Fish Oil for Rheumatoid Arthritis: A Home Medicine Review Initiative

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune condition that affects about 2% of the Australian population [1]. In RA, the overproduction of inflammatory mediators such as tumour necrosis factor, interleukin-1, 6, 8 and cytokines, causes chronic inflammation and pain in joints [2]. There is growing evidence of the benefits of omega-3 long chain polyunsaturated fatty acids found in fish oil in reducing chronic inflammation associated with RA [3]. Fish oil contains eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) that compete with inflammatory precursors [3]. Clinical studies and independent therapeutics guidelines [4-7] suggest to use at least 2.7g of EPA in addition to DHA present in fish oil per day for the pharmacological management of RA. Human studies have shown that fish oil can significantly reduce inflammatory mediators, although this appears to be most significant at when the dose of EPA+DHA is above ≥2.7g daily suggesting that there is a threshold dose required for the effectiveness of fish oil in reducing inflammation [2]. Fish oil has also been shown to reduce the use of nonsteroidal anti-inflammatory drug (NSAID) consumption [2, 3] and thus the risk of well-known NSAID adverse effects such as gastrointestinal bleeding or exacerbation of heart failure [8].