Ask an answerable question (PICO)：
Rheumatoid arthritis patients, in order to alleviate their disease symptoms such as inflammation and joint pain, in addition to conventional pharmacotherapy, the literature has indicated that the principal constituent of fish oil, Omega-3 polyunsaturated fatty acids, can ameliorate the inflammatory response, thereby mitigating joint pain in patients. Therefore, building upon this notion, we aim to empirically investigate the potential of Omega-3 polyunsaturated fatty acid supplements in reducing joint pain in rheumatoid arthritis patients, with the aspiration of offering rheumatoid patients a dietary therapy option in conjunction with pharmacotherapy. Formulating the PICO question "Can the use of Omega-3 polyunsaturated fatty acid supplements improve joint pain in patients with rheumatoid arthritis" based on the clinical context. Based on the comprehensive findings of this study, it is anticipated that it may provide efficacious pain relief for rheumatoid arthritis patients, ultimately enhancing their quality of life.
The Method and Analysis of Literature Review：
Utilizing evidence-based medicine steps to establish PICOs, the following search keywords with Mesh terms and synonyms were formulated: P: "Rheumatoid Arthritis"; I: "Omega-3 Polyunsaturated Fatty Acids" or "Omega-3 PUFA"; C: "Placebo" or "Conventional Treatment"; O: "Arthritis Pain" or "Arthritic Pain" or "Joint Pain". Applying Bollinger logic and limits as Humans, Systematic Review, or Randomized Controlled Trial, the article limit from January 2019 to September 2024 was set, with inclusion criteria for adult and literature written in English. Electronic databases including Cochrane, PubMed, and ProQuest Health et al. were searched, resulting in a total of 79 articles. These articles were screened using the PRISMA 2020 process to exclude duplicates and inconsistencies, ultimately yielding 1 systematic review and 1 randomized controlled trial literature for rigorous review.
Critical Appraisal：
The systematic literature review uses the Systematic Review Critical Appraisal Sheet, CEBM University of Oxford, 2010, and the randomized controlled trials use the Risk of Bias from Cochrane Handbook for Systematic Review of Interventions. Version 5.1.0 (2011) as a critical reading tool. The evidence level part uses the 2011 version of the Oxford Center for Empirical Medicine Evidence Level Table Evaluation. The evidence level of this SR document is Level 1 and the RCT is Level 2.
The results of the research quality evaluation indicated "What question (PICO) did the systematic review address?" "Is it unlikely that important, relevant studies were missed?" "Were the criteria used to select articles for inclusion appropriate?" "Were the included studies sufficiently valid for the type of question asked?" and "Were the results similar from study to study?" with all items marked as "YES". Originally, the review included 41 randomized controlled trial articles, but 11 articles were subsequently excluded due to the unavailability of key data such as standard deviation, mean value, or number of patients included, despite attempts to obtain such data via email communication with the original authors. These exclusions were reflected in the final analysis. The Cochrane Risk of Bias Scale was used to assess the methodological quality of the included studies, revealing that 56% were assessed as low risk of bias, 43% as unclear, and 1% as high risk. Considering the heterogeneity of the included studies, the review used Meta-regression to analyze the symptoms and subgroups in order to compare the overall effect of oral polyunsaturated fatty acid supplements on parameters of inflammatory rheumatic disease activity.
The results of the RCT literature quality evaluation include "whether groups are assigned in random order", "whether the subject tracking rate is high enough, and whether the data of lost patients are included in the analysis", and "others such as conflicts of interest, manufacturer sponsorship, etc." For Low risk, this article is a single-blind randomized controlled study, using an online random number generator for allocation. A total of 120 patients were included, with a loss rate of 15%. It compared the effects of flaxseed on different indicators in patients with rheumatoid
Results, Conclusions and Recommendations：
omized controlled trials (RCTs) with a combined total of 1420 participants who had inflammatory rheumatic diseases. The average age of the participants was 53.3 years, with 73.5% of them being women. The intervention measures involved taking polyunsaturated fatty acid supplements, and the effects of different preparation sources, ingredients, doses, and treatment durations were compared.
The main result of the review, which integrated data from 25 articles that compared the pain visual analogue scale, in rheumatoid arthritis patients taking polyunsaturated fatty acid supplements compared to placebo, showed that taking polyunsaturated fatty acid supplements had a significant effect in reducing pain (standardized mean difference [SMD] = -0.53; 95% confidence interval [CI] = -1.05, -0.01; I2 = 93.2%). Specifically, when polyunsaturated fatty acid supplements were taken for a duration of 3 months, based on 13 articles, the results showed a significant difference in reducing pain as measured by pain VAS (SMD = -0.57; 95% CI = -0.99, -0.15; I2 = 83%).
RCT review literature Ghaseminasab-Parizi M et al (2022) included a total of 120 patients, who were diagnosed with rheumatoid arthritis, had a disease duration of at least 6 months, were aged 18-70 years old, and were willing to participate in the trial. The intervention measures were [Art. One group: Flaxseed (30g/day) plus an anti-inflammatory diet] and [Group 2: Flaxseed (30g/day) plus a regular diet] were conducted for 12 weeks. The main results are presented in patients with rheumatoid arthritis. [Group 1: flaxseed plus anti-inflammatory diet] and [Group 2: flaxseed plus regular diet], there was a significant difference in reducing pain scale (VAS) (P<0.001).
According to the reviewed literature by Sigaux et al. (2022), we suggested that patients with rheumatoid arthritis can benefit from taking animal-based polyunsaturated fatty acids, particularly those containing Omega-3, at a daily dose of greater than 2g. Taking these supplements for at least 3 months may improve disease activity and alleviate symptoms such as pain, joint swelling, and tenderness. Vegetarians and other patients with rheumatoid arthritis are advised to add flaxseed to their diet at a daily dose of 30 grams for at least 12 weeks, which can effectively reduce pain indicators.
However, it is important to be mindful of potential gastrointestinal discomfort as a side effect. Fish oil, being a commonly available food supplement, is widely accepted by Chinese people. Nevertheless, it is crucial to remember that polyunsaturated fatty acids, like all nutrients, should be taken in moderation. Excessive intake of fat, including polyunsaturated fatty acids, can lead to excessive calorie intake or increase the risk of certain diseases. Therefore, it is recommended to maintain a balanced diet and consult with a physician or a nutritionist for appropriate guidance when choosing foods and considering supplementation.
