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Systematic Reviews

Efficacy of n-3 fatty acid supplementation on rheumatoid arthritis’ disease activity indicators: a systematic review and meta-analysis of randomized placebo-controlled trials

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References

  • Adam, O., C. Beringer, T. Kless, C. Lemmen, A. Adam, M. Wiseman, P. Adam, R. Klimmek, and W. Forth. 2003. Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis. Rheumatology International 23 (1):27–36. doi: 10.1007/s00296-002-0234-7.
  • Aletaha, D., and J. Smolen. 2005. The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): A review of their usefulness and validity in rheumatoi. Clinical Experimental Rheumatology 23 (5 S39):S100–S108.
  • Almutairi, K., J. Nossent, D. Preen, H. Keen, and C. Inderjeeth. 2021. The global prevalence of rheumatoid arthritis: A meta-analysis based on a systematic review. Rheumatology International 41 (5):863–77. doi: 10.1007/s00296-020-04731-0.
  • Arnett, F. C., S. M. Edworthy, D. A. Bloch, D. J. McShane, J. F. Fries, N. S. Cooper, L. A. Healey, S. R. Kaplan, M. H. Liang, H. S. Luthra, et al. 1988. The Αmerican Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis and Rheumatism 31 (3):315–24. doi: 10.1002/art.1780310302.
  • Bahreini, M., A.-H. Ramezani, F. Shishehbor, and A. Mansoori. 2018. The effect of omega-3 on circulating adiponectin in adults with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials. Canadian Journal of Diabetes 42 (5):553–9. doi: 10.1016/j.jcjd.2017.12.002.
  • Bai, Z.-G., A. Bo, S.-J. Wu, Q.-Y. Gai, and I. Chi. 2018. Omega-3 polyunsaturated fatty acids and reduction of depressive symptoms in older adults: A systematic review and meta-analysis. Journal of Affective Disorders 241 (December):241–8. doi: 10.1016/j.jad.2018.07.057.
  • Balduzzi, S., G. Rücker, and G. Schwarzer. 2019. How to perform a meta-analysis with R: A practical tutorial. Evidence-Based Mental Health 22 (4):153–60. doi: 10.1136/EBMENTAL-2019-300117.
  • Barnard, N. D., W. C. Willett, and E. L. Ding. 2017. The misuse of meta-analysis in nutrition research. JAMA 318 (15):1435–6. doi: 10.1001/jama.2017.12083.
  • Belch, J. J., D. Ansell, R. Madhok, A. O’Dowd, and R. D. Sturrock. 1988. Effects of altering dietary essential fatty acids on requirements for non-steroidal anti-inflammatory drugs in patients with rheumatoid arthritis: A double blind placebo controlled study. Annals of the Rheumatic Diseases 47 (2):96–104. doi: 10.1136/ard.47.2.96.
  • Berbert, A. A., C. R. M. Kondo, C. L. Almendra, T. Matsuo, and I. Dichi. 2005. Supplementation of fish oil and olive oil in patients with rheumatoid arthritis. Nutrition 21 (2):131–6. doi: 10.1016/j.nut.2004.03.023.
  • Caughey, G. E., M. J. James, S. M. Proudman, and L. G. Cleland. 2010. Fish oil supplementation increases the cyclooxygenase inhibitory activity of paracetamol in rheumatoid arthritis patients. Complementary Therapies in Medicine 18 (3–4):171–4. doi: 10.1016/j.ctim.2010.05.032.
  • Cleland, L. G., J. K. French, W. H. Betts, G. A. Murphy, and M. J. Elliott. 1988. Clinical and biochemical effects of dietary fish oil supplements in rheumatoid arthritis. The Journal of Rheumatology 15 (10):1471–5.
  • Dawczynski, C., M. Dittrich, T. Neumann, K. Goetze, A. Welzel, P. Oelzner, S. Völker, A. M. Schaible, F. Troisi, L. Thomas, et al. 2018. Docosahexaenoic acid in the treatment of rheumatoid arthritis: A double-blind, placebo-controlled, randomized cross-over study with microalgae vs. sunflower oil. Clinical Nutrition 37 (2):494–504. doi: 10.1016/j.clnu.2017.02.021.
