FROM:
Ann Intern Med 1987 (Apr); 106 (4): 497–503
Kremer JM, Jubiz W, Michalek A, Rynes RI, Bartholomew LE,
Bigaouette J, Timchalk M, Beeler D, Lininger L
Study Objective: To determine the efficacy of fish-oil dietary
supplements in active rheumatoid arthritis and their effect on
neutrophil leukotriene levels.
Design: Nonrandomized, double-blinded, placebo-controlled,
crossover trial with 14-week treatment periods and 4-week washout
periods.
Setting: Academic medical center, referral-based rheumatology
clinic.
Patients: Forty volunteers with active, definite, or classical
rheumatoid arthritis. Five patients dropped out, and two were
removed for noncompliance.
Interventions: Treatment with nonsteroidal anti-inflammatory
drugs, slow-acting antirheumatic drugs, and prednisone was
continued. Twenty-one patients began with a daily dosage of 2.7 g
of eicosapaentanic acid and 1.8 g of docosahexenoic acid given in
15 MAX-EPA capsules (R.P. Scherer, Clearwater, Florida), and 19
began with identical-appearing placebos. The background diet was
unchanged.
Measurements and Main Results: The following results favored
fish oil placebo after 14 weeks: mean time to onset of fatigue
improved by 156 minutes (95% confidence interval, 1.2 to 311.0
minutes), and number of tender joints decreased by 3.5 (95% Cl,
-6.0 to -1.0). Other clinical measures favored fish oil as well
but did reach statistical significance. Neutrophil leukotriene B4
production was correlated with the decrease in number of tender
joints (Spearman rank correlation r=0.53; p less than 0.05).
There were no statistically significant differences in hemoglobin
level, sedimentation rate, or presence of rheumatoid factor or in
patient-reported adverse effects. An effect from the fish oil
persisted beyond the 4-week washout period.
Conclusions: Fish-oil ingestion results in subjective alleviation
of active rheumatoid arthritis and reduction in neutrophil
leukotriene B4 production. Further studies are needed to
elucidate mechanisms of action and optimal dose and duration of
fish-oil supplementation.