Tricks or Treatments

Released Oct. 21, 2025

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Trina Wilcox: Welcome to the Live Yes! With Arthritis podcast. I'm Trina Wilcox, your host for this episode, and Halloween is just around the corner, so we're going to have a little bit of fun and hopefully learn a few things, too. I was diagnosed at age 6, and now, as an adult, I have heard a lot of things that people think may or may not help you. So, this episode we are calling Tricks or Treatments. Dr. Brian Andonian is here to discuss some uncommon and even creepy arthritis therapies.

Some actually have evidence and might be worth trying in certain cases; others could be harmful. So, often they'll sound legit, but we're going to find out. None of these are replacements for your prescribed medication, so we'll talk about how to discuss complementary therapies with your doctor. So, Dr. Andonian, welcome. Tell me a little bit about yourself and why you're so interested in these topics.

Dr. Brian Andonian: Yeah, thanks for having me, Trina. This is going to be a fun conversation. I'm a rheumatologist, also a physician scientist at Duke University, and the focus of my practice and research is specifically lifestyle medicine. So, incorporating exercise, diet, sleep, stress management in the care of my patients with arthritis, from rheumatoid arthritis to osteoarthritis. And I think of lifestyle medicine as being closely related to integrative medicine, which to me is thinking about whole person care, combining both medications plus integrative or non-pharmacologic therapies, which we'll be discussing today. But my background's really in athletic training, exercise physiology. So, even before in medical school, I've been long interested in how non-pharmacologic or non-medications really can help our patients specifically with arthritis.

Trina Wilcox: Fantastic. So, what should people do if they are taking their prescribed medications, but maybe they're still having some of these, you know, issues, symptoms, things that just aren't resolved?

Dr. Brian Andonian: You have to discuss with your rheumatologist or provider about anything you're considering and all the things we'll be talking about today. Some of these do have interactions with our medications, so I think that's important just from that standpoint.

Trina Wilcox: A lot of folks are really resistant. They have their guard up to taking medications and are willing to try just about anything else first. Can you talk about if this is really OK or not?

Dr. Brian Andonian: Resistance is OK, I'm guilty of this myself. I think the goal is always to use the least amount of medications that are helpful without causing harm. And I think it applies to anything we're talking about here, too, because the reality is: Medication or not, all therapies have potential harms; they also have potential benefits. So, to me, it's all about weighing those risks and benefits. And I think having a little resistance to any therapy is reasonable. We’ve got to make sure we’re all comfortable with any plan.

Trina Wilcox: Very good. Why is it important for people to stick with their prescribed treatment as their first and foremost thing before they go off experimenting?

Dr. Brian Andonian: I think especially when we're talking about inflammatory diseases, like rheumatoid arthritis, where we really need medications to calm inflammation. Otherwise, we can get damage, joint damage or other organ damage, for example, our lungs. So, to me that's really important that we're using medications and whatever therapies to really calm down that inflammation, because if we're not, that's going to lead to long-term problems. But even when I would say inflammation is controlled, symptoms can persist, right? You can still have pain, you can still have fatigue. Not all our medications are going to target that.

So, that's where lifestyle integrative therapies I think have a real, big role. When I think about osteoarthritis, we really don't have what we call disease-modifying therapies. For example, we can't regrow cartilage, which is a key aspect of osteoarthritis. So, I think there's even more potential for lifestyle integrative therapies  in osteoarthritis, knowing that any medication we're using is not necessarily getting at the heart of the problem either.

Trina Wilcox: OK. Well, I've got quite a list, so let's dive in and talk about these. Years ago, someone said copper bracelets could help with arthritis. Now, I'm not sure I believe it, to be honest, but I figured if I could have a cute piece of jewelry and it may help, I'm going try it. So, what do you think?

Dr. Brian Andonian: Yeah, I think this is going to be fun. And even before we get to copper, as a general comment, I'd like to think of grouping these into categories. Think of a two-by-two table where there's benefit on one side and safety on the other side. So, you can have something that's like one, beneficial and safe. This would be the ideal thing, right? It's beneficial itself. It's safe, not going to cause harm. Then you have another thing that's beneficial but has a lot of potential risks. Three, there's the unproven, and we don't really know how they work exactly, but they're safe, so I think could be reasonable to try. And then there's the unproven but risky things that maybe we should avoid.

The copper and copper bracelets I would put in the unproven but safe category. There's not a lot of evidence to say that copper ions can penetrate the skin, get into the joint and have a beneficial effect, but ultimately there's no harm. And as you mentioned, maybe there's some fashion benefits, too. So, minimally, that could be benefit there.

Trina Wilcox: What about magnets then? Is that kind of the same concept people are pulling from as with the copper bracelets?

Dr. Brian Andonian: It's a little different, but I would say similar category in terms of unproven but still safe. The concept here is that magnets can assist with the flow of metals, particularly iron through our body, to perhaps get into the joints and actually have a beneficial effect there. The problem is that the iron in our blood, it doesn't react to magnets themselves. So, it's hard to know exactly how the magnets are helping. But again, overall safe.

Trina Wilcox: Alright. This one really interests me because it was the first therapy that I was on, and it is a gold shot.

Dr. Brian Andonian: This is an interesting one: injectable gold shots. So, sodium orothiomalate was the most commonly used