WHEN Nina Abbas was diagnosed with rheumatoid arthritis seven years ago, like most people with the condition, she was prescribed anti-inflammatory painkillers.

However, also like most patients, the 37-year-old found that the medication had side effects, in her case mainly nausea. Continuing to take the painkillers became the lesser of two evils. That was until her mother suggested she start taking cod liver oil supplements. Now, while her arthritis has not cleared, Nina has found that she can often manage without her prescription drugs.

"It started in my wrist," she remembers. "I'd be holding a cup of hot tea and it would become painful and I'd have to put it down because I thought I would drop it."

Rheumatoid arthritis is a chronic, progressive and disabling auto-immune disease which affects about one per cent of adults in the UK. It is an incredibly painful condition, causing swelling and damaging cartilage and bone around the joints. Any joint may be affected but it is commonly the hands, feet and wrists. This can cause severe disability, depending on how aggressive the disease is, and ultimately affects a person's ability to carry out everyday tasks.

In Nina's case it means that she can no longer participate in sports which use her left arm and has to use an automatic car when driving because she finds it difficult to change gear.

After a hospital diagnosis, which included a blood test and X-Ray, Nina was given a splint to wear on her left hand and anti-inflammatory tablets to take as well as being offered physiotherapy to help maintain flexibility in her affected joints.

Uncomfortable

"I found the splint very uncomfortable to wear," says Nina, a trainee financial advisor from Stockport.

"And the tablets didn't agree with me at all - I was always feeling very sick. I was complaining about it to my mum and she said, `Have you not started taking cod liver oil?'

"I've been taking it ever since. I don't know if I can put it down to the supplements, but I don't take any painkillers now unless I'm really desperate because the pain is stopping me sleeping."

Nina's story is not unusual. Indeed it was because so many arthritis patients sought alternative or complementary treatments that Professor Jill Belch began her research at Ninewells Hospital and Medical School in Dundee, into the possible benefits of cod liver oil for the condition.

"I found a lot of my patients, who are quite disabled and can't work, were spending money, which they could ill afford, on alternative therapies for which there was no scientific proof," she says. "So, we looked at what appeared to be the ones with the best scientific basis and one of these was fish oil."

Professor Belch's team tracked the health of almost 100 rheumatoid arthritis patients taking non-steroidal anti-inflammatory drugs (NSAIDs).

Half were given 10 mg of Seven Seas Extra High Strength Cod Liver Oil, the equivalent to two teaspoons - to take alongside their daily dose of painkillers while half were given dummy capsules. After three months the volunteers were asked to try and reduce their reliance on NSAIDs.

The study lasted nine months, after which time 39 pc of those in the cod liver oil group had managed to cut their daily dose of the painkillers by more than 30 pc, while only 10 pc of the other group had managed to do the same.

Research

Professor Belch explains: "The study reinforces previous research that has shown cod liver oil, and its high content of Omega-3 essential fatty acids, to have significant anti-inflammatory properties in patients with rheumatoid arthritis.

"Patients with rheumatoid arthritis all need anti-inflammatory drugs that may have rather horrid side effects - they irritate the tummy, they can sometimes raise blood pressure and there is a question now of how good long-term anti-inflammatories are for your heart. That's the big worry and why we're quite keen to cut them down.

"We don't necessarily want patients to stop taking them if they can't, but we want them to cut down because we know these side effects are dose related. The more you take the more side effects you get."

NSAIDs work by stopping pro-inflammatory chemicals from being produced in the body, whereas fish oils work with the body's natural defences, by encouraging the production of natural anti-inflammatory chemicals in the body. It is not yet clear, however, if fish oils have any role in preventing the progression of the disease.

"We know that NSAIDs get rid of the pain and swelling but they don't stop the destruction," says Professor Belch. "What we don't know is whether the fish oil, which does help decrease the pain and inflammation, will also stop the joint destruction. At the moment we have no evidence for that. All we can say is it's got anti-inflammatory effects like the painkilling drugs that the patients are already using."

Scientific studies

The dose of 10mg a day used in the trial was determined on the basis of scientific studies which examined its effect on inflammation in joint tissue.

Although some patients reported a fishy taste in their mouth, no ill effects of supplementing the diet with cod liver oil were found.

And Professor Belch says that it is safe to try it out yourself at home. However, she advises people wanting to take this high dose to make sure that the oil taken does not contain vitamin A. "Vitamin A is stored in the liver, so you don't want to be taking high amounts. People should stick to one that contains vitamin E, which is not stored in the body, and not one that has vitamin A in it.

"You will need to take both the oil and your pain killers for three months because the fish oil needs time to get into the cells. At the end of three months you can gradually try to reduce your anti-inflammatories. I tell patients: `Don't push it, just do what's comfortable - don't try to get off it and cause pain - just see if you can reduce the dose gradually and don't do it until you've been on the fish oil for three months.'"

This is the team's third study into cod liver oil, all of which have shown similar positive results. Fish oil is already available on prescription for other conditions for which there has been scientific proof of its benefits, such as lowering cholesterol.

Until now its benefits had not been proved for rheumatoid arthritis and studies of longer duration are now being planned to explore its effects in more detail.