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Arthritis Today

Backed by Science: 9 Supplements for Arthritis Symptoms

Find out which supplements have been scientifically proven to ease symptoms of osteoarthritis and rheumatoid arthritis.

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The supplement market is booming. More than half of adults in the United States use vitamins, botanicals and other natural medicines to treat or pre-vent disease, spending $28 billion on them annually, according to Consumer Reports. Not surprisingly, products that promote joint health are top sellers.

Unfortunately, research hasn’t kept pace with consumer demand. Until fairly recently, “most of the scientific world was against most supplements,” says Gladys Block, PhD, professor emerita of public health nutrition at the University of California, Berkeley, so supplements were ignored by researchers. But, she adds, attitudes have changed in the past 15 years.

That’s good news because it means more natural medicines are being put to the test in well-designed clinical trials. The recommendations in this guide reflect findings from the best of those studies.

Learn about the top  supplements for osteoarthritis (OA) and rheumatoid arthritis (RA) – some of which have proven effective for both diseases, and some of which work for other conditions, too.

BEST FOR OA

SAM-e (S-adenosylmethionine)

WHAT IT IS: The synthetic form of a chemical found in all human cells

HOW IT WORKS: SAM-e is a natural analgesic and anti-inflammatory and may stimulate cartilage growth by signaling production of cartilage proteins. It also affects neurotransmitters such as serotonin.

STUDIES: Equivalency trials have shown that SAM-e relieves OA symptoms as effectively as nonsteroidal anti-inflammatories (NSAIDs), with fewer side effects and more prolonged benefit. A 2004 University of California, Irvine study found SAM-e equal to the prescription drug celecoxib (Celebrex) and a 2009 study found it comparable to the NSAID nabumetone.

HOW MUCH: Capsules (preferably in blister pack): 600 to 1,200 milligrams (mg) daily in three divided doses for OA; 200 to 800 mg twice daily for fibromyalgia; 800 to 1,600 mg twice daily for depression (but talk to your doctor if you have bipolar disorder). Taking with vitamin B12, B6 and folate improves absorption.

Boswellia serrata (Indian frankincense)

WHAT IT IS: Gum resin of the boswellia tree

HOW IT WORKS: Boswellic acids – the active components – have strong anti-inflammatory and analgesic properties. They also may help prevent cartilage loss and inhibit the autoimmune process, making boswellia a potential therapy for RA, too.

STUDIES: A 2008 study in India, where boswellia is a traditional remedy, found that a supplement called 5-Loxin significantly improved OA pain and function within seven days and slowed cartilage damage after three months.

HOW MUCH: Capsule or tablet: 300 to 400 mg three times daily. Look for 60 percent boswellic acids.

Capsaicin (Capsicum frutescens)

WHAT IT IS: The active, heat-producing component in chili peppers

HOW IT WORKS: Applied as a topical cream, gel or patch, capsaicin temporarily reduces substance P, a pain transmitter.

STUDIES: Many studies have shown that capsaicin effectively reduces pain from OA. In a 2010 study published in Phytotherapy Research, joint pain decreased nearly 50 percent after three weeks’ use of 0.05 percent capsaicin cream.

HOW MUCH: Most capsaicin products contain between 0.025 and 0.075 percent concentrations. Apply regularly three times a day.

NOTE: Studies show capsaicin may help reduce pain in RA and improve grip strength in fibromyalgia.

Turmeric/curcumin (Curcuma longa)

WHAT IT IS: An ingredient in many curries and often used in ayurvedic medicine, turmeric is the root of a plant in the ginger family. Curcumin is a key chemical in turmeric.

HOW IT WORKS: Curcumin blocks inflammatory cytokines and enzymes, including cyclooxygenase-2 (COX-2), the target of celecoxib.

STUDIES: A 2010 clinical trial found that a turmeric supplement called Meriva (standardized to 75 percent curcumin combined with phosphatidylcholine) provided long-term improvement in pain and function in 100 patients with knee OA. In a small 2012 pilot study, a curcumin product called BCM-95 reduced joint pain and swelling in patients with active RA better than diclofenac sodium did.

