Abstract
There is a general belief among doctors, in part grounded in experience, that patients with arthritis need nonsteroidal anti-inflammatory drugs (NSAIDs). Implicit in this view is that these patients require the symptomatic relief provided by inhibiting synthesis of nociceptive prostaglandin E2, a downstream product of the enzyme cyclo-oxygenase (COX), which is inhibited by NSAIDs. However, the concept of 'safe' NSAIDs has collapsed following a multiplicity of observations establishing increased risk for cardiovascular events associated with NSAID use, especially but not uniquely with the new COX-2-selective NSAIDs. This mandates greater parsimony in the use of these agents. Fish oils contain a natural inhibitor of COX, reduce reliance on NSAIDs, and reduce cardiovascular risk through multiple mechanisms. Fish oil thus warrants consideration as a component of therapy for arthritis, especially rheumatoid arthritis, in which its symptomatic benefits are well established. A major barrier to the therapeutic use of fish oil in inflammatory diseases is ignorance of its mechanism, range of beneficial effects, safety profile, availability of suitable products, effective dose, latency of effects and instructions for administration. This review provides an evidence-based resource for doctors and patients who may choose to prescribe or take fish oil.
Highlights
Essential dietary constituents are those that cannot be synthesized endogenously
The n6 polyunsaturated fatty acids (PUFAs) contain the n6 double bond, and the n3 PUFAs have both n6 and n3 double bonds. (The n or ω notation refers to the position of the double bond relative to the methyl terminus of the fatty acid molecule.) In contrast to vitamins, n6 and n3 fatty acids are macronutrients, and diets in industrialized Western countries are generally abundant in n6 PUFAs and poor in n3 PUFAs
Effects of fish oil, below) and the reduced discretionary use of nonsteroidal antiinflammatory drugs (NSAIDs) seen in RA patients taking anti-inflammatory doses of fish oil [9,10,11]
Summary
Essential dietary constituents are those that cannot be synthesized endogenously. Vitamins are familiar examples of essential micronutrients. Effects of fish oil, below) and the reduced discretionary use of NSAIDs seen in RA patients taking anti-inflammatory doses of fish oil [9,10,11]. Cod liver oil is widely available as both bottled oil and in capsules It contains approximately 10% EPA and 10% DHA, and so it is a good source of LC n3 PUFAs. at anti-inflammatory doses cod liver oils, which are rich in the fat-soluble vitamins A and D, contain more vitamin A than recommended intakes. Fish oil or purified n3 fatty acids reduced the incidence of arrhythmias in animal models of ischaemically induced ventricular fibrillation [58,59] These findings correlate with the striking reduction in cardiac mortality and, in particular, sudden cardiac death seen with fish oil and diets rich in n3 PUFAs from vegetable sources after myocardial infarction [46,60,61]. That fish oil is not used more widely to manage cardiovascular risk appears to reflect more the influence of pharmaceutical product marketing on the practice of ‘evidence-based medicine’ than the merits of fish oil relative to those of commonly used proprietary agents
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