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Extended report
Fish oil in knee osteoarthritis: a randomised clinical trial of low dose versus high dose
  1. Catherine L Hill1,2,
  2. Lynette M March3,
  3. Dawn Aitken4,
  4. Susan E Lester1,
  5. Ruth Battersby1,
  6. Kristen Hynes4,
  7. Tanya Fedorova3,
  8. Susanna M Proudman5,
  9. Michael James5,
  10. Leslie G Cleland5,
  11. Graeme Jones4
  1. 1Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, South Australia
  2. 2University of Adelaide, The Health Observatory, Adelaide, South Australia
  3. 3Royal North Shore Hospital, Institute of Bone and Joint Research, St Leonards, New South Wales, Australia
  4. 4Menzies Research Institute, Hobart, Tasmania, Australia
  5. 5Rheumatology Unit, Royal Adelaide Hospital, Adelaide, South Australia
  1. Correspondence to Dr Catherine Hill, Rheumatology Unit, The Queen Elizabeth Hospital, 28 Woodville Road Woodville, SA 5011, Australia; catherine.hill{at}


Objectives To determine whether high-dose fish oil is superior to low-dose supplementation for symptomatic and structural outcomes in knee osteoarthritis (OA).

Methods A randomised, double-blind, multicentre trial enrolled 202 patients with knee OA and regular knee pain. They were randomised 1:1 to high-dose fish oil (4.5 g omega-3 fatty acids) 15 mL/day or (2) low-dose fish oil (blend of fish oil and sunola oil; ratio of 1:9, 0.45 g omega-3 fatty acids) 15 mL/day. The primary endpoints were Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score at 3, 6, 12 and 24 months, and change in cartilage volume at 24 months. Secondary outcomes included WOMAC function, quality of life, analgesic and non-steroidal anti-inflammatory drug use and bone marrow lesion score.

Results Although there was improvement in both groups, the low-dose fish oil group had greater improvement in WOMAC pain and function scores at 2 years compared with the high-dose group, whereas between-group differences at 1 year did not reach statistical significance. There was no difference between the two groups in cartilage volume loss at 2 years. For other secondary endpoints, there was no difference between the two groups at 2 years.

Conclusions In people with symptomatic knee OA, there was no additional benefit of a high-dose fish oil compared with low-dose fish oil. The combination comparator oil appeared to have better efficacy in reducing pain at 2 years, suggesting that this requires further investigation.

Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN 12607000415404).

  • Knee Osteoarthritis
  • Treatment
  • Epidemiology

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