Introduction
Fish oil is a popular supplement derived from fatty fish oil or cod liver oil. In addition to being high in omega-3 fatty acids, fish oil is rich in vitamins. There is a theory that fish oil containing omega-3 fatty acids may be useful for patients suffering from arthritis (Saidane et al., 2019). For example, theoretically, it can reduce joint pain associated with this disease (Saidane et al., 2019). Fatty acids high in omega-3 include eicosatetraenoic acid, docosahexaenoic acid, and alpha-linolenic acid (Cordingley & Cornish, 2022). Fish oil can be only recommended to patients as a supplement when changing their diet to a healthier one.
Rationale for the Choice
Fish oil is a fairly popular treatment for many ailments and a well-known supplement that many patients take in order to switch to a healthier diet (Raad et al., 2021). The main danger is that some patients consume this supplement on their own without consulting a doctor (Kostoglou-Athanassiou et al., 2020). Since arthritis is a disease that usually develops with age, older patients are at a separate risk group. For example, fish oil increases blood sugar levels, which is categorically contraindicated in patients with diabetes mellitus (Cordingley & Cornish, 2022). In addition, fish oil may be incompatible with medications taken by patients as ongoing therapy (Cordingley & Cornish, 2022). The main research question is whether Omega 3-FA is useful in treating arthritis. The study will address gaps in existing research and draw a clear conclusion as to whether omega-3 fish oil can be recommended for patients with arthritis.
Search History
Synopsis
Some studies were excluded because they dealt with the benefits and drawbacks of omega-3 acid treatment for other conditions. There are no complete and comprehensive studies of the effect of fish oil and reviews of the course of arthritis over the past 5 years. Therefore, the study focused on qualitative research and reviews of the existing literature. The search criteria were the English language, the openness of the source, and the date of publication. For the search, the Google Scholar database was used because of the ease of setting up filters and a large amount of open information.
During the search in Google Scholar Database searched with the terms Omega 3-FA and treating arthritis, it turned out that there is not enough scientific data on the topic of the use of fish oil in the treatment of arthritis. Most of the articles focus on the impact of dietary changes on the management of patients with arthritis. That is why the search and analysis of articles has been extended to studies containing data on the use of omega-3 acids, not necessarily in the form of fish oil. Search keywords included: fish oil, omega-3s, arthritis, osteoarthritis and rheumatoid arthritis. More than twenty articles were studied during the research. As a result of selection, seven studies were included in the review that are most relevant to the chosen topic.
Summary and Critical Analysis of Results
Cordingley and Cornish conducted the study aimed at identifying if fatty acids are a possible option for treating osteoarthritis (2022). The sample size was 13.6% of adults over 20 years, RCT was Canada and the United States of America, and meta-analysis was pre-clinical and clinical evidence. Researchers are highlighting the anti-inflammatory properties of polyunsaturated fatty acids, which may be helpful in curbing inflammatory markers in osteoarthritis (Cordingley & Cornish, 2022). Cordingley and Cornish provide preclinical and clinical data on the use of omega-3s in the treatment of osteoarthritis (2022). Preclinical data provides strong evidence for human trials of the use of omega-3s as a possible treatment option for osteoarthritis, while evidence requires further research to determine optimal treatment protocols (Cordingley & Cornish, 2022). It has been suggested that anti-inflammatory properties may alleviate a mild inflammatory environment and slow cartilage catabolism and the disease progression (Cordingley & Cornish, 2022). The reduction in cartilage inflammation and catabolism may be consistent with increased function and improvement in symptoms associated with osteoarthritis, such as joint pain and stiffness.
If future research concludes that omega-3 treatment regimens, along with additional potentially beneficial therapeutic diets, can improve patient-reported outcomes, this could be a cost-effective treatment option, resulting in lower health care costs (Raad et al., 2021). The study is limited to a descriptive approach, despite the use of clinical and preclinical data. Subsequent research should include direct experimentation with an established focus group to fill in the existing knowledge gaps (Elfagi, 2021).
