A systematic literature review of omega 3 in the treatment of rheumatoid arthritis

Background: Many different elements and variations of diet in the management of rheumatoid arthritis (RA) have been studied over the years such as vegan or Mediterranean diets. Objectives: This systematic literature review covers one food stuff, omega-3 polyunsaturated fats efficacy in the management of RA alongside or independent of conventional DMARD therapy. Methods: A systematic review of the literature between 1966–2017 was conducted using MEDLINE, CINAHL and EMBASE databases, with key words ”RA” and ”omega-3” for English-language articles producing 209 hits. We then refined to publications within the last 10 years, giving 96 results. Only including clinical trials gave 12 hits pertaining to 8 trials. Results: The table above shows a summary of the evidence found. In total, 751 were exposed to omega-3 versus 1733 controls with the smallest study being an RCT involving 13 people and the largest a case-control study with 1569 participants. A notable difference between these studies was the use of DMARD therapy as part of the inclusion or exclusion criteria. Another difference noted was the RA stage eligible for a trial. Some studies required a diagnosis of RA of <12 months whereas most required stable RA ongoing for >12 months. Conclusions: This review concludes that omega-3 leads to clinical and statistically significant improvements in RA. There was a significant heterogeneity in the trials published with different inclusion criteria especially regarding disease duration and concomitant DMARD therapy. It would seem prudent to include dietary advice in our advice to patients when treating RA. Possible reasons for this evidence would include altering the microbiome. References: The British Journal of Nutrition 2015;114(6):885–90. Epidemiology 1996;7(3):256–63. Archives of Medical Research 2012;43(5):356–62. Journal of Parenteral and Enteral Nutrition 2010;34(2):151–5. Global Journal of Health Science 2015;8(7):18. Arthritis Care & Research 2017. Rheumatology (Oxford, England) 2008;47(5):665–9. Nutrients 2017;9(4). Disclosure of Interest: None declared DOI: 10.1136/annrheumdis-2018-eular.3325 Abstract AB0375 – Table 1 Reference: Study type Participants in intervention group Participants in control group Omega-3 dose Duration Did it show efficacy? How did they assess response? Proudman et al RCT 86 53 3.7 g/day 1 year Yes Success/failure of DMARDs Shapiro et al Case-control 324 1245 >2 servings boiled/baked fish per week Diet from a 1 year period Yes RA risk Lee et al Meta-analysis 183 187 >2.7 g/day >3 months Clinical not statistical significance NSAID consumption, tender/swollen joint count, physical function Bahadori et al RCT 8 5 0.2 g/kg– fish oil emulsion 22 weeks Yes Decrease in swollen and tender joint counts Rajaei et al RCT 30 30 3.9 g/day 12 weeks Yes DAS28 Tedeschi et al Cross sectional analysis 31 145 Eat fish>2 x per week (<5.5 g/day) Diet from past yr Yes DAS28 Galarraga et al RCT 49 48 2.2 g/day 9 months Yes in reducing NSAID intake but not in DAS28 Daily NSAID requirement Veselinovic et al RCT 40 20 600 mg/day 12 weeks Yes DAS28 Citation: Ann Rheum Dis, volume 77, supplement Suppl, year 2018, page A1357Session: Rheumatoid arthritis – comorbidity and clinical aspects