Taking paracetamol with fish oil could be the safest and best method of pain relief for arthritis, researchers with the University of South Australia (UniSA) say.
The research, published in international peer-reviewed journal Complementary Therapies in Medicine
, recommends the simple combination of paracetamol and fish oil for symptom relief in both rheumatoid arthritis and osteoarthritis, ahead of commonly prescribed anti-inflammatory drugs such as Celebrex and over-the-counter ibuprofen.
Lead author, Dr Gillian Caughey from UniSA's Sansom Institute for Health Research, says with nearly one in five Australians having arthritis, her findings are important in helping to address this major health issue.
"Non-steroidal anti-inflammatory drugs (NSAIDs) provide prompt, short-term symptomatic relief from arthritis," Dr Caughey says. "Unfortunately, use of these anti-inflammatories is associated with increased risk of stomach problems and cardiovascular events. They also don't improve long-term outcomes for arthritis patients, including those with osteoarthritis and rheumatoid arthritis."
Dr Caughey says non-steroidal anti-inflammatory drugs such as ibuprofen provide relief from the symptoms of inflammation and pain through inhibition of an enzyme called cyclooxygenase (COX).
"Paracetamol and fish oil act on COX via different mechanisms, which raises the possibility of a positive interaction between fish oil and paracetamol with regard to COX inhibition, and this was addressed in our study," she says.
In the pilot study conducted at the Royal Adelaide Hospital, Dr Caughey and RAH Rheumatology Unit colleagues Prof Michael James, Dr Susanne Proudman and Prof Leslie Cleland examined if the combination of fish oil and paracetamol could reduce synthesis of key mediators of inflammation and pain in patients with rheumatoid arthritis. Patients were divided into two groups based on their level of fish oil intake, and both were given paracetamol.
"By analysing blood samples, we found that those patients from the higher dose fish oil group had lower levels of inflammatory mediators than those in the lower dose fish oil group, with the study demonstrating that suppression of COX activity by paracetamol is enhanced by fish oil ingestion," she says.
"The findings provide encouragement for clinical trials to evaluate the benefits of combined therapy with long-term fish oil and paracetamol by comparison with traditional anti-inflammatory medicines in osteoarthritis. If the effectiveness of this inexpensive combination proves comparable to that of NSAIDs, its improved safety relative to long-term NSAID therapy will be especially advantageous."