Dietary Interventions with or without Omega-3 Supplementation
Raad, T., Griffin, A., George, E. S., Larkin, L., Fraser, A., Kennedy, N., & Tierney, A. C. (2021). Dietary interventions with or without omega-3 supplementation for the management of rheumatoid arthritis: A systematic review.Nutrients, 13(10), 1-20. Web.
Raad et al. are concentrating on research into dietary intervention in the treatment of rheumatoid arthritis (2021). The aim of the systematic review is to investigate the effect of dietary interventions with or without omega-3 supplementation on the treatment of rheumatoid arthritis (Raad et al., 2021). 15 studies were reviewed, the findings were that dietary interventions can help relieve symptoms significantly, others worsen symptoms. The gaps of the studies were the lack of reliance on experimental data to a descriptive approach. Electronic databases were systematically searched for clinical trials of dietary interventions with or without omega-3 supplements to find documents from their inception to April 2021 (Raad et al., 2021). Summary of the findings is the following: dietary interventions with an anti-inflammatory base may be an effective option for adults with rheumatoid arthritis seeking additional therapies that could potentially improve certain parameters (Raad et al., 2021). The type of study was systematic review; sample sizes are 15 cross-country studies.
However, long-term studies are needed that are well designed and have sufficient power to investigate the effect of a diet rich in omega-3 fatty acids on the course of the disease. Some dietary interventions can help relieve symptoms significantly, others worsen symptoms (Raad et al., 2021). The main focus of future research should be to study the effect of dietary changes on pain in arthritis (Raad et al., 2021).
The Effect of Omega-3 Fatty Acids on Rheumatoid Arthritis
A study by Kostoglou-Athanassiou et al. focuses on the overall health benefits of omega- 3 fatty acids, which are thought to play an important role in health conditions. The aim of the research is to identify if the effect of omega-3 on patients, suffering from rheumatoid arthritis condition. Omega-3 fatty acids are believed to have immunomodulatory properties as they act as precursors to lipid inflammatory mediators that can limit or modulate the inflammatory response (Kostoglou-Athanassiou et al., 2020). Researchers conclude that omega-3 fatty acids prevent or alleviate experimental arthritis. The type of study is clinical studies; the sample size is 32 patients with RA.
Omega-3 fatty acids have been shown to improve or prevent experimental arthritis and may reduce disease activity in rheumatoid arthritis (Kostoglou-Athanassiou et al., 2020). Clinical studies have shown that omega-3 fatty acids may have a modulating effect on disease activity, namely the number of swollen and painful joints (Kostoglou-Athanassiou et al., 2020). The study is unequivocal in its judgment and recommends treatment with omega-3 fatty acids. However, the study is descriptive and has little evidence base (Kostoglou-Athanassiou et al., 2020). The findings are mostly based on theoretical assumptions about the overall benefits of polyunsaturated fatty acids.
The Mediterranean Diet, Fish Oil Supplements and Rheumatoid Arthritis Outcomes
Peterson et al. pay attention to the types of diets and nutritional supplements used in the treatment of rheumatoid arthritis (2018). The study aims to understand the effect the diet has on patients’ conditions. The researchers recognize an unmet need for a better understanding of the impact of specific dietary interventions on disease outcomes, along with growing patient interest in lifestyle interventions beyond pharmacotherapy, which is what prompted this descriptive literature review (Petersson et al., 2018). There is growing evidence that polyunsaturated fat supplementation can reduce inflammation and provide clinical benefits, possibly «slowing the transition to pharmacotherapy» (Petersson et al., 2018). However, many of these studies to date are limited in their methodology: for example, they only used limited evidence; this is partly a reflection of the complexity of the research questions being addressed. Therefore, the conclusions that can reasonably be drawn from their results are limited (Petersson et al., 2018).
