

Answer: There were no significant differences in the DAS28 scores achieved. This was expected within the treat-to-target algorithm-based strategy for early RA, in which doses of DMARDs are increased or DMARDs are added until the disease activity target is attained.

On the other hand, there was an increased rate of ACR remission in the fish oil group, despite the decreased intensity of DMARD use,  indicating that more patients achieved the desired goal of treatment. This difference was masked by simply examining the mean DAS28 scores achieved.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: Two meta-analyses have confirmed the anti-inflammatory effects of fish oil which include reduced joint pain and swelling and NSAID-sparing effects. This study suggests that fish oil may have more than symptomatic benefits as the same low disease activity state can be reached with less intensive DMARD use in a rules-based, treat-to-target protocol in which doses of DMARDs are adjusted or new DMARDs are added until the target is reached. The decreased intensity of DMARD use for effective disease control in the fish oil group is an important finding because their failure can lead to use of costly biological agents.

This trial also demonstrates the effectiveness of treat-to-target triple DMARD therapy and that these benefits can be achieved with minimal NSAID and glucocorticoid use.

Using this novel study design, it is possible to conduct a RCT on a background of treat-to-target therapy, now considered best practice approach to the treatment of RA.

In addition to benefits for joint disease in RA, fish oil is safe and has additional collateral benefits of particular relevance to patients with RA including reduced cardiovascular risk.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: This study design in which drug use in a treat-to-target strategy is used as an outcome measure, should be considered for examining therapies in the context of modern drug treatment for recent onset RA

Examining the effects of fish oil on radiographic outcomes are planned.


Fish oil in recent onset rheumatoid arthritis: a randomised, double-blind controlled trial within algorithm-based drug use

Susanna M Proudman, Michael J James, Llewellyn D Spargo, Robert G Metcalf, Thomas R Sullivan, Maureen Rischmueller, Katerina Flabouris, Mihir D Wechalekar, Anita T Lee, Leslie G Cleland

Ann Rheum Dis annrheumdis-2013-204145Published Online First: 30 September 2013 doi:10.1136/annrheumdis-2013-204145


Last Updated on October 3, 2013 by Marie Benz MD FAAD