Effect of omega-three supplementation on serum urate and gout flares in people with gout; a pilot randomized trial

This was a pilot randomized trial in adults with gout and elevated serum urate in New Zealand. The omega-3 fish oil arm included 19 participants; participants were either on a stable dose of allopurinol or not receiving urate-lowering therapy.

The active regimen was oral Melrose fish oil, 20 ml daily, providing a total of 6.2 g omega-3 fatty acids for 24 weeks. Participants in the omega-3 group received supply at baseline and week 12; the comparator was control/no omega-3 supplementation.

Omega-3 fish oil did not significantly lower serum urate or change weight/BMI over 24 weeks. In the omega-3 group, serum urate changed by -0.021 (0.02) mmol/l versus -0.006 (0.02) mmol/l in controls, with a between-group mean difference of 0.015 (95% CI -0.07 to 0.04) mmol/l (p = 0.59). Gout flares were also not significantly different overall, although higher red cell omega-3 concentrations were associated with fewer flares between weeks 12 and 24. The supplement was associated with gastrointestinal adverse effects in 4 participants, while two serious adverse events occurred in the control group.

This was a small pilot study with only 19 participants in the active arm, limiting power to detect clinically meaningful effects. The 24-week duration may have been too short to assess flare prevention robustly, and results may not generalize beyond adults with gout in New Zealand. Secondary outcome findings were mixed and should be interpreted cautiously.