n-3 Fatty acid supplements in rheumatoid arthritis

Ingestion of dietary supplements of n-3 fatty acids has been consistently s hown to reduce both the number of tender joints on physical examination and the amount of morning stiffness in patients with rheumatoid arthritis. In these cases, supplements were consumed daily in addition to background medi cations and the clinical benefits of the n-3 fatty acids were not apparent until they were consumed for greater than or equal to 12 wk. It appears tha t a minimum daily dose of 3 g eicosapentaenoic and docosahexaenoic acids is necessary to derive the expected benefits. These doses of n-3 fatty acids are associated with significant reductions in the release of leukotriene B- 4 from stimulated neutrophils and of interleukin 1 from monocytes. Both of these mediators of inflammation are thought to contribute to the inflammato ry events that occur in the rheumatoid arthritis disease process. Several i nvestigators have reported that rheumatoid arthritis patients consuming n-3 dietary supplements were able to lower or discontinue their background dos es of nonsteroidal antiinflammatory drugs or disease-modifying antirheumati c drugs. Because the methods used to determine whether patients taking n-3 supplements can discontinue taking these agents are variable, confirmatory and definitive studies are needed to settle this issue. n-3 Fatty acids hav e virtually no reported serious toxicity in the dose range used in rheumato id arthritis and are generally very well tolerated.