Fish Oil Safely Reduces Need for Anti-Inflammatory Drugs in Rheumatoid Arthritis

A new study found taking cod liver oil supplements lowered the dose of anti-inflammatory medications needed to manage joint pain and swelling in rheumatoid arthritis. The fish oil worked as well as the drugs but with less safety risks

Rheumatoid Arthritis: A Review of Conventional and Complementary Approaches

Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by inflammatory arthritis and synovial joint destruction. The incidence of RA is increasing globally, now affecting about 1% of the population.¹ Unfortunately, current treatments like nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs) have limited effectiveness and significant adverse effects.² There is a clear unmet need for safer, more effective therapies.

Emerging research suggests certain dietary modifications, nutritional supplements, herbal medicines, and mind-body practices may provide symptom relief with few risks. This article reviews conventional RA pharmacological management and highlights evidence supporting promising complementary and alternative approaches, beginning with a recent study on fish oil in rheumatoid arthritis patients treated with anti-inflammatory drugs.

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are among the most commonly prescribed medications, with over 111 million NSAID prescriptions written in one recent year in the U.S. alone.¹ These medications reduce swelling and pain in diseases like rheumatoid arthritis (RA) that involve excessive inflammation. But NSAIDs also come with health risks, especially when taken regularly long-term. They can irritate the stomach lining and cause internal bleeding and ulcers.² NSAIDs also raise blood pressure and worsen kidney function and heart failure.³

New research tested whether fish oil supplements containing omega-3 fatty acids could reduce how much NSAIDs patients with RA need to control their symptoms. The results published in Rheumatology showed 39% of patients taking 10 grams daily of cod liver oil were able to decrease their NSAID dose by at least one-third, compared to only 10% of patients taking a placebo.⁴ And this NSAID-sparing effect occurred without RA disease activity getting worse.

Omega-3s like those in fish oil have natural anti-inflammatory properties. Lead study author Dr. Beatriz Galarraga of the University of Dundee explained, "Increasing the ingestion of omega-3 fatty acids may result in a reduction of inflammation." Earlier studies likewise found fish oil supplements improve inflammation, pain, and stiffness in RA, but most were small and short-term.  

This larger 9 month trial provides some of the most compelling evidence yet that fish oil allows RA patients to substantially cut back on NSAIDs. Given concerns over heart, kidney and stomach complications with long-term NSAID use, achieving similar control of symptoms while lowering drug dosage could provide a safer approach. Omega-3s also benefit cardiovascular and brain health. 

This compelling new research indicates that nutritional strategies like fish oil should be considered alongside standard medications in managing complex conditions like RA. The good news is that fish oil is only the tip of the iceberg, as far as well research, effective, safe, affordable and easily accessible alternatives to convention, drug-based symptom management approaches.

Conventional Treatments and Limitations

The most common medications used to treat RA target symptoms of inflammation and pain. NSAIDs like ibuprofen inhibit cyclooxygenase (COX) enzymes but long-term use damages the gastrointestinal tract and increases cardiovascular disease risk.³ Corticosteroids suppress the immune system but also produce systemic toxicity. The anchor DMARD, methotrexate, increases liver damage and infection risk.⁴ Biologic response modifiers that block inflammatory cytokines like tumor necrosis factor α (TNF-α) also broadly suppress immunity with complications including fungal infections and lymphoma.⁵

Joint replacement surgery is increasingly performed for patients with uncontrolled RA progression. While artificial joints provide symptom relief initially, implants substantially restrict mobility within 10-15 years due to loosening, erosion, and periprosthetic osteolysis.⁶ There is no cure for RA with current standard approaches - only temporary palliation between periods of flare-ups or accelerated joint destruction. Cost is another major limitation, with TNF inhibitor drugs costing up to $50,000 a year.⁷

Safest RA treatments induce disease remission by specifically targeting molecular mediators of inflammation without completely abrogating immune function. They must also enhance chondroprotection and repair endogenous cartilage damage. No existing pharmaceuticals meet both criteria. However, natural substances offer opportunities to address pathological processes while supporting overall health.

