Effect of Omega-3

Effect of Omega-3 Polyunsaturated Fatty Acids Supplementation for Patients with Osteoarthritis: A Meta-analysis

Journal of Orthopaedic Surgery and Research
May 24, 2023; Vol. 18; No. 1; Article 381

Deng W, Zhiqian Yi, Enzhi Yin, Rui Lu, Hongbo You, Xuefeng Yuan: This study cites 35 references.

These authors performed a systematic review and meta-analysis to comprehensively evaluate the influence of n-3 PUFAs on symptom and joint function of patients with osteoarthritis (OA).

Nine randomized clinical trials (RCTs) with 2,070 patients with OA contributed to the meta-analysis. The follow-up durations were 1 to 63 months.

KEY POINTS FROM THIS ARTICLE:

1) “Worldwide, osteoarthritis (OA) is the most common degenerative joint disease affecting cartilage and surrounding tissues, which has become a leading cause of disability worldwide, particularly of the older population.”

2) “With a growing elderly and obese population, the incidence of OA in recent decades has been increasing, and this has also resulted in a substantial economic burden for the global populations.”

3) Due to the adverse events associated with the long-term use of OA drugs, patients have been seeking alternative and complementary agents for relieving the symptoms and improving the function of the affected arthritis.

4) “Omega-3 polyunsaturated fatty acids (n-3 PUFAs) confers anti-inflammatory efficacy.”

5) “Omega-3 polyunsaturated fatty acids (n-3 PUFAs), mainly including eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA), have been suggested to be effective for patients with OA because of their efficacy for attenuating the systemic inflammatory response and the catabolic environment that accelerates cartilage degradation.”

6) Findings:

• “Pooled results showed that n-3 PUFAs supplementation could significantly relieve the arthritis pain as compared to placebo.” [Key Point]
• “No severe AEs [adverse events] related to the treatment with n-3 PUFA were reported among the included studies.”

7) Conclusions:

• “Compared to placebo or no additional treatment, supplementation of n-3 PUFA could significantly relieve arthritis pain and improve joint function in patients with OA.”
• No severe treatment related AEs were reported.
• “These results suggest that supplementation of n-3 PUFAs is effective and safe in patients with OA.” [Key Point]
• “We found that n-3 PUFA is effective in relieving pain and improving joint function in patients with OA.”
• “Supplementation of n-3 PUFAs is effective to relieve pain and improve joint function in patients with OA.” [Key Point]

8) This study has these methodological strengths:

• “An extensive literature search was performed in three commonly used electronic databases, which could provide the up-to-date studies regarding the role of n-3 PUFA supplementation in patients with OA.”
• “Only RCTs were included, and all of the included studies were of double-blind design.”
• “Besides the symptom of pain, influences of n-3 PUFA supplementation on joint function was also evaluated, as well as the safety outcome.”

9) The mechanisms underlying the benefits of n-3 PUFA include:

• “EPA and DHA supplementation could reduce the expression of multiple inflammatory markers involved in the pathogenesis of cartilage degeneration, such as interleukin-1 beta (IL-1β) and inducible nitric oxide synthase.”
• Supplementation with EPA and DHA could reduce IL-1β-induced activation of nuclear factor-κB, thereby attenuating leptin-induced cartilage degeneration.
• EPA reduces oxidative stress-induced apoptosis and matrix loss of chondrocytes by inhibiting metalloproteinases and chondrocyte apoptosis.

10) “The optimal dose, components (ratio of EPA to DHA), and treatment duration of n-3 PUFA supplementation for OA remains to be determined.”

11) “To sum up, results of the meta-analysis indicate that supplementation of n-3 PUFAs is effective to relieve pain and improve joint function in patients with OA, without increasing the risk of treatment related AEs.”

• “These findings support the use of n-3 PUFAs supplementation as an alternative treatment for OA.”

COMMENTS FROM DAN MURPHY:

We have reviewed these Articles that also support the use of omega-3s for OA:

Article Review 09-08:
A Meta-analysis of the Analgesic Effects of Omega-3 Polyunsaturated Fatty Acid Supplementation for Inflammatory Joint Pain

Article Review 15-08:
Fish Oil: What the Prescriber Needs to Know

Article Review 35-11:
Effect of Glucosamine Sulfate with or without Omega-3 Fatty Acids in Patients with Osteoarthritis

Article Review 11-13:
Omega-3 Fatty Acids and Synovitis in Osteoarthritic Knees

Article Review 21-06:
Omega-3 Fatty Acids (Fish Oil) as an Anti-inflammatory: An Alternative to Nonsteroidal Anti-inflammatory Drugs for Discogenic Pain

Several of these studies suggest the optimal dose of omega-3s is 3,000 mg/day: EPA 2,000 + DHA 1,000.