  • Dawczynski, C., R. Schubert, G. Hein, A. Müller, T. Eidner, H. Vogelsang, S. Basu, and G. Jahreis. 2009. Long-term moderate intervention with n-3 long-chain PUFA-supplemented dairy products: Effects on pathophysiological biomarkers in patients with rheumatoid arthritis. The British Journal of Nutrition 101 (10):1517–26. doi: 10.1017/S0007114508076216.
  • DeSalvo, J. C., M. B. Skiba, C. L. Howe, K. E. Haiber, and J. L. Funk. 2019. Natural product dietary supplement use by individuals with rheumatoid arthritis: A scoping review. Arthritis Care & Research 71 (6):787–97. doi: 10.1002/acr.23696.
  • Di Giuseppe, D., A. Wallin, M. Bottai, J. Askling, and A. Wolk. 2014. Long-term intake of dietary long-chain n-3 polyunsaturated fatty acids and risk of rheumatoid arthritis: A prospective cohort study of women. Annals of the Rheumatic Diseases 73 (11):1949–53. doi: 10.1136/annrheumdis-2013-203338.
  • Dwan, K., T. Li, D. G. Altman, and D. Elbourne. 2019. CONSORT 2010 statement: Extension to randomised crossover trials. BMJ 366 (July):l4378. doi: 10.1136/bmj.l4378.
  • Elbourne, D. R., D. G. Altman, J. P. Higgins, F. Curtin, H. V. Worthington, and A. Vail. 2002. Meta-analyses involving cross-over trials: Methodological issues. International Journal of Epidemiology 31 (1):140–9. doi: 10.1093/ije/31.1.140.
  • Fletcher, A., M. Lassere, L. March, C. Hill, G. Carroll, C. Barrett, and R. Buchbinder. 2020. Oral complementary medicine use among people with inflammatory arthritis: An Australian Rheumatology Association database analysis. International Journal of Rheumatology 2020:1–9. doi: 10.1155/2020/6542965.
  • Follmann, D., P. Elliott, I. Suh, and J. Cutler. 1992. Variance imputation for overviews of clinical trials with continuous response. Journal of Clinical Epidemiology 45 (7):769–73. doi: 10.1016/0895-4356(92)90054-Q.
  • Fortin, P. R., R. A. Lew, M. H. Liang, E. A. Wright, L. A. Beckett, T. C. Chalmers, and R. I. Sperling. 1995. Validation of a meta-analysis: The effects of fish oil in rheumatoid arthritis. Journal of Clinical Epidemiology 48 (11):1379–90. doi: 10.1016/0895-4356(95)00028-3.
  • Fu, Y., G. Li, X. Zhang, G. Xing, X. Hu, L. Yang, and D. Li. 2015. Lipid extract from hard-shelled mussel (Mytilus coruscus) improves clinical conditions of patients with rheumatoid arthritis: A randomized controlled trial. Nutrients 7 (1):625–45. doi: 10.3390/nu7010625.
  • Fuchs, H. A., R. H. Brooks, L. F. Callahan, and T. Pincus. 1989. A simplified twenty-eight–joint quantitative articular index in rheumatoid arthritis. Arthritis and Rheumatism 32 (5):531–7. doi: 10.1002/anr.1780320504.
  • Galarraga, B., M. Ho, H. M. Youssef, A. Hill, H. McMahon, C. Hall, S. Ogston, G. Nuki, and J. J. F. Belch. 2008. Cod liver oil (n-3 fatty acids) as an non-steroidal anti-inflammatory drug sparing agent in rheumatoid arthritis. Rheumatology (Oxford, England) 47 (5):665–9. doi: 10.1093/rheumatology/ken024.
  • Geusens, P., C. Wouters, J. Nijs, Y. Jiang, and J. Dequeker. 1994. Long-term effect of omega-3 fatty acid supplementation in active rheumatoid arthritis. a 12-month, double-blind, controlled study. Arthritis and Rheumatism 37 (6):824–9. doi: 10.1002/art.1780370608.