Anti-arthritic Botanical Medicines

A variety of herbal preparations have shown preclinical efficacy in arthritis models. A 2011 review identified curcumin, epigallocatechin gallate (EGCG), pomegranate, and resveratrol as prime botanical candidates for preventing cartilage degeneration in RA and osteoarthritis.⁸ Multiple human trials also demonstrate anti-inflammatory and analgesic properties of these safe, plant-derived compounds:

Turmeric (Curcumin)

• 3g curcumin + mesalamine improved symptoms and achieved clinical remission in 53% of RA patients unresponsive to mesalamine alone⁹ 
• 600-1200mg curcumin daily matched ibuprofen for relieving knee osteoarthritis inflammation and pain over 6 weeks¹⁰

Green Tea (EGCG) 

• 400mg EGCG twice daily decreased joint swelling and tenderness in RA after 3 months¹¹
• 50mg EGCG thrice daily reduced inflammation markers interleukin-6 (IL-6) and C-reactive protein (CRP) in RA patients on methotrexate¹²

Pomegranate 

• 1g pomegranate extract twice daily lowered CRP by 19% and disease activity by 17% in RA after 12 weeks¹³
• Pomegranate juice decreased inflammatory IL-1β and IL-6 expression in isolated human chondrocytes¹⁴

Resveratrol

• 500mg resveratrol + diclofenac twice daily reduced joint pain and swelling better than diclofenac alone in active RA¹⁵
• Resveratrol protected cartilage and bone health in animal models by downregulating inflammatory and catabolic mediators¹⁶

Benefits are dose-dependent but generally free from concerning toxicity. Targeting multiple inflammatory pathways likely enhances therapeutic potential. Most researchers conclude botanical bioactives show promise for managing RA symptoms with superior safety to pharmaceuticals - either as monotherapies or adjuvants to standard care.¹⁷ Larger clinical trials are still needed to evaluate efficacy compared with DMARDs and biologics.

Top Natural RA Remedies

Population data and emerging clinical research signal the potential of various nutritional supplements and herbs for inflammatory arthritis. An open access natural medicine resource, GreenMedInfo.com, provides the public free searchable access to global peer-reviewed literature on over 1800 natural substances and 3,000+ different ailments.

Analysis of the GreenMedInfo Rheumatoid Arthritis database identifies several non-toxic alternatives highly relevant for rheumatoid arthritis:¹⁸

Vitamin D

With 30 citations on arthritis and over 3,000 studies in total, vitamin D rivals leading drugs for safety and efficacy across many chronic inflammatory disorders. Deficiency is an independent risk factor for developing RA.¹⁹ Supplementation reduces symptoms, with greater effects in those with low pretreatment blood levels.²⁰

Fish Oil

Omega-3 essential fatty acids EPA and DHA found abundantly in cold water fish uniquely regulate inflammatory processes without immunosuppression. In RA they improve pain, morning stiffness, and joint tenderness.²¹ Fish oil also spares NSAID/corticosteroid dosage up to 45%.²²

Curcumin 

This vibrant yellow turmeric root compound has over 4,000 studies demonstrating versatile anti-inflammatory, antioxidant and immunomodulating properties. Multiple trials confirm marked improvement in RA disease activity and reduction in inflammatory cytokines IL-1, IL-6, and TNF-α.²³

Black Seed (Nigella sativa) 

Used for millennia in the Middle East for arthritis relief, extracts of this flowering plant reduce inflammation and swelling in animal models.²⁴ Studies show benefit for human RA through lowered inflammation (CRP), disease activity scores, and immune cell ratio correction.²⁵

Green Tea (EGCG)

Abundant preclinical research highlights potent cartilage protective effects of this ubiquitous beverage ingredient on inflammatory arthritis.²⁶ Clinical data also supports favorable modulation of central inflammation mediators like IL-6, CRP, and autoantibodies.²⁷

Conclusion

While conventional medications only transiently suppress peripheral symptoms, emerging research shows certain non-pharmacological approaches may effectively target root pathological processes in rheumatoid arthritis. Nutritional strategies and bioactive compounds from time-tested botanical medicines often outperform synthetic drugs for safety and true healing potential. Non-toxic plants still contain our most sophisticated intelligence for addressing and sometimes even curing complex chronic diseases. Combining the best of ancient wisdom with modern science offers the way forward for rheumatoid arthritis management.