Consumption of omega-3 polyunsaturated fatty acid (PUFA) in the form of fatty fish reduced the risk for recurrent gout flares in adults when adjusted for purine intake, according to a report published in Arthritis & Rheumatology.
Given that gout flare recurrence often remains high despite urate-lowering therapies, investigators sought to explore alternative management options. While omega-3 PUFA consumption has anti-inflammatory effects, with recognized efficacy in several arthritic conditions, there have been few studies examining its effect on gout. Researchers sought to examine the correlation between omega-3 PUFA and flare risk, hypothesizing that consumption in any form would lower the risk for flare.
Between 2003 and 2012, the internet-based case-crossover Boston University Online Gout Study recruited 724 patients with gout (mean age, 54.5 years; 78.5% men; 88.7% white; mean body mass index, 32.1 kg/m2; mean disease duration, 8.0 years), to explore recurrent flare risk factors over the course of a year. Individuals completed online questionnaires during gout flares (hazard period) as well as every 3 months during flare-free stretches (control period), reporting dietary and supplemental omega-3 PUFA exposures during the 48 hours immediately prior.
Primary exposures included diet and supplementation, geography, medications, and physical activity. Primary outcomes were the odds of having a gout flare during hazard and control periods; secondary outcomes were flare risk by omega-3:omega-6 ratios. Multivariable conditional logistic regression analysis, with adjustments for alcohol and total purine intake as well as for diuretic and gout medication use, evaluated correlations between omega-3 PUFA consumption and recurrent gout flares.
Of those enrolled in the study, 85% had acute gout according to the 1977 American College of Rheumatology criteria, and 48% were taking some type of gout medication. When completing online surveys, 22% of patients reported consuming omega-3 PUFA in some form (19% dietary and 4.6% as supplements) within the preceding 48 hours.
Following multivariable adjustment, compared with no consumption, omega-3 PUFA supplementation (via fish oil, cod liver oil, or direct supplements) did not have an effect on recurrent flare risk (adjusted odds ratios [aOR], 1.01; 95% CI, 0.63-1.60; P =.98), but consuming any quantity of fatty fish significantly lowered flare risk by 33% (aOR, 0.77; 95% CI, 0.61-0.96; P =.02). In a dose-response manner, eating 1 serving of omega-3 PUFA-rich fatty fish numerically reduced flare risk (aOR, 0.79; 95% CI, 0.61-1.03; P =.08), while consumption of ≥2 servings significantly decreased the risk for recurrent gout flares (aOR, 0.74; 95% CI, 0.54-0.99; P =.04).
When evaluating flare risk according to ratios, as opposed to the findings for high omega-3:omega-6 foods above, ≥2 servings of neutral foods offered no risk reduction (aOR, 1.19; 95% CI, 0.85-1.66), while low omega-3:omega-6 foods significantly raised flare risk (aOR, 1.34; 95% CI, 1.10-1.63).
Study strengths included a large sample size, case-crossover design, self-matching that avoided control selection bias, internet recruitment facilitating patient access, real-time self-reports that lowered recall bias, and robustness to unmeasured confounding.
Study limitations included not using the diagnostic gold standard of crystal aspiration, exposure self-reporting, varying omega-3 PUFA levels in fish, lack of serum urate or omega-3 PUFA levels, and lack of information regarding ingestion of other high-purine foods.
“Our study highlights the potentially beneficial effect of [omega-3] PUFA for limiting the symptom burden from acute flares in gout,” noted the authors, adding, “Consumption of specific sources and adequate doses of [omega-3] PUFA for gout flare prevention warrants further study in an adequately powered clinical trial.”
Disclosure: Dr. Robert Terkeltaub reports research grants from Ardea/Astra Zeneca and Ironwood. He has served as a consultant for SOBI, Kowa, Horizon, Acquist, and Selecta.
Zhang M, Zhang Y, Terkeltaub R, Chen C, Neogi T. Effect of dietary and supplemental omega‐3 polyunsaturated fatty acids on risk of recurrent gout flares [published online March 25, 2019]. Arthritis Rheumatol. doi:10.1002/art.40896