With a focus on clinical fish oil, this review critically analyses the evidence, discusses research findings in the broader context of impact on the patient outcomes, methodological issues, and practical considerations (Petersson et al., 2018). Dietary interventions such as fish oil supplements are important in the treatment, but research advocates their use in combination with other non- dietary interventions, including appropriate pharmacotherapy where indicated (Petersson et al., 2018). Further research should focus on specifically examining the impact of each diet, with an experimental part. At the moment, the study is limited by the lack of emphasis on data obtained in the course of practical research (Petersson et al., 2018).
Relationship between Omega-3 Dietary Intake and Rheumatoid Arthritis
Elfagi notes the problem of low awareness of doctors and patients about the role of nutrition in the treatment of rheumatoid arthritis and this paper is dedicated to the problem of arthritis. This low awareness is thought to be related to the low prevalence of the disease. The aim of the study is to summarize the relationship between consumption of omega-3 fatty acids in the form of fish oil and positive outcomes in the treatment of rheumatoid arthritis (Elfagi, 2021). The study was cross-sectional and included a sample of one hundred patients diagnosed with rheumatoid arthritis; the P value is higher than the value of the alpha-level z-indicator. (Elfagi, 2021). An attempt was made to prove the role of the anti-inflammatory properties of omega-3 in the activity of RA disease, as well as to study patients’ knowledge of omega-3 and their attitudes towards nutrition (Elfagi, 2021). Both a significant statistical difference and the level of awareness support the need to use omega-3 fatty acids in the diet. (Elfagi, 2021). The overall conclusion of the study was that a diet rich in omega-3s, regardless of its source, may be associated with a reduction in rheumatoid arthritis activity.
In the summary of the findings the article concludes that based on the data obtained, patients should be educated, especially the elderly, to increase their knowledge and awareness of the benefits of omega-3 (Elfagi, 2021). It is important to reduce the symptoms of the disease in addition to therapy to increase the daily dose, and the dose of omega-3 should also be encouraged, whether from dietary sources or supplements (Elfagi, 2021). However, further research is needed to determine if more frequent consumption of omega-3 rich foods is associated with lower disease activity in rheumatoid arthritis. The study is limited by focusing on low awareness, not on the evidences of omega-3 treatment outcomes.
Could Omega-3 Fatty Acids Prevent Rheumatoid Arthritis?
The systematic research conducted by Saidane et al. in 2019 focuses on the role of omega-3s in preventing the risk of rheumatoid arthritis. The aim of the research is to review literature on the omega-3 treatment. The review indicates conflicting results that do not provide clear conclusions (Saidane et al., 2019). The authors concludes that overall, fatty acid intake may influence the risk of developing rheumatoid arthritis (Saidane et al., 2019). Research values were calculated based on the content of erythrocyte membranes, which may be relevant methods for drawing conclusions (Saidane et al., 2019). The next step of the research can be considered an assessment of individuals at risk of developing of rheumatoid arthritis, assessing their protective properties during the transition from preclinical autoimmunity to established disease.
Omega-3 fatty acids can be clearly identified as a dietary factor capable of modulating the course of rheumatoid arthritis with preclinical phases of the established disease by the evidence-level practice. Omega-3s show a negative relationship with the formation of autoantibodies in genetically predisposed individuals, and with the development of RA in individuals who have already developed biological autoimmunity (Saidane et al., 2019). Although the study uses a significant amount of literature, it is limited by the lack of clear conclusions due to low level of evidence because of the type of studies and sample sizes. A lack of practical evidence is again a knowledge gap. Further research is needed to determine the impact of a high-fatty acid diet for people who have a genetic predisposition to develop rheumatoid arthritis.
Rheumatoid Arthritis and Dietary Interventions: Systematic Review of Clinical Trials
Philippou et al. aimed at studying the effect of dietary interventions on rheumatoid arthritis, which is characterized by an immune-inflammatory response. To draw the conclusion, a systematic literature review method based on the latest available data which is a higher level of evidence was used (Philippou et al., 2021). The researchers focused on 70 studies that conducted experiments with a group of subjects (Philippou et al., 2021). The introduction of omega-3 polyunsaturated fatty acids in high doses led to a decrease in of rheumatoid arthritis disease activity and a lower rate of failure of RCts pharmacotherapy (Philippou et al., 2021). The findings of the review are that several dietary interventions, including the addition of omega-3s as fish oil to the diet, may have a positive effect on the course of rheumatoid arthritis. However, the study is limited by the fact that the results are very individual and cannot be considered completely reliable. Further research should concern the study of individual reactions in order to close this knowledge gap.