  • Ghorbanihaghjo, A., S. Kolahi, S. Seifirad, N. Rashtchizadeh, H. Argani, M. Hajialilo, A. Khabazi, S. Alizadeh, and E. Bahreini. 2012. Effect of fish oil supplements on serum paraoxonase activity in female patients with rheumatoid arthritis: A double-blind randomized controlled trial. Archives of Iranian Medicine 15 (9):549–52.
  • Giannaccare, G., M. Pellegrini, S. Sebastiani, F. Bernabei, M. Roda, L. Taroni, P. Versura, and E. C. Campos. 2019. Efficacy of omega-3 fatty acid supplementation for treatment of dry eye disease. Cornea 38 (5):565–73. doi: 10.1097/ICO.0000000000001884.
  • Gioxari, A., A. C. Kaliora, F. Marantidou, and D. P. Panagiotakos. 2018. Intake of ω-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: A systematic review and meta-analysis. Nutrition 45 (January):114–24.e4. doi: 10.1016/j.nut.2017.06.023.
  • Goldberg, R. J., and J. Katz. 2007. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain 129 (1–2):210–23. doi: 10.1016/j.pain.2007.01.020.
  • Gruenwald, J., H.-J. Graubaum, K. Hansen, and B. Grube. 2004. Efficacy and tolerability of a combination of lyprinol and high concentrations of EPA and DHA in inflammatory rheumatoid disorders. Advances in Therapy 21 (3):197–201. doi: 10.1007/BF02850125.
  • Guo, Q., Y. Wang, D. Xu, J. Nossent, N. J. Pavlos, and J. Xu. 2018. Rheumatoid arthritis: Pathological mechanisms and modern pharmacologic therapies. Bone Research 6 (1):1–14. doi: 10.1038/s41413-018-0016-9.
  • He, S., N. Joseph, M. Mirzamani, S. J. Pye, A. H. M. Al-anataki, A. E. Whitten, Y. Chen, H. Kumari, and C. L. Raston. 2020. Vortex fluidic mediated encapsulation of functional fish oil featuring in situ probed small angle neutron scattering. NPJ Science of Food 4 (1):12. doi: 10.1038/s41538-020-00072-1.
  • Hernández-Cruz, B., J. Alcocer-Varela, and M. H. Cardiel. 1998. Omega-3 fatty acids supplementation in Mexican patients with rheumatoid arthritis with standard treatment. A blinded, randomized, placebo controlled, one year, clinical tral. Arthritis & Rheumatism 41 (9 supp):S155.
  • Higgins, Julian P. T., James Thomas, Jacqueline Chandler, Miranda Cumpston, Tianjing Li, Matthew J. Page, and Vivian A. Welch, eds. 2019. Cochrane handbook for systematic reviews of interventions. Chichester (UK): John Wiley & Sons. doi: 10.1002/9781119536604.
  • Hochberg, M. C., R. W. Chang, I. Dwosh, S. Lindsey, T. Pincus, and F. Wolfe. 1992. The American College of Rheumatology 1991 revised criteria for the classification of global functional status in rheumatoid arthritis. Arthritis and Rheumatism 35 (5):498–502. doi: 10.1002/art.1780350502.
  • Ierna, M., A. Kerr, H. Scales, K. Berge, and M. Griinari. 2010. Supplementation of diet with krill oil protects against experimental rheumatoid arthritis. BMC Musculoskeletal Disorders 11 (June):136. doi: 10.1186/1471-2474-11-136.
  • Ioannidis, J. P. A., N. A. Patsopoulos, and E. Evangelou. 2007. Uncertainty in heterogeneity estimates in meta-analyses. BMJ (Clinical Research ed.) 335 (7626):914–6. doi: 10.1136/bmj.39343.408449.80.
  • Kay, J., and K. S. Upchurch. 2012. ACR/EULAR 2010 rheumatoid arthritis classification criteria. Rheumatology 51 (suppl 6):vi5–vi9. doi: 10.1093/rheumatology/kes279.
