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Effects of omega-3 supplementation on lipid metabolism, inflammation, and disease activity in rheumatoid arthritis: a meta-analysis of randomized controlled trials

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Abstract

Introduction

Omega-3 possesses anti-inflammatory and lipid metabolism modifying effects in rheumatoid arthritis (RA), but inconsistency exists among previous studies. This meta-analysis intended to explore the effects of omega-3 supplementation on fatty acid distribution, blood lipid profiles, inflammation, and disease activity in RA patients.

Methods

This meta-analysis followed the Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) protocol. PubMed, Web of Science, and Embase databases were searched until August 31, 2023.

Results

Eighteen randomized controlled trials with 1018 RA patients were included. Regarding fatty acid distribution, omega-3 supplementation increased eicosapentaenoic acid (EPA) [standardized mean difference (SMD): 0.74; 95% confidence interval (CI): 0.46, 1.01; P < 0.001] and docosahexanoic acid (DHA) (SMD: 0.62; 95% CI: 0.35, 0.89; P < 0.001), but reduced omega-6:omega-3 ratio (SMD: -1.06; 95% CI: -1.39, -0.73; P < 0.001) in RA patients. Regarding blood lipid, omega-3 supplementation decreased triglyceride (TG) in RA patients (SMD: -0.47; 95% CI: -0.78, -0.16; P = 0.003). Regarding clinical symptoms, omega-3 supplementation reduced tender joint count (TJC) in RA patients (SMD: -0.59; 95% CI: -0.79, -0.39; P < 0.001). Notably, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and disease activity score on 28 joints (DAS28) score were slightly decreased by omega-3 supplementation but without statistical significance (all P > 0.05). Publication bias was low, and stability assessed by sensitivity analysis was good.

Conclusion

Omega-3 supplementation increases EPA and DHA, but reduces the omega-6:omega-3 ratio, TG, and TJC in RA patients.

Key Points

• Omega-3 increased EPA and DHA, but decreased omega-6:omega-3 ratio in RA patients.

• Omega-3 reduced TG and TJC in RA patients.

• Omega-3 showed limited effects on CRP, ESR, and DAS28 scores in RA patients.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Rheumatology & Immunology, The Suqian Clinical College of Xuzhou Medical University, Suqian, 223800, China

    Wen Wang, Yan Xu, Jun Zhou & Yinshan Zang

  2. Department of Rheumatology & Immunology, The Affiliated Suqian First People’s Hospital of Nan**g Medical University, Suqian, 223800, China

    Wen Wang, Yan Xu & Yinshan Zang

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  2. Yan Xu
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Contributions

Conceptualization, Wen Wang and Yinshan Zang; Methodology, Yinshan Zang; Formal Analysis, Wen Wang and Yinshan Zang; Investigation, Yan Xu and Jun Zhou; Resources, Yan Xu and Jun Zhou.; Data Curation, Wen Wang, Yan Xu and Jun Zhou; Writing – Original Draft Preparation, All authors; Writing – Review & Editing, All authors; Supervision, Yinshan Zang; Project Administration, Wen Wang;

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Correspondence to Yinshan Zang.

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Wang, W., Xu, Y., Zhou, J. et al. Effects of omega-3 supplementation on lipid metabolism, inflammation, and disease activity in rheumatoid arthritis: a meta-analysis of randomized controlled trials. Clin Rheumatol (2024). https://doi.org/10.1007/s10067-024-07040-0

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  • DOI: https://doi.org/10.1007/s10067-024-07040-0

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