title: The concomitant consumption of cod liver oil causes a reduction in the daily diclofenac sodium usage in rheumatoid arthritis patients: a pilot study.
abstract: OBJECTIVE
  To evaluate whether the concomitant consumption of Cod liver oil can reduce the daily dose of Diclofenac Sodium and probably the risk of the side effects which are associated with it in Rheumatoid Arthritis patients.
  
  
  METHODS
  This longitudinal, prospective, open label study was conducted from April to September 2012 at Mahatma Gandhi Medical College and Hospital, Jaipur, India. 30 Rheumatoid Arthritis patients who were aged between 19 to 60 years, who fulfilled the inclusion criteria, were enrolled. Each patient was given five Cod liver oil capsules twice a day, for a period of 24 weeks. Each capsule which contained 300 mg of Cod liver oil had Eicosapentaenoic acid-20 mg and Docosahexaenoic acid-30 mg. The patients who took different Nonsteroidal anti-inflammatory drugs daily were switched over to Diclofenac Sodium 50 mg as a single dose, up to a maximum dose of 200 mg per day. The dose of Diclofenac Sodium which was consumed per day and the average daily requirement at different visits were recorded in each patient and they were compared. The patients were assessed for their pain scores by using the Visual Analogue Scale (VAS) at different weeks. In addition, the 'Subjective Response' to the pain was evaluated in each patient at the respective visits. The Student's "t"-test was applied for the analysis of the VAS pain score and for the evaluation of the reduction in the mean daily dose of the Diclofenac Sodium consumption. A probability value of less than 0.05 (p< 0.05) was considered to be statistically significant. Moreover, the results of the 'Subjective Response' to the pain were expressed as percentage.
  
  
  RESULTS
  A significant decrease (p< 0.05) in the mean VAS pain score from 80.38 ± 6.4 at week 0 to 67.30 ± 5.3 at week 24 was noted in the patients. There was a significant reduction (p<0.05) in mean dose of Diclofenac Sodium consumed from 115.04 ± 24.56 at week 4 to 98.83 ± 22.32 at week 24. Moreover, the percentage of the patients who experienced a 'Better' Subjective Response increased from 15.38% at week 4 to 61.53% at week 24 of the treatment follow up.
  
  
  CONCLUSIONS
  This study revealed that the concurrent use of Cod liver oil which contained n-3 Essential Fatty Acid in Rheumatoid Arthritis patients reduced the mean daily dose of Diclofenac Sodium consumed and probably the incidence of the side effects which were associated with it.
authors.affiliation: Demonstrator, Department of Pharmacology, Mahatma Gandhi Medical College and Hospital , Jaipur, India .
authors.forename: Vinay Kumar
authors.initials: VK
authors.lastname: Gupta
authors.forename: Z Y Zafer
authors.initials: ZY
authors.lastname: Khan
authors.forename: Mushtaq
authors.initials: M
authors.lastname: Ahmad
keywords: Diclofenac Sodium; Essential Fatty Acid; Rheumatoid Arthritis; Visual Analogue Scale