Fish Oil (Omega-3 Fatty Acids) and Rheumatoid Arthritis

Article by Arnie Gitomer

When a high dose of EPA/DHA omega-3 oils is added to conventional drugs in the treatment of early Rheumatoid Atthritis, the treatment results are significantly improved.

Rheumatoid arthritis is an inflammatory disease characterized by inflammation, pain and joint destruction. It is an autoimmune disease, which means the body mistakenly attacks the lining of the joints. To control symptoms and stop joint damage, rheumatologists usually try one or a combination of disease-modifying antirheumatic drugs (DMARDs). One effective, commonly used drug combination is methotrexate, sulfasalazine and hydroxychloroquine – dubbed “triple therapy” – but it doesn’t work for everybody.

Fish oil, which contains anti-inflammatory omega-3 fatty acids has been shown in previous studies to reduce inflammation and pain associated with RA – and to allow patients to cut back on the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen.

This recent, randomized, double-blind study, focused on patients with “early” RA (those who had had RA symptoms for less than 12 months) but had not yet been treated with disease-modifying antirheumatic drugs (DMARDs). Patients were divided into two groups: those in the high-dose fish oil group got 5.5 grams of fish oil omega-3 fastty acids per day while those in the low-dose group (which served as the control group) got 0.4 grams of omega-3 fatty acids per day.*

Patients in both groups also received triple therapy (disease-modifying antirheumatic drugs). The dosage of these drugs was adjusted over the treatment time based upon their response.  Patients were assessed every three weeks for the first 12 weeks and every six weeks thereafter.

The study found that at one year, just over 10 percent of patients in the high-dose fish oil group had “failed” triple therapy compared to 32 percent of patients in the control group. The time to achieving remission was also significantly less in the high-dose fish oil group than in the control group. Additionally, significantly more patients in the high-dose fish oil group than the control group had tapered off NSAIDs (which was discouraged during the study) by 12 weeks.

This is very impressive, and the reason, according to the lead researcher Dr. Proudman, is that omega-3 fatty acids act like NSAIDs in the body.  

This is good news for rheumatoid arthritis patients who are always looking for ways to proactively manage their disease in a more natural way. The researchers caution that the study does not suggest you should replace disease-modifying antirheumatic drugs (DMARD) therapy with fish oil,  "But when used together, supplementing with 3 or 4 grams of fish oil looks like it can be helpful, especially since it can diminish NSAID use." NSAIDs can have cardiovascular and gastrointestinal side effects.

There could be an extra bonus to taking fish oil as well. RA patients are at increased risk of cardiovascular problems, points out Dr. Mileti, a rheumatologist at Cleveland Clinic, in Ohio.  "Fish oil is already known to confer additional cardiovascular protections."

You can take away various lessons from this study. You can focus on the specifics of the study, or you can make a more general conclusion, i.e. that onega-3 rich fish oil supplementation does indeed exert a beneficial, anti-inflammatory action for many people suffering from rheumatoid arthritis. You can perhaps conclude that omega-3 oils exerts similar beneficial anti-inflammatory action on other health problems involving inflammation. You can also conclude that to achieve this effect, you may need a high dose of omega-3 oils, and select you supplements accordingly.

 Reference: Fish oil in recent onset rheumatoid arthritis: a randomised, double-blind controlled trial within algorithm-based drug use
Ann Rheum Dis 2015;74:1 89-95 Published Online First: 30 September 2013

Don Goldberg

*It is important to note that some articles reporting on this study have incorrectly reported the dose of “fish oil” used. Typically, they say “5.5 grams of fish oil per day.” This is not only incorrect, and misleading, but it reveals a lack of knowledge about fish oil supplements, which come in many different strengths.

I originally read about this study in an article from the Arthritis Foundation, Atlanta GA, by Chrystle Fiedler. To determine the actual dosage used, I located a copy of the actual abstract. What the researchers actually said was “5.5 or 0.4 g/day, respectively, of the omega-3 fats, eicosapentaenoic acid + docosahexaenoic acid,” not 5.5 or 0.4 g “of fish oil per day.”

To illustrate the difference, let’s look at how many capsules you would need to take in order to get the 5.5 grams of omega-3 fats (EPA/DHA) actually specified in the study.

> If you used Nordic Naturals Ultimate Omega Softgels, you would need about 8 ½ softgels to obtain 5.5 grams of omega-3. Each softgel provides 0.64 grams of omega-3.
> If you used Natural Factors RxOmega-3 Ultra Strength Softgels, you would need to take 6 softgels to obtain 5.5 grams of omega-3. Each softgel provides 0.9 g of omega-3.
> If you used Natural Factors Wild Alaskan Salmon Oil, you would need to take 27 ½ softgels to get 5.5 grams of omega-3. Each softgel, while containing 1 gram of “fish oil,” only contains 0.2 gram of omega-3 fats!

That’s a big difference, isn’t it–6 softgels in one case compared to 27 ½ softgels in the other?

There are two important things to remember when it comes to fish oil and omega-3's. First, always look for the actual amount of omega-3 fatty acids used in a study or dosage recommendation–not the amount of “fish oil.” Second, when reading the label, look for the amount of total omega-3's or the amount of EPA and DHA per unit dose. This is the true measure of potency, and is the most meaningful way to compare one product to another.    

Don Goldberg


Products mentioned:
Nordic Naturals Ultimate Omega, #52093 120 Softgels List: $49.95
Natural Factors RxOmega3 Ultra Strength, #41830 120 Softgels, List: $29.95
Natural Factors Wild Alaskan Salmon Oil, #40862, 180 Softgels, List: $24.95