SIR—Inappropriate prescribing (IP) encompasses the use of medicines where the risk of an adverse drug event (ADE) outweighs the clinical benefit, particularly when safer or more effective alternatives are available [ 1, 2 ]. IP also includes the use of medicines that increase the likelihood of drug–drug and drug–disease interactions, the mis-prescribing of medicines (incorrect dose, frequency and duration) and the under-use of clinically indicated medicines [ 3–5 ]. IP is highly prevalent in older people and has been associated with preventable ADEs, hospitalisation, institutionalisation, death and resource wastage [ 6–12 ]. With increasing proportions of older people worldwide, quality and safety of prescribing are becoming a global healthcare concern [ 5 , 13 ].

Inflammation is part of the normal host response to infection and injury. However, inappropriate inflammation contributes to several diseases, including inflammatory bowel disease (IBD) and rheumatoid arthritis (RA). Both conditions are characterized by the excessive production of inflammatory cytokines, arachidonic acid (AA)-derived eicosanoids, and other inflammatory agents (e.g., reactive oxygen species, adhesion molecules). By virtue of their antiinflammatory action, ω-3 polyunsaturated fatty acids (PUFA) may be beneficial in inflammatory diseases. A large body of evidence supports a protective effect of ω-3 PUFA in experimental animal and ex-vivo models of Crohns disease (CD), Ulcerative colitis (UC) and RA. Although fish oil supplementation in patients with IBD results in ω-3 PUFA incorporation into gut mucosal tissue and modification of inflammatory mediator profiles, the evidence of clinical benefits of ω-3 PUFA is weak. On the other hand, more convincing data support the efficacy of ω-3 PUFA in reducing pain, number of tender joints, duration of morning stiffness, use of non-steroidal anti-inflammatory drugs and improving physical performance in RA patients. In both IBD and RA further clinical trials with large sample size are needed to clarify the efficacy of ω-3 PUFA as a treatment.