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Oiling up arthritic joints

There have been many, many randomized trials done on fish oil and other marine oils, looking at their effects on arthritis. But when you look at all the trials together, what's the verdict?

Study under review: Marine Oil Supplements for Arthritis Pain: A Systematic Review and Meta-Analysis of Randomized Trials

Introduction

Arthritis afflicts[1] 46 million Americans, or approximately 21% of the U.S. population. Although types of arthritis differ in their cause, all are characterized by joint inflammation that leads to pain, stiffness, swelling, and other unpleasant symptoms. For instance, osteoarthritis is caused by a progressive loss of cartilage that leads to joint inflammation via bone-on-bone rubbing, whereas rheumatoid arthritis is an autoimmune inflammatory disease that targets joint tissue. Some of the underlying mechanisms are pictured in Figure 1.

The omega-3 fatty acids, EPA and DHA, are heavily investigated anti-inflammatory compounds. A recent meta-analysis[2] showed that EPA and DHA supplementation significantly reduced several inflammatory molecules, including tumor necrosis factor alpha (TNFα), C-reactive protein (CRP), and interleukin-6 (IL-6). It is possible that supplementing with EPA and DHA could help relieve arthritic symptoms, such as pain, by exerting an anti-inflammatory effect.

Three meta-analyses have been[3] published[4] comparing omega-3 supplementation to a control treatment in patients with rheumatoid arthritis, all of which found a beneficial effect of EPA and DHA for reducing joint pain, tenderness, and stiffness. However, these meta-analyses included all omega-3 fatty acids, not just EPA and DHA, and did not quantitatively assess the risk of bias and the quality of evidence. Plus, the most recent meta-analysis was conducted in 2012, meaning that five years of research has not been evaluated.

The study under review is a meta-analysis looking at the effect of EPA and DHA on arthritic symptoms, including pain, physical function, and inflammation. The study also evaluated adverse events from EPA and DHA supplementation.

Figure 1: How cartilage degrades in osteoarthritis versus rheumatoid arthritis

Adapted from: Pap et al. Nat Rev Rheumatol. 2015 Jul.

Arthritis is a condition characterized by inflammation of the joints. It stands to reason that EPA and DHA may benefit patients with arthritis, considering their potent anti-inflammatory effects. Accordingly, the current meta-analysis sought to evaluate whether EPA and DHA supplementation reduced arthritic pain, benefited physical function, reduced inflammation, and was tolerable and safe.

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