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Abstract
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.
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[6] Arthritis Care & Research2017.
[7] Rheumatology (Oxford, England)2008;47(5):665–9.
[8] Nutrients2017;9(4).
Disclosure of Interest None declared
| 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 al1 | RCT | 86 | 53 | 3.7 g/day | 1 year | Yes | Success/failure of DMARDs |
| Shapiro et al2 | Case-control | 324 | 1245 | >2 servings boiled/baked fish per week | Diet from a 1 year period | Yes | RA risk |
| Lee et al3 | Meta-analysis | 183 | 187 | >2.7 g/day | >3 months | Clinical not statistical significance | NSAID consumption, tender/swollen joint count, physical function |
| Bahadori et al4 | RCT | 8 | 5 | 0.2 g/kg– fish oil emulsion | 22 weeks | Yes | Decrease in swollen and tender joint counts |
| Rajaei et al5 | RCT | 30 | 30 | 3.9 g/day | 12 weeks | Yes | DAS28 |
| Tedeschi et al6 | Cross sectional analysis | 31 | 145 | Eat fish>2 x per week (<5.5 g/day) | Diet from past yr | Yes | DAS28 |
| Galarraga et al7 | RCT | 49 | 48 | 2.2 g/day | 9 months | Yes in reducing NSAID intake but not in DAS28 | Daily NSAID requirement |
| Veselinovic et al8 | RCT | 40 | 20 | 600 mg/day | 12 weeks | Yes | DAS28 |
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