  • Kim, J. Y., K. Lim, K. H. Kim, J. H. Kim, J. S. Choi, and S. C. Shim. 2018. N-3 polyunsaturated fatty acids restore Th17 and treg balance in collagen antibody-induced arthritis. PLOS One 13 (3):e0194331. doi: 10.1371/journal.pone.0194331.
  • Kjeldsen-Kragh, J., J. A. Lund, T. Riise, B. Finnanger, K. Haaland, R. Finstad, K. Mikkelsen, and O. Førre. 1992. Dietary omega-3 fatty acid supplementation and naproxen treatment in patients with rheumatoid arthritis. The Journal of Rheumatology 19 (10):1531–6.
  • Kolahi, S., A. Ghorbanihaghjo, S. Alizadeh, N. Rashtchizadeh, H. Argani, A.-R. Khabazzi, M. Hajialilo, and E. Bahreini. 2010. Fish oil supplementation decreases serum soluble receptor activator of nuclear factor-kappa B ligand/osteoprotegerin ratio in female patients with rheumatoid arthritis. Clinical Biochemistry 43 (6):576–80. doi: 10.1016/j.clinbiochem.2009.12.011.
  • Kremer, J. M., D. A. Lawrence, G. F. Petrillo, L. L. Litts, P. M. Mullaly, R. I. Rynes, R. P. Stocker, N. Parhami, N. S. Greenstein, B. R. Fuchs, et al. 1995. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Clinical and immune correlates. Arthritis & Rheumatism 38 (8):1107–14. doi: 10.1002/art.1780380813.
  • Kremer, J. M., A. V. Michalek, L. Lininger, C. Huyck, J. Bigauoette, M. A. Timchalk, R. I. Rynes, J. Zieminski, and L. E. Bartholomew. 1985. Effects of manipulation of dietary fatty acids on clinical manifestations of rheumatoid arthritis. The Lancet 325 (8422):184–7. doi: 10.1016/S0140-6736(85)92024-0.
  • Kremer, J. M., W. Jubiz, A. Michalek, R. I. Rynes, L. E. Bartholomew, J. Bigaouette, M. Timchalk, D. Beeler, and L. Lininger. 1987. Fish-oil fatty acid supplementation in active rheumatoid arthritis. A double-blinded, controlled, crossover study. Annals of Internal Medicine 106 (4):497–503. doi: 10.7326/0003-4819-106-4-497.
  • Kremer, J. M., D. A. Lawrence, W. Jubiz, R. DiGiacomo, R. Rynes, L. E. Bartholomew, and M. Sherman. 1990. Dietary fish oil and olive oil supplementation in patients with rheumatoid arthritis. Clinical and immunologic effects. Arthritis and Rheumatism 33 (6):810–20. doi: 10.1002/art.1780330607.
  • Krok-Schoen, J. L., T. M. Brasky, R. P. Hunt, T. E. Rohan, T. A. Baker, W. Li, L. Carbone, R. H. Mackey, L. Snetselaar, M. B. Lustberg, et al. 2018. Dietary long-chain n-3 fatty acid intake and arthritis risk in the women’s health initiative. Journal of the Academy of Nutrition and Dietetics 118 (11):2057–69. doi: 10.1016/j.jand.2018.04.005.
  • Larkin, J. G., H. A. Capell, and R. D. Sturrock. 1985. Seatone in rheumatoid arthritis: A six-month placebo-controlled study. Annals of the Rheumatic Diseases 44 (3):199–201. doi: 10.1136/ARD.44.3.199.
  • Lau, C. S., K. D. Morley, H. McMahon, and J. Belch. 1991. Maxepa Reduces Non-Steroidal Anti-Inflammatory Drug Requirement in Patients with Mild Rheumatoid Arthritis. Clinical Science 81 (s25):3P. doi:10.1042/cs081003Pb.
  • Lau, C., M. McLaren, and J. J. F. Belch. 1995. Effects of fish oil on plasma fibrinolysis in patients with mild rheumatoid arthritis. Clinical and Experimental Rheumatology 13 (1):87–90.
