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There are at least 13 randomized controlled clinical trials that show benefit from fish oil supplements in patients with rheumatoid arthritis [92]. A common feature of the studies has been a reduction in symptoms and in the number of tender canker sores joints. There was a reduction in the dose of analgesic anti-inflammatory drugs. In canker sores a subsequent meta-analysis, morning stiffness was decreased, as well as canker sores the number of tender joints [93]. Cleland and James have attempted to develop a standard laboratory index of omega-3 nutritional status. They have explored the feasibility of using an assay to guide prevention and therapeutic treatments with omega-3 fatty acids. They have established that there is little diurnal variation in levels of plasma phospholipid EPA, no relationship with meals and a close correlation with cellular EPA levels.
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