Kabeljauwleverolie als pijnstiller bij Reumatische artritis*
Uit een kleine Engelse studie onder patiënten met reumatische artritis (RA) blijkt
dat iedere dag kabeljauwleverolie de te nemen hoeveelheid pijnstillers met wel 30% kan veminderen. Het voordeel van de kabeljauwleverolie, die
DHA en EPA bevat is bovendien dat deze geen bijwerkingen heeft. Aan het ziekteproces zelf werden geen veranderingen gemeten.
Cod Liver Oil Reduces Painkiller Use
"Two teaspoons of cod liver oil a day can cut the number of powerful painkillers needed to ease the pain of arthritis", reports the Daily Mail. Patients who were given the supplements "were able to reduce their daily dose of anti-inflammatory drugs", the newspaper says. These findings are important because the long-term use of anti-inflammatory drugs "can double the threat of heart attack and raise the risk of strokes and heart disease", the Mail adds. The reports are based on a small study in people with rheumatoid arthritis that showed the potential benefits of cod liver oil capsules in reducing the use of non-steroidal anti-inflammatory drugs (NSAIDs). The picture is complicated because the people taking the capsules were also on other drugs for their rheumatoid arthritis, and the study did not aim to reduce the dosages of these other medications. Not all people with rheumatoid arthritis will be able to reduce their NSAID dosage with cod liver oil capsules, and some people will not be able to stick with the daily regimen of 10 capsules. Although cod liver oil supplements may be worth considering by some people with rheumatoid arthritis, patients should talk to their doctor before making any drastic changes in the medicines they
take.
Dr Bernat Galarraga and colleagues from the Ninewells Hospital and Medical School in Dundee; the Western General Hospital in Edinburgh, and the University of Dundee, carried out this research. The study was funded by Willem Van Dias and Seven Seas Ltd, who sell cod liver oil capsules and other food "supplements". It was published in the peer-reviewed medical
journal: Rheumatology.
This was a double-blind randomised controlled trial looking at whether taking high strength cod liver oil capsules could reduce the need for specific painkillers (NSAIDs) in people with rheumatoid arthritis. Cod liver oil contains the essential fatty acids DHA and EPA, which are thought to have anti-inflammatory
effects.
The researchers enrolled 97 people aged 37 to 78 years old with rheumatoid arthritis (who had had the disease for an average of 13 years) from the rheumatology departments of two hospitals in Dundee and Edinburgh. To be included in the study, the person's disease and medication had to have been stable for the past three months, and they had to have been taking regular NSAID medication. People with unstable disease that required changes in medication, those taking high doses of steroids, those with other severe diseases or those already taking supplements containing essential fatty acids were excluded.
Eligible participants were assigned at random to nine months treatment of either daily capsules containing a mixture of cod liver oil and fish oil (Seven Seas Marine Oil 1 capsules), containing 10g of oil in total, or identical air filled capsules (a placebo). At three and nine months, blood samples were taken to measure the levels of the essential fatty acid EPA (contained in cod liver oil) to see if participants had been taking their capsules.
Participants were also asked to record their daily NSAID use. After 12 weeks, participants were asked to gradually reduce their use of NSAIDs, and then stop using them if possible. The researchers calculated how much NSAID medication participants were using on average daily, how severely they were affected by their disease, and how active their disease was at the start of the study, as well as at four, 12, 24 and 36 weeks. The researchers then looked at how these levels changed over the study in the cod liver oil and placebo groups. They were primarily interested in comparing what proportion of people in each group had been able to reduce their daily NSAID use by more than 30% over the course of the study. Any participants who dropped out of the study were included in analyses, and assumed to have not reduced their NSAID usage by more than 30%.
Only 60% of participants completed the full nine-month study period. More people in the cod liver oil group (39%) were able to reduce their NSAID intake by more than 30% compared with the placebo group (10%). This reduction was still significant following exclusion of the seven people (four in the cod liver oil group and three in the placebo group) whose use of other medications (such as steroids) increased during the
study.
In general, there was no difference between the groups in the severity or activity of the disease on any of the measures used, except for a small but significant reduction in self-reported pain in the cod liver oil group compared with the placebo group. There was no difference between the groups in the type or number of side effects experienced, which were mostly mild.
The researchers concluded that cod liver oil capsules could be used by people with rheumatoid arthritis to cut their NSAID intake.
Cod liver oil (n-3 fatty acids) as an non-steroidal anti-inflammatory drug sparing agent in rheumatoid arthritis
B. Galarraga1, M. Ho1, H. M. Youssef2, A. Hill1, H. McMahon1, C. Hall2, S. Ogston3, G. Nuki2 and J. J. F. Belch1
1Vascular and Inflammatory Diseases Research Unit, University Division of Medicine and Therapeutics, Ninewells Hospital and Medical School, Dundee, 2Rheumatic Diseases Unit, Western General Hospital, Edinburgh and 3Public Health Section, Community Health Science Division, University of Dundee, Dundee, UK.
Correspondence to: B. Galarraga, The Institute of Cardiovascular Research, Vascular and Inflammatory Diseases Research Unit, University Division of Medicine and Therapeutics, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. E-mail:
b.galarraga@dundee.ac.uk
Abstract
Objectives. Dose-dependant gastrointestinal and cardiovascular side-effects limit the use of NSAIDs in the management of RA. The n-3 essential fatty acids (EFAs) have previously demonstrated some anti-inflammatory and NSAID-sparing properties. The objective of this study was to determine whether cod liver oil supplementation helps reduce daily NSAID requirement of patients with RA.
Methods. Dual-centre, double-blind placebo-controlled randomized study of 9 months’ duration. Ninety-seven patients with RA were randomized to take either 10 g of cod liver oil containing 2.2 g of n-3 EFAs or air-filled identical placebo capsules. Documentation of NSAID daily requirement, clinical and laboratory parameters of RA disease activity and safety checks were done at 0, 4, 12, 24 and 36 weeks. At 12 weeks, patients were instructed to gradually reduce, and if possible, stop their NSAID intake. Relative reduction of daily NSAID requirement by >30% after 9 months was the primary outcome measure.
Results. Fifty-eight patients (60%) completed the study. Out of 49 patients 19 (39%) in the cod liver oil group and out of 48 patients 5 (10%) in the placebo group were able to reduce their daily NSAID requirement by >30% (P = 0.002, chi-squared test). No differences between the groups were observed in the clinical parameters of RA disease activity or in the side-effects observed.
Conclusions. This study suggests that cod liver oil supplements containing n-3 fatty acids can be used as NSAID-sparing agents in RA patients.
(Mei
2008)
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