Fish oil for joint pain

Arthritis is a chronic disease characterized by joint pain, swelling, reduced joint movement, and stiffness.

It is considered the leading cause of disability in the United States, affecting more than 50 million adults.¹

Treatment for rheumatoid arthritis aims for reducing symptoms during the early stages of the disease as well as preventing further progression of arthritis.²

Some studies suggest that treating rheumatoid arthritis with disease-modifying anti-rheumatic drugs (DMARDs) and biologics is considered more effective than NSAIDs and corticosteroids.

Fish oil supplements

Fish oil supplements can be used to help treat or manage symptoms of arthritis.

Studies suggest they have anti-inflammatory properties.³ Common fish oil supplements include cod liver oil and fish oil.

Cod liver oil, made from the liver of cod fish, has been used to treat rheumatoid arthritis since the 18^th century.⁴

It is also used to treat rickets, a bone disease affecting children, caused by lack of sunlight exposure and vitamin D deficiency. Cod liver is a rich source of both vitamins A and D, suggesting it can be effective in treating or preventing rickets.⁴

Fish oil, made from marine or cold water fish bodies, can help treat or manage symptoms associated with arthritis such as joint pain.

They are generally taken as a supplement to NSAIDs and other arthritis medications.⁵

Health benefits of fish oil for joint pain

Fish oil is rich in omega-3 fatty acids.  It contains high levels of two types of omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).⁶

Research indicates both EPA and DHA can play a role in reducing inflammation in the joints.

The consumption of fish oil can lead to increased levels of EPA and DHA and decreased levels of the omega-6 fatty acid, arachidonic acid in the immune cell membranes.⁶

This, according to studies, results in blocking the formation of eicosanoids – lipid compounds produced by the omega-6 fatty acids.

These eicosanoids are generally responsible for increasing the inflammatory response and play a key role in several chronic inflammatory diseases.

According to studies, fish oil is linked to relieving pain and other symptoms of arthritis.

A 2017 study, published in Nutrients, reviewed over twenty clinical trials that looked at the effects of fish oil supplements on pain.⁷ The findings of the study suggest that fish oil can be effective in reducing pain in patients with rheumatoid arthritis.

However, more research is needed to evaluate the effects of fish oil in pain relief as well as improving other symptoms.

Some research studies reported the benefits of fish oil on patients with rheumatoid arthritis from the review of several clinical trials.

These studies found that fish oil can help decrease joint pain as well as the duration of morning stiffness and the number of swollen or tender joints.^{8, 9}

Several studies suggest that fish oil can help decrease the use of anti-inflammatory medications such as NSAIDs and corticosteroids.

A 2012 study, published in the Archives of Medical Research, suggests that fish oil taken at amounts greater than 2.7 grams/day for over three months can lower the use of NSAIDs in patients with rheumatic arthritis.¹⁰

This may be because, like NSAIDs, fish oil can inhibit the COX enzyme, reducing the need for pain relief drugs.¹¹ 

In a 2015 study, published in the Global Journal of Health Science, researchers suggest that taking fish oil supplements along with DMARDs can potentially reduce symptoms for newly diagnosed rheumatoid arthritis patients.¹²

The findings of the study also suggest that including fish oil in the treatment of rheumatoid arthritis can decrease the use of pain relief medications.

The Arthritis Foundation recommends taking fish oil supplements at a dosage of around 2.6 grams/day twice daily to experience the clinical benefits for patients with rheumatoid arthritis.¹³

According to studies, patients taking fish oil can expect to take around three months to experience any improvement in their symptoms.^5,11

Side effects of fish oil

Side effects of fish oil include heartburn, diarrhea as well as fish breath odor, and fish aftertaste, which many patients find to be unpleasant.11

Some methods to avoid the fish aftertaste include adding citrus or peppermint flavor to fish oil, taking fish oil in a small glass of fruit or vegetable juice, or having fish oil immediately before meals.^5,11

Cod liver oil contains vitamin A at levels higher than the recommended amounts at the dosage needed to produce an anti-inflammatory response.

According to some studies, cod liver oil at that dosage may be linked to an elevated risk of hip fracture and decreased bone density.¹¹

Talk to your doctor about your medical condition and seek medical advice on whether you can take fish oil with your medications or medical conditions.

Written by Ranjani Sabarinathan, MSc                                                                                      

References

1. Park J, Mendy A, Vieira ER. Various Types of Arthritis in the United States: Prevalence and Age-Related Trends From 1999 to 2014. Am J Public Health. 2018;108(2):256-258. doi:10.2105/AJPH.2017.304179
2. Senthelal S, Li J, Goyal A, et al. Arthritis. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518992/
3. Nielsen, Sabrina. (2015). Conference abstract: Marine Oil Supplements for Arthritis Pain: A Systematic Review and Meta-Analysis of Randomized Trials. 10.13140/RG.2.1.4150.4724.
4. Rajakumar K. Vitamin D, cod-liver oil, sunlight, and rickets: a historical perspective. Pediatrics. 2003 Aug;112(2):e132-5. doi: 10.1542/peds.112.2.e132. PMID: 12897318.
5. Cleland, Leslie & James, Michael & Proudman, Susanna. (2003). The Role of Fish Oils in the Treatment of Rheumatoid Arthritis. Drugs. 63. 845-53. 10.2165/00003495-200363090-00001.
6. Akbar, Umair BS; Yang, Melissa BS; Kurian, Divya BS; Mohan, Chandra MD, PhD Omega-3 Fatty Acids in Rheumatic Diseases, JCR: Journal of Clinical Rheumatology: September 2017 – Volume 23 – Issue 6 – p 330-339 doi: 10.1097/RHU.0000000000000563
7. Senftleber NK, Nielsen SM, Andersen JR, et al. Marine Oil Supplements for Arthritis Pain: A Systematic Review and Meta-Analysis of Randomized Trials. Nutrients. 2017;9(1):42. Published 2017 Jan 6. doi:10.3390/nu9010042
8. Goldberg RJ, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain. 2007 May;129(1-2):210-23. doi: 10.1016/j.pain.2007.01.020. Epub 2007 Mar 1. PMID: 17335973.
9. Miles, E., & Calder, P. (2012). Influence of marine n-3 polyunsaturated fatty acids on immune function and a systematic review of their effects on clinical outcomes in rheumatoid arthritis. British Journal of Nutrition, 107(S2), S171-S184. doi:10.1017/S0007114512001560
10. Lee YH, Bae SC, Song GG. Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis. Arch Med Res. 2012 Jul;43(5):356-62. doi: 10.1016/j.arcmed.2012.06.011. Epub 2012 Jul 24. PMID: 22835600.
11. Cleland, L.G., James, M.J. & Proudman, S.M. Fish oil: what the prescriber needs to know. Arthritis Res Ther 8, 202 (2005). https://doi.org/10.1186/ar1876
12. Rajaei E, Mowla K, Ghorbani A, Bahadoram S, Bahadoram M, Dargahi-Malamir M. The Effect of Omega-3 Fatty Acids in Patients With Active Rheumatoid Arthritis Receiving DMARDs Therapy: Double-Blind Randomized Controlled Trial. Glob J Health Sci. 2015;8(7):18-25. Published 2015 Nov 3. doi:10.5539/gjhs.v8n7p18
13. Supplement and Herb Guide for Arthritis Symptoms. Retrieved from https://www.arthritis.org/health-wellness/treatment/complementary-therapies/supplements-and-vitamins/supplement-and-herb-guide-for-arthritis-symptoms
14. Image by Monfocus from Pixabay