HOW MUCH: Extract, which is more likely to be free of contaminants, or capsule: 500 mg two to four times daily for OA; 500 mg twice daily for RA. “Curcumin makes up only about 2 to 6 percent of turmeric, so be sure to check the standardized amount of curcumin,” says Randy Horwitz, MD, medical director of the University of Arizona Center for Integrative Medicine in Tucson.

Avocado-soybean unsaponifiables (ASU)

WHAT IT IS: A supplement composed of one-third avocado oil and two-thirds soybean oil

HOW IT WORKS: ASU blocks pro-inflammatory chemicals, prevents deterioration of synovial cells, which line joints, and may help regenerate normal connective tissue.

STUDIES: It has been studied extensively in Europe, where it is routinely used to treat OA. A 2008 meta-analysis found that ASU improved symptoms of hip and knee OA and reduced or eliminated NSAID use. Especially notable: A large, three-year study published in 2013 in the BMJ showed that ASU significantly reduced progression of hip OA compared with placebo.

BEST FOR RA

Cat’s claw (Uncaria tomentosa)

WHAT IT IS: The bark and root of a South American vine

HOW IT WORKS: Cat’s claw is an anti-inflammatory that inhibits tumor necrosis factor (TNF), a target of powerful RA drugs. It also contains compounds that may benefit the immune system.

STUDIES: A small 2002 trial showed it reduced joint pain and swelling by more than 50 percent compared with placebo.

HOW MUCH: Capsule, tablet, tea, extract: 60 mg daily in divided doses. Look for a brand that is free of tetracyclic oxindole alkaloids.

Fish oil

WHAT IT IS: Oil from cold-water fish such as herring and salmon – a rich source of the omega-3 fatty acids EPA and DHA

HOW IT WORKS: Omega-3s block inflammatory cyto-kines and prostaglandins, and are converted by the body into powerful anti-inflammatory chemicals called resolvins.

STUDIES: EPA and DHA have been extensively studied for RA and dozens of other inflammatory conditions. A 2010 meta-analysis found that fish oil significantly decreased joint tenderness and stiffness in RA patients and reduced or eliminated NSAID use.

HOW MUCH: Softgel, liquid: 3.8 grams EPA and 2 grams DHA daily for RA. (Look for 85 percent to 90 percent concentrations of omega-3s).

NOTE: Studies show fish oil also can relieve symptoms of OA, depression and Sjögren’s syndrome.

GLA (gamma linolenic acid)

WHAT IT IS: An omega-6 fatty acid found in some plant-seed oils, including black currant, borage and evening primrose

HOW IT WORKS: The body converts GLA into anti-inflam--matory chemicals.

STUDIES: In a 2005 trial, 56 patients with active RA showed significant improvement in joint pain, stiffness and grip strength after six months and progressive improvement in control of disease activity at one year. A smaller study found that a combination of evening primrose oil and fish oil significantly reduced the need for conventional pain relievers.

HOW MUCH: Capsule, oil, softgel: 300 mg to 3 grams daily in divided doses or 450 mg GLA and 240 mg EPA daily

Ginger (Zingiber officinale)

WHAT IT IS: The dried or fresh root of the ginger plant

HOW IT WORKS: Used in Asian medicine for centuries, ginger has been shown to have anti-inflammatory properties similar to ibuprofen and COX-2 inhibitors. Ginger also suppresses leukotrienes (inflammatory molecules) and switches off certain inflammatory genes, making it potentially more effective than conventional pain relievers.

STUDIES: In a 2012 in vitro study, a specialized ginger extract called Eurovita Extract 77 reduced inflammatory reactions in RA synovial cells as effectively as steroids did.

HOW MUCH: Capsules, extract, tea: In studies, 255 mg of Eurovita Extract 77 twice daily.

NOTE: Several trials show ginger may help relieve OA pain

Honorable Mentions

These nine supplements aren’t the only ones that might be worth trying for your arthritis symptoms. Although the available studies on the following supplements are less compelling or more preliminary than for our top picks, they hold some promise for OA or RA.

Osteoarthritis: Pine bark extract

Rheumatoid arthritis: Rosehips, green-lipped mussel extract

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