Discussion of Findings
At the moment, there is little evidence that fish oil is guaranteed to relieve arthritis. Despite a large body of literature on the effect of omega-3 fatty acids on the course of arthritis, no single study offers clear conclusions. Over the past five years, no quantitative studies have been conducted that would indicate a clear dynamic of the disease in reduction in symptoms with the use of fish oil supplements and without this intervention. Most researchers note a positive trend with the use of large amounts of omega-3, for example, Saidane and Elgafi. However, it is impossible to say with accuracy what caused such a dynamic omega-3 effect: individual characteristics, a change in nutrition, or the characteristics of the course of arthritis.
All researchers are unanimous in their opinion about the existing research gap: there is no relevant evidence base for real improvements in the conditions of patients with arthritis when taking fish oil. Several of the large systematic reviews showed a reduction of symptoms when O3FAs were added to the diet; however, findings could not be applied to the general population (Cordingley & Cornish, 2022). Based on these findings, it is impossible to decide whether to recommend the use of fish oil supplements for a particular patient (Kostoglou-Athanassiou et al., 2020). Omega-3, if used, should be combined with the main treatment, and not be a substitute for it Kostoglou-Athanassiou et al., 2020). However, the research question – whether Omega 3-FA is useful in treating arthritis – remains unanswered. In the absence of contraindications, increased Omega-3 intake may be recommended to patients, but only as part of a transition to a healthier diet.
Conclusion
The evidence base has not been sufficient to draw a firm conclusion about how fish oil supplementation can be a treatment for arthritis. Research is limited by the descriptive approach, as well as the lack of clear benefit indicators. There was a lack of RCTs and clinical trials of some sort in some of the studies, for example, in Philippou et al. (2021). It is not known what specific fact influenced the improvement in the condition of patients using fish oil. At this stage, fish oil cannot be recommended as a treatment for patients with arthritis. Further extensive quantitative studies are required to exclude the possibility of mutual influence. Currently, only a dietary change to more omega-3s consumption can be recommended for patients, suffering from arthritis, unless there are contraindications for doing so in most of the studies.
References
Cordingley, D. M., & Cornish, S. M. (2022). Omega-3 Fatty Acids for the Management of Osteoarthritis: A Narrative Review.Nutrients, 14(16), 33-62. Web.
Elfagi, S. (2021). Study the Relationship between Omega-3 Dietary Intake and Rheumatoid Arthritis.Sch Acad J Pharm, 8(1), 128-138. Web.
Kostoglou-Athanassiou, I., Athanassiou, L., & Athanassiou, P. (2020). The effect of omega-3 fatty acids on rheumatoid arthritis.Mediterranean journal of rheumatology, 31(2), 190- 205. Web.
Petersson, S., Philippou, E., Rodomar, C., & Nikiphorou, E. (2018). The Mediterranean diet, fish oil supplements and Rheumatoid arthritis outcomes: Evidence from clinical trials.Autoimmunity reviews, 17(11), 1105-1114. Web.
Philippou, E., Petersson, S. D., Rodomar, C., & Nikiphorou, E. (2021). Rheumatoid arthritis and dietary interventions: systematic review of clinical trials.Nutrition reviews, 79(4), 410-428. Web.
Raad, T., Griffin, A., George, E. S., Larkin, L., Fraser, A., Kennedy, N., & Tierney, A. C. (2021). Dietary interventions with or without omega-3 supplementation for the management of rheumatoid arthritis: A systematic review.Nutrients, 13(10), 1-20. Web.
Saidane, O., Semerano, L., & Sellam, J. (2019). Could omega-3 fatty acids prevent rheumatoid arthritis?Joint Bone Spine, 86(1), 9-12. Web.