  • Lau, C. S., K. D. Morley, and J. J. F. Belch. 1993. Effects of fish oil supplementation on non-steroidal anti-inflammatory drug requirement in patients with mild rheumatoid arthritis-a double-blind placebo controlled study. Rheumatology 32 (11):982–9. doi: 10.1093/rheumatology/32.11.982.
  • Lee, Y. H., S.-C. Bae, and G.-G. Song. 2012. Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: A meta-analysis. Archives of Medical Research 43 (5):356–62. doi: 10.1016/j.arcmed.2012.06.011.
  • Levack, W. M., R. A. Martin, F. P. Graham, and E. J. Hay-Smith. 2019. Compared to what? An analysis of the management of control groups in cochrane reviews in neurorehabilitation. European Journal of Physical and Rehabilitation Medicine 55 (3):353–63 doi: 10.23736/S1973-9087.19.05795-2.
  • Lindqvist, H. M., I. Gjertsson, T. Eneljung, and A. Winkvist. 2018. Influence of blue mussel (Mytilus edulis) intake on disease activity in female patients with rheumatoid arthritis: The MIRA randomized cross-over dietary intervention. Nutrients 10 (4):481. doi: 10.3390/nu10040481.
  • Magaro, M., L. Altomonte, A. Zoli, L. Mirone, P. De Sole, G. D. Mario, S. Lippa, and A. Oradei. 1988. Influence of diet with different lipid composition on neutrophil chemiluminescence and disease activity in patients with rheumatoid arthritis. Annals of the Rheumatic Diseases 47 (10):793–6. doi: 10.1136/ard.47.10.793.
  • Magaro, M., A. Zoli, L. Altomonte, L. Mirone, P. De Sole, G. D. Mario, and E. D. Leo. 1992. Effect of fish oil on neutrophil chemiluminescence induced by different stimuli in patients with rheumatoid arthritis. Annals of the Rheumatic Diseases 51 (7):877–80. doi: 10.1136/ard.51.7.877.
  • Miles, E. A., and P. C. Calder. 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.
  • Muchow, M., E. I. Schmitz, N. Despatova, P. Maincent, and R. H. Müller. 2009. Omega-3 fatty acids-loaded lipid nanoparticles for patient-convenient oral bioavailability enhancement. Die Pharmazie 64 (8):499–504.
  • Navarini, L., A. Afeltra, G. G. Afflitto, and D. P. E. Margiotta. 2017. Polyunsaturated fatty acids: Any role in rheumatoid arthritis? Lipids in Health and Disease 16 (1):197. doi: 10.1186/s12944-017-0586-3.
  • Nielsen, G. L., K. L. Faarvang, B. S. Thomsen, K. L. Teglbjaerg, L. T. Jensen, T. M. Hansen, H. H. Lervang, E. B. Schmidt, J. Dyerberg, and E. Ernst. 1992. The effects of dietary supplementation with N-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: A randomized, double blind trial. European Journal of Clinical Investigation 22 (10):687–91. doi: 10.1111/j.1365-2362.1992.tb01431.x.
  • O’Mahoney, L. L., J. Matu, O. J. Price, K. M. Birch, R. A. Ajjan, D. Farrar, R. Tapp, D. J. West, K. Deighton, and M. D. Campbell. 2018. Omega-3 polyunsaturated fatty acids favourably modulate cardiometabolic biomarkers in type 2 diabetes: A meta-analysis and meta-regression of randomized controlled trials. Cardiovascular Diabetology 17 (1):98. doi: 10.1186/s12933-018-0740-x.
  • Olendzki, B. C., K. Leung, S. Van Buskirk, G. Reed, and R. B. Zurier. 2011. Treatment of rheumatoid arthritis with marine and botanical oils: Influence on serum lipids. Evidence-Based Complementary and Alternative Medicine 2011:1–9. doi: 10.1155/2011/827286.
  • Page, M. J., J. E. McKenzie, P. M. Bossuyt, I. Boutron, T. C. Hoffmann, C. D. Mulrow, L. Shamseer, J. M. Tetzlaff, E. A. Akl, S. E. Brennan, et al. 2021. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 372:n71. doi: 10.1136/bmj.n71.
