RESEARCH - Cod liver oil (n-3 fatty acids) as a NSAID sparing agent in RA

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Rheumatology Advance Access published online on March 24, 2008

Rheumatology, doi:10.1093/rheumatology/ken024

Cod liver oil (n-3 fatty acids) as an non-steroidal anti-inflammatory

drug sparing agent in rheumatoid arthritis

B. Galarraga1, M. Ho1, H. M. Youssef2, A. Hill1, H. McMahon1, C.

Hall2, S. Ogston3, G. Nuki2 and J. J. F. Belch1

1Vascular and Inflammatory Diseases Research Unit, University Division

of Medicine and Therapeutics, Ninewells Hospital and Medical School,

Dundee, 2Rheumatic Diseases Unit, Western General Hospital, Edinburgh

and 3Public Health Section, Community Health Science Division,

University of Dundee, Dundee, UK.

Abstract

Objectives. Dose-dependant gastrointestinal and cardiovascular

side-effects limit the use of NSAIDs in the management of RA. The n-3

essential fatty acids (EFAs) have previously demonstrated some

anti-inflammatory and NSAID-sparing properties. The objective of this

study was to determine whether cod liver oil supplementation helps

reduce daily NSAID requirement of patients with RA.

Methods. Dual-centre, double-blind placebo-controlled randomized study

of 9 months' duration. Ninety-seven patients with RA were randomized

to take either 10 g of cod liver oil containing 2.2 g of n-3 EFAs or

air-filled identical placebo capsules. Documentation of NSAID daily

requirement, clinical and laboratory parameters of RA disease activity

and safety checks were done at 0, 4, 12, 24 and 36 weeks. At 12 weeks,

patients were instructed to gradually reduce, and if possible, stop

their NSAID intake. Relative reduction of daily NSAID requirement by

>30% after 9 months was the primary outcome measure.

Results. Fifty-eight patients (60%) completed the study. Out of 49

patients 19 (39%) in the cod liver oil group and out of 48 patients 5

(10%) in the placebo group were able to reduce their daily NSAID

requirement by >30% (P = 0.002, chi-squared test). No differences

between the groups were observed in the clinical parameters of RA

disease activity or in the side-effects observed.

Conclusions. This study suggests that cod liver oil supplements

containing n-3 fatty acids can be used as NSAID-sparing agents in RA

patients.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/ken024v1?papetoc

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