Today's treatment of rheumatic disease is directed toward suppressing symptoms and preventing joint deformation. Medical treatment is characterized by an aggressive approach, combining non-steroidal anti-inflammatory drugs (NSAIDs) with cytostatics or other immune-suppressants. The goal of this aggressive treatment is to improve the patient's long-term outcome with respect to symptoms and function. However, the challenge is to prevent adverse effects while monitoring liver and bone marrow function.

Omega-3s have beneficial effects
Omega-3 fatty acids not only reduce symptoms and may potentially facilitate lower doses of NSAIDs, they also appear to preserve joint function, meaning they act as drug-disease-modifiers. To take optimal advantage of the beneficial effects of omega-3 fatty acids, individuals must take large doses, larger quantities than what is possible to get through diet alone. This requires dietary supplements of concentrated omega-3 fatty acids, 5-6 grams per day.

Curb dietary omega-6s
Diet can interfere with the clinical course of a disease since fatty acids help fine-tune the human immune system. omega-3 fatty acids reduce immunological effects while omega-6 fatty acids have the opposite effect. Besides eating a diet rich in fish containing omega-3 fatty acids and/or taking dietary supplements, individuals with rheumatism should eat a diet low in red meat and avoid using vegetable oils rich in omega-6 fatty acids, such as soy, corn and sunflower oil. Use olive oil and rapeseed oil instead because they contain more Omega-9 fatty acids, which do not increase immune functions.

Clinical studies have demonstrated the effects
Several controlled clinical studies have shown significant symptom relief from taking high doses of omega-3 fatty acids for a period of at least 2 to 3 months. Furthermore, intake of omega-3 fatty acids reduced the need for NSAIDs, which is important to prevent adverse effects from the gastro-intestinal tract. A summary of the most important studies has been published in the Journal of Clinical Epidemiology. (1)

One interesting and very important observation was made by a Danish doctor working on the Faeroe Islands and in Greenland. Upon X-raying patients with rheumatoid arthritis (Personal communication), he found their joints to be normal or almost normal even when they had had the disease for 10 years or more. This result would have been very different in a Danish population where joint deformation increases in direct proportion to time.

Low occurrence in Japan
Rheumatic arthritis is an auto-immune disease, affecting about 1% of the population in western countries. The mechanism underlying the development of auto-immune diseases such as rheumatoid arthritis is not completely understood. Most certainly, it involves a combination of genetic and environmental factors, but psychological factors may also be involved. The coastal population of Japan has a high incidence of a genetic configuration, which is often accompanied by rheumatic diseases (so-called HLA-D4). However, rheumatoid arthritis rarely occurs in Japan, probably due to the high intake of fish and thereby omega-3 fatty acids in the Japanese diet.

(1) Fortin PR et al. Validation of a meta-analysis: the effects of fish oil in rheumatoid arthritis. J Clin Epidemiol 1995;48:1379-1390.

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