title: Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Clinical and immune correlates.
abstract: OBJECTIVE
  To determine the following: 1) whether dietary supplementation with fish oil will allow the discontinuation of nonsteroidal antiinflammatory drugs (NSAIDs) in patients with rheumatoid arthritis (RA); 2) the clinical efficacy of high-dose dietary omega 3 fatty acid fish oil supplementation in RA patients; and 3) the effect of fish oil supplements on the production of multiple cytokines in this population.
  
  
  METHODS
  Sixty-six RA patients entered a double-blind, placebo-controlled, prospective study of fish oil supplementation while taking diclofenac (75 mg twice a day). Patients took either 130 mg/kg/day of omega 3 fatty acids or 9 capsules/day of corn oil. Placebo diclofenac was substituted at week 18 or 22, and fish oil supplements were continued for 8 weeks (to week 26 or 30). Serum levels of interleukin-1 beta (IL-1 beta), IL-2, IL-6, and IL-8 and tumor necrosis factor alpha were measured by enzyme-linked immunosorbent assay at baseline and during the study.
  
  
  RESULTS
  In the group taking fish oil, there were significant decreases from baseline in the mean (+/- SEM) number of tender joints (5.3 +/- 0.835; P < 0.0001), duration of morning stiffness (-67.7 +/- 23.3 minutes; P = 0.008), physician's and patient's evaluation of global arthritis activity (-0.33 +/- 0.13; P = 0.017 and -0.38 +/- 0.17; P = 0.036, respectively), and physician's evaluation of pain (-0.38 +/- 0.12; P = 0.004). In patients taking corn oil, no clinical parameters improved from baseline. The decrease in the number of tender joints remained significant 8 weeks after discontinuing diclofenac in patients taking fish oil (-7.8 +/- 2.6; P = 0.011) and the decrease in the number of tender joints at this time was significant compared with that in patients receiving corn oil (P = 0.043). IL-1 beta decreased significantly from baseline through weeks 18 and 22 in patients consuming fish oil (-7.7 +/- 3.1; P = 0.026).
  
  
  CONCLUSIONS
  Patients taking dietary supplements of fish oil exhibit improvements in clinical parameters of disease activity from baseline, including the number of tender joints, and these improvements are associated with significant decreases in levels of IL-1 beta from baseline. Some patients who take fish oil are able to discontinue NSAIDs without experiencing a disease flare.
authors.affiliation: Division of Rheumatology, Albany Medical College A-100, NY 12208, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Kremer
authors.forename: D A
authors.initials: DA
authors.lastname: Lawrence
authors.forename: G F
authors.initials: GF
authors.lastname: Petrillo
authors.forename: L L
authors.initials: LL
authors.lastname: Litts
authors.forename: P M
authors.initials: PM
authors.lastname: Mullaly
authors.forename: R I
authors.initials: RI
authors.lastname: Rynes
authors.forename: R P
authors.initials: RP
authors.lastname: Stocker
authors.forename: N
authors.initials: N
authors.lastname: Parhami
authors.forename: N S
authors.initials: NS
authors.lastname: Greenstein
authors.forename: B R
authors.initials: BR
authors.lastname: Fuchs
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000178:diet therapy* / Q000188:drug therapy / Q000276:immunology; D016207:Cytokines / Q000096:biosynthesis / Q000276:immunology; D003627:Data Interpretation, Statistical; D004008:Diclofenac / Q000627:therapeutic use; D004334:Drug Administration Schedule; D015525:Fatty Acids, Omega-3 / Q000276:immunology / Q000627:therapeutic use; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos; D013997:Time Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016207:Cytokines; D015525:Fatty Acids, Omega-3; D005395:Fish Oils; D010919:Placebos; D004008:Diclofenac