EFFECTS OF HIGH-DOSE FISH-OIL ON RHEUMATOID-ARTHRITIS AFTER STOPPING NONSTEROIDAL ANTIINFLAMMATORY DRUGS - CLINICAL AND IMMUNE CORRELATES

Objective. To determine the following: 1) whether dietary supplementat ion with fish oil will allow the discontinuation of nonsteroidal antii nflammatory drugs (NSAlDs) 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 sup plements on the production of multiple cytokines in this population, M ethods, Sixty-six RA patients entered a double-blind, placebo-controll ed, prospective study of fish oil supplementation while taking diclofe nac (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 sub stituted 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), 1L-2, 1L-6, and IL-8 and tumor necrosis factor alpha were measu red by enzyme-linked immunosorbent assay at baseline and during the st udy. Results, In the group taking fish oil, there were significant dec reases 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 i mproved from baseline, The decrease in the number of tender joints rem ained significant 8 weeks after discontinuing diclofenac in patients t aking fish oil (-7.8 +/- 2.6; P = 0.011) and the decrease in the numbe r of tender joints at this time was significant compared with that in patients receiving corn oil (P = 0.043), IL-1 beta decreased significa ntly from baseline through weeks 18 and 22 in patients consuming fish oil (-7.7 +/- 3.1; P = 0.026). Conclusion, Patients taking dietary sup plements of fish oil exhibit improvements in clinical parameters of di sease activity from baseline, including the number of tender joints, a nd these improvements are associated with significant decreases in lev els of IL-1 beta from baseline. Some patients who take fish oil are ab le to discontinue NSAIDs without experiencing a disease hare.