• Score on Persian version of health assessment questionnaire (PE-HAQ) at 0, 6 and 12 weeks
  
• Disease activity score at 0, 6 and 12 weeks
  
• Duration of morning stiffness (in minutes) at 0, 6 and 12 weeks
  
• Joint pain intensity, on a five-point scale (0, absent) at 0, 6 and 12 weeks
  
• Onset of fatigue (in minutes) after walking at 0, 6 and 12 weeks
  
• Ritchie’s articular index for pain joints at 0, 6 and 12 weeks
  
• Right and left grip strength (in mmHg) measured with a sphygmomanometer cuff inflated to 20 mmHg at 0, 6 and 12 weeks
  
• Patient’s global assessment of disease activity (0 to 10 cm visual analog scale: 0, symptom free; 10, very severe) at 0, 6 and 12 weeks
  
• Classification of functional status in RA according to revised criteria of the American
  
• College of Rheumatology at 0, 6 and 12 weeks
  
• Patient’s satisfaction in activities of daily living based on a Persian version of Health Assessment Questionnaire (PE-HAQ) at 0, 6 and 12 weeks
  

• TNF-alpha at 0, 6 and 12 weeks
  
• IL-1 beta at 0, 6 and 12 weeks
  
• C-reactive protein at 0, 6 and 12 weeks
  
• Erythrocyte sedimentation rate at 0, 6 and 12 weeks
  
• Malondialdehyde at 0, 6 and 12 weeks
  
• Systolic blood pressure at 0, 6 and 12 weeks
  
• Diastolic blood pressure at 0, 6 and 12 weeks
  

The purpose of this study is to determine whether simultaneous supplementation with omega-3 fatty acids and vitamin E is effective in the treatment of patients with rheumatoid arthritis.

Most of studies on omega-3 fatty acids (omega-3) supplementation in patients with rheumatoid arthritis (RA) have clearly shown potentially beneficial changes in cytokine and eicosanoid metabolism. The overall clinical improvement, however, has been only moderate. One explanation is that an increased intake of omega-3 leads to a reduction in the availability of antioxidants and an increased generation of lipid peroxides. The majority of the anti-inflammatory drugs routinely used nowadays are COX (cyclo-oxygenase) inhibitors. Mechanism of COX II inhibitors is similar of omega-3. So, it is difficult to differentiate omega-3 net effects in some situations. Existing clinical trials on omega-3 and vitamin E (Vit E) are sometimes questioned due to using omega-6 fatty acids as placebo and neglecting omega-6 fatty acid intake in the diet. A comprehensive randomized controlled double-blind trial would have omega-6 fatty acids served as placebo in patients who are well matched in terms of therapies and drugs.

Comparison(s): Comparison of groups supplemented with omega-3, omega-3 with Vit E, and placebo (Medium chain triglycerides: MCT).