Fish Oils in Osteoarthritis – Low Dose vs. High Dose

Using the common sense approach that if a little bit is good then more is better in the treatment of “rheumatism” Catherine Hill, M.D., of the University of Adelaide in Australia and colleagues looked at the effect of taking low dose fish oil supplements versus high dose fish oil supplements. When one looks at the adult population of Australia, one third of them take fish oil supplements and had within a month of this study. The typical dose is one ml of fish oil per day. Experts say the dose for anti-inflammatory effect for arthritis is considerably higher at 2.7 gram or 10 ml per day. Dr Hill’s theory was that high dose fish oil for symptomatic and structural outcomes in people with knee osteoarthritis was better.

She enrolled 202 symptomatic patients in a double blind study. High dose group patients received 4.5 g EPA/HPA per day. The low dose group were given a blended of fish oil containing 0.45 g EPA /DHA per day in combination with Sunola oil. Both supplements were flavored with citrus oil.

All patients received a baseline MRI of the knee at inception of the study and at two years. The patients mean age was 61 years and body mass index was 29kg/meter squared. Both groups showed x-ray evidence of arthritis in the knee at inception and both groups were allowed to take non-steroidal anti-inflammatory medications and acetaminophen for arthritic pain during the course of the study.

At two years there was no difference in the MRI findings or cartilage volume loss between the high dose and low dose groups. Each group took similar amounts of NSAIDs and acetaminophen for pain on a regular basis. The high dose had no benefit over the low dose.

The researchers concluded that there was no benefit in their study to high dose versus low dose fish oil supplementation for arthritis. They reasoned that since patients in the study were permitted to take additional fish oils on their own during the study this may have altered the findings. The researchers additionally had little control over how much fish the participants ate.

In reviewing the data it seems to indicate that fish oil played a minor role in slowing down arthritis in the knee joint. Low dosage had as good of an effect as high dosage but the studies lack of a true control group who did not take fish oil at all made the conclusions hard to accept.

I will suggest to my patients that they continue to eat two fleshy fish meals per week to get their fish oils for arthritis and cardiovascular protection, rather than purchasing and taking low dose or high dose fish oil supplements.

Study Reveals No Deterioration of Kidney Function …

NSAIDSAs we age and try and keep moving we notice the severe aches and pains from wear and tear and osteoarthritis that we feel at the start of a day. To relieve those feelings we often reach for the over the counter bottle of Advil ( ibuprofen) or Aleve ( naproxen sodium) knowing full well that the medication will help the aches and pains but may irritate our stomach or contribute to the downfall of our kidneys.

The problem and decision making in prescribing NSAIDs is even more critical in patients with Rheumatoid Arthritis. A recent scientific publication in the Annals of Rheumatic Disease 2015:74: 718-723 authored by B Moeller MD of the Unselspital-University Hospital, Bern, Switzerland looked at this question. They “found reassuring data regarding preserved renal function despite long-term NSAID use in Rheumatoid Arthritis (RA) patients.” Kidney function was followed on 4101 RA patients between 1996 and 2007. 2739 patients used NSAID while 136 2 patients did not.

They assessed and followed kidney function by the accepted methods of calculating the Glomerular Filtration Rate ( GFR). Their results revealed that there was no decline in kidney function in patients who had less than stage 4 Chronic Kidney Disease at the start of the study. They went on to recommend that if a patient’s eGFR or glomerular filtration rate was less than 30 ml per minute they should not take NSAIDs to treat their aches and pains from RA because of the high risk of these medications exacerbating their already compromised kidney function.

The study included medicine from two different classes of NSAIDs, both the “coxib” and “rofecoxib” class. With this data it is safe to say that individuals with arthritic aches and pains can take NSAIDs without fear of kidney deterioration as long as they do not already have severe chronic kidney disease.