© 1993 British Society for Rheumatology
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EFFECTS OF FISH OIL SUPPLEMENTATION ON NON-STEROIDAL ANTI—INFLAMMATORY DRUG REQUIREMENT IN PATIENTS WITH MILD RHEUMATOID ARTHRITIS—A DOUBLE-BLIND PLACEBO CONTROLLED STUDY
Department of Medicine, Ninewells Hospital and Medical School Dundee DDJ 9SY, Scotland
Correspondence to:
Correspondence to C. S. Lau, University Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong
Maxepa contains eicosapentaenoic acid (EPA) (171 mg/capsule) and docosahexaenoic acid (DHA) (114 mg/capsule). EPA acts as an alternative substrate to arachidonate, leading to the formation of the less proinflammatory prostaglandins (‘3’ series) and leukotrienes (‘5’ series), If Maxepa has anti-inflammatory properties it could be expected to reduce the requirement for NSAIDs in patients with RA. This has not been investigated nor has Maxepa therapy been studied over a full 1–yr period.
Sixty-four patients with stable RA requiring NSAID therapy only were studied. Patients received either 10 Maxepa or air-filled placebo capsules per day for 12 months. All then received placebo capsules for a further 3 months. Patients were reviewed at 3-monthly intervals. NSAID requirement at entry visit for each patient was assigned as 100%. Patients were instructed to slowly reduce their NSAID dosage providing there was no worsening of their symptoms. Clinical and labora tory parameters of RA activity were also measured. There was a significant reduction in NSAID usage in patients on Maxepa when compared with placebo from month 3 [ (95% CI. for mean) requirement–71.1 (55.9–86.2)% and 89.7 (73.7—105.7)%, respectively]. This effect reached its maximum at month 12 [(24.5–56.6)% and 84.1 (62.7 – 105.5)%, respectively] and persisted to month 15 [(27.6–61.8)% and 85.8 (60.5–111.1)%, respectively] (P<0.001, ANOVA). These patients were able to reduce their NSAID requirement without experiencing any deterioration in the clinical and laboratory parameters of RA activity.
KEY WORDS: Inflammatory arthritis, Essential fatty acids, Eicosapentaenoic acid, Eicosanoids, Prostaglandins, Leukotrienes
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