  • Park, Y., A. Ri Lee, S.-C S.-C S. C. Shim, J. H. Lee, J. Y. J.-Y. Jung-Yoon Choe, H. Ahn, C. B. Choi, Y. K. Sung, and S. C. Bae. 2013. Effect of N-3 polyunsaturated fatty acid supplementation in patients with rheumatoid arthritis: A 16-week randomized, double-blind, placebo-controlled, parallel-design multicenter study in Korea. The Journal of Nutritional Biochemistry 24 (7):1367–72. doi: 10.1016/j.jnutbio.2012.11.004.
  • Perricone, C., F. Ceccarelli, S. Matteo, G. Di Carlo, D. P. Bogdanos, R. Lucchetti, A. Pilloni, G. Valesini, A. Polimeni, and F. Conti. 2019. Porphyromonas gingivalis and rheumatoid arthritis. Current Opinion in Rheumatology 31 (5):517–24. doi: 10.1097/BOR.0000000000000638.
  • “PIKASOL PREMIUM”. 2020. Accessed December 5. https://www.pikasol.dk/product/pikasol-premium-120-stk/.
  • Prevoo, M. L., M. A. van’t Hof, H. H. Kuper, M. A. van Leeuwen, L. B. van de Putte, and P. L. van Riel. 1995. Modified disease activity scores that include twenty-eight-joint counts development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis and Rheumatism 38 (1):44–8. doi: 10.1002/art.1780380107.
  • Rajaei, E., K. Mowla, A. Ghorbani, S. Bahadoram, M. Bahadoram, and M. Dargahi-Malamir. 2015. The effect of Omega-3 fatty acids in patients with active rheumatoid arthritis receiving DMARDs therapy: Double-blind randomized controlled trial. Global Journal of Health Science 8 (7):18–25. doi: 10.5539/gjhs.v8n7p18.
  • Reed, G. W., K. Leung, R. G. Rossetti, S. VanBuskirk, J. T. Sharp, and R. B. Zurier. 2014. Treatment of rheumatoid arthritis with marine and botanical oils: An 18-month, randomized, and double-blind trial. Evidence-Based Complementary and Alternative Medicine 2014:1–9. doi: 10.1155/2014/857456.
  • Rohekar, G., and J. Pope. 2009. Test-retest reliability of patient global assessment and physician global assessment in rheumatoid arthritis. The Journal of Rheumatology 36 (10):2178–82. doi: 10.3899/jrheum.090084.
  • Ropes, M. W., G. A. Bennett, S. Cobb, R. Jacox, and R. A. Jessar. 1959. 1958 REVISION of diagnostic criteria for rheumatoid arthritis. Arthritis & Rheumatism 2 (1):16–20. doi: 10.1002/1529-0131(195902)2:1<16::AID-ART1780020104>3.0.CO;2-9.
  • Sakkas, L. I., and D. P. Bogdanos. 2018. Multiple hit infection and autoimmunity. Current Opinion in Rheumatology 30 (4):403–9. doi: 10.1097/BOR.0000000000000503.
  • Sakkas, L. I., D. Daoussis, A. Mavropoulos, S.-N. Liossis, and D. P. Bogdanos. 2019. Regulatory B cells: New players in inflammatory and autoimmune rheumatic diseases. Seminars in Arthritis and Rheumatism 48 (6):1133–41. doi: 10.1016/j.semarthrit.2018.10.007.
  • Sakkas, L. I., A. Mavropoulos, C. Perricone, and D. P. Bogdanos. 2018. IL-35: A new immunomodulator in autoimmune rheumatic diseases. Immunologic Research 66 (3):305–12. doi: 10.1007/s12026-018-8998-3.
  • Schneider, I., J. P. Schuchardt, H. Meyer, and A. Hahn. 2011. Effect of gastric acid resistant coating of fish oil capsules on intestinal uptake of eicosapentaenoic acid and docosahexaenoic acid. Journal of Functional Foods 3 (2):129–33. doi: 10.1016/j.jff.2011.03.001.
