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Prescribe fish for treatment of rheumatoid arthritis

Prescribe fish for treatment of rheumatoid arthritis

Rheumatologists often recommend fish oil supplementation for their rheumatoid arthritis (RA) patients, a practice that is supported by at least one randomized trial.Some clinicians also recommend fish oil supplements for patients with Knee osteoarthritis but strong evidence to support that practice is lacking.Proudman SM et al.conducted a randomized, double-blind controlled trial to examine the effects of high versus low dose FO in early RA.The investigators found that Fish Oil was associated with benefits that included reduced triple DMARD failure and a higher rate of ACR remission.The study has been published in Annals of  Rheumatic Diseases.

Some  ω-3 fatty acids downregulate proinflammatory cytokines; therefore, researchers have evaluated their effectiveness in patients with rheumatoid arthritis (RA). Therefore in the present study, they aimed to find whether Fish oil supplements, when added to traditional nonbiologic triple therapy, can produce higher rates of remission and lower counts of tender joints.

In order to examine whether dietary fish intake also attenuates RA disease activity, investigators studied a subset of 176 RA patients with RA <12 months’ duration and who were DMARD-naïve were enrolled and randomised 2:1 to FO at a high dose or low dose.The participants were categorized by frequency of fish consumption (ranging from less than once monthly to twice weekly or more often and excluding fried fish, nonfried shellfish, and fish in mixed dishes). A single trained, blinded assessor evaluated disease activity scores (DAS) in 28 joints using DAS28-CRP scores (which reflect both clinical findings and C-reactive protein [CRP] levels).

Participants who ate fish more than twice weekly had significantly lower DAS28-CRP scores than those who ate fish less than once monthly. For each additional serving of fish weekly, DAS28-CRP was reduced significantly. Results were similar after adjusting for several demographic and clinical variables.

The authors concluded that FO was associated with benefits additional to those achieved by combination ‘treat-to-target’ DMARDs with similar MTX use. These included reduced triple DMARD failure and a higher rate of ACR remission.

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DOI: 10.1136/annrheumdis-2013-204145


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