  • Schulz, K. F., and D. A. Grimes. 2002. Blinding in randomised trials: Hiding who got what. The Lancet 359 (9307):696–700. doi: 10.1016/S0140-6736(02)07816-9.
  • Schünemann, Holger, Jan Brożek, Gordon Guyatt, and Andrew Oxman, eds. 2013. GRADE handbook for grading quality of evidence and strength of recommendations. The GRADE Working Group, 2013. Available from guidelinedevelopment.org/handbook
  • Sedgwick, P. 2013. Meta-analyses: How to read a funnel plot. BMJ 346 (mar01 2):f1342. doi: 10.1136/bmj.f1342.
  • Senftleber, N., S. Nielsen, J. Andersen, H. Bliddal, S. Tarp, L. Lauritzen, D. Furst, M. Suarez-Almazor, A. Lyddiatt, and R. Christensen. 2017. Marine oil supplements for arthritis pain: A systematic review and meta-analysis of randomized trials. Nutrients 9 (1):42. doi: 10.3390/nu9010042.
  • Serfert, Y., S. Drusch, and K. Schwarz. 2010. Sensory odour profiling and lipid oxidation status of fish oil and microencapsulated fish oil. Food Chemistry 123 (4):968–75. doi: 10.1016/j.foodchem.2010.05.047.
  • Sigaux, J., S. Mathieu, Y. Nguyen, P. Sanchez, J.-G. Letarouilly, M. Soubrier, S. Czernichow, R.-M. Flipo, J. Sellam, and C. Daïen. 2022. Impact of type and dose of oral polyunsaturated fatty acid supplementation on disease activity in inflammatory rheumatic diseases: A systematic literature review and meta-analysis. Arthritis Research & Therapy 24 (1):100. doi: 10.1186/s13075-022-02781-2.
  • Sitzia, C., M. Meregalli, M. Belicchi, A. Farini, M. Arosio, D. Bestetti, C. Villa, L. Valenti, P. Brambilla, and Y. Torrente. 2019. Preliminary evidences of safety and efficacy of flavonoids- and omega 3-based compound for muscular dystrophies treatment: A randomized double-blind placebo controlled pilot clinical trial. Frontiers in Neurology 10(July). Frontiers: 755. :755. doi: 10.3389/fneur.2019.00755.
  • Smolen, J. S., F. C. Breedveld, M. H. Schiff, J. R. Kalden, P. Emery, G. Eberl, P. L. van Riel, and P. Tugwell. 2003. A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology 42 (2):244–57. doi: 10.1093/rheumatology/keg072.
  • Smolen, J. S., D. Aletaha, A. Barton, G. R. Burmester, P. Emery, G. S. Firestein, A. Kavanaugh, I. B. McInnes, D. H. Solomon, V. Strand, et al. 2018. Rheumatoid arthritis. Nature Reviews Disease Primers 4 (1):1–23. doi: 10.1038/nrdp.2018.1.
  • Sparks, J. A., É. J. O’Reilly, M. Barbhaiya, S. K. Tedeschi, S. Malspeis, B. Lu, W. C. Willett, K. H. Costenbader, and E. W. Karlson. 2019. Association of fish intake and smoking with risk of rheumatoid arthritis and age of onset: A prospective cohort study. BMC Musculoskeletal Disorders 20 (2):1–13. doi: 10.1186/s12891-018-2381-3.
  • Stamp, L. K., M. J. James, and L. G. Cleland. 2005. Diet and rheumatoid arthritis: A review of the literature. Seminars in Arthritis and Rheumatism 35 (2):77–94. doi: 10.1016/J.SEMARTHRIT.2005.05.001.
  • Sterne, J. A. C., J. Savović, M. J. Page, R. G. Elbers, N. S. Blencowe, I. Boutron, C. J. Cates, H.-Y. Cheng, M. S. Corbett, S. M. Eldridge, et al. 2019. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ (Clinical Research ed.) 366:l4898. doi: 10.1136/bmj.l4898.
  • Sundrarjun, T., S. Komindr, N. Archararit, W. Dahlan, O. Puchaiwatananon, S. Angthararak, U. Udomsuppayakul, and S. Chuncharunee. 2004. Effects of n-3 fatty acids on serum interleukin-6, tumour necrosis factor-α and soluble tumour necrosis factor receptor p55 in active rheumatoid arthritis. The Journal of International Medical Research 32 (5):443–54. doi: 10.1177/147323000403200501.
  • Tedeschi, S. K., J. M. Bathon, J. T. Giles, T. C. Lin, K. Yoshida, and D. H. Solomon. 2018. Relationship between fish consumption and disease activity in rheumatoid arthritis. Arthritis Care & Research 70 (3):327–32. doi: 10.1002/acr.23295.
  • Tulleken, J. E., P. C. Limburg, F. A. Muskiet, and M. H. Van Rijswijk. 1990. Vitamin E status during dietary fish oil supplementation in rheumatoid arthritis. Arthritis and Rheumatism 33 (9):1416–9. doi: 10.1002/art.1780330914.
  • Tulleken, J. E., P. Limburg, and M. H. Van Rijswijk. 1988. Fish oil and plasma fibrinogen. BMJ 297:615.
  • van der Tempel, H., J. E. Tulleken, P. C. Limburg, F. A. Muskiet, and M. H. van Rijswijk. 1990. Effects of fish oil supplementation in rheumatoid arthritis. Annals of the Rheumatic Diseases 49 (2):76–80. doi: 10.1136/ard.49.2.76.
  • Veroniki, A. A., D. Jackson, R. Bender, O. Kuss, D. Langan, J. P. T. Higgins, G. Knapp, and G. Salanti. 2019. Methods to calculate uncertainty in the estimated overall effect size from a random-effects meta-analysis. Research Synthesis Methods 10 (1):23–43. doi: 10.1002/jrsm.1319.
  • Veroniki, A. A., D. Jackson, W. Viechtbauer, R. Bender, J. Bowden, G. Knapp, O. Kuss, J. P. Higgins, D. Langan, and G. Salanti. 2016. Methods to estimate the between-study variance and its uncertainty in meta-analysis. Research Synthesis Methods 7 (1):55–79. doi: 10.1002/jrsm.1164.
  • Viechtbauer, W. 2010. Conducting meta-analyses in R with the metafor package. Journal of Statistical Software 36 (3):1–48. doi: 10.18637/jss.v036.i03.
  • Vieira, K. C. d. O., H. R. A. d. Silva, I. P. M. Rocha, E. Barboza, and L. K. W. Eller. 2021. Nanoencapsulation of unsaturated omega-3 fatty acids as protection against oxidation: A systematic review and data-mining. Critical Reviews in Food Science and Nutrition 62 (16):4356–70. doi: 10.1080/10408398.2021.1874870.
  • Volker, D., P. Fitzgerald, G. Major, and M. Garg. 2000. Efficacy of fish oil concentrate in the treatment of rheumatoid arthritis. Journal of Rheumatology 27 (10):2343–6.
  • Wilsey, B., R. Deutsch, and T. D. Marcotte. 2016. Maintenance of blinding in clinical trials and the implications for studying analgesia using cannabinoids. Cannabis and Cannabinoid Research 1 (1):139–48. doi: 10.1089/CAN.2016.0016.
  • Wolyniak, C. J., J. T. Brenna, K. J. Murphy, and A. J. Sinclair. 2005. Gas chromatography-chemical ionization-mass spectrometric fatty acid analysis of a commercial supercritical carbon dioxide lipid extract from New Zealand green-lipped mussel (Perna canaliculus). Lipids 40 (4):355–60. doi: 10.1007/S11745-006-1394-0.
  • Yan, J.-H., B.-J. Guan, H.-Y. Gao, and X.-E. Peng. 2018. Omega-3 polyunsaturated fatty acid supplementation and non-alcoholic fatty liver disease. Medicine 97 (37):e12271. doi: 10.1097/MD.0000000000012271.
  • Ye, J., and S. Ghosh. 2018. Omega-3 PUFA vs. NSAIDs for preventing cardiac inflammation. Frontiers in Cardiovascular Medicine 5 (October):146. doi: 10.3389/FCVM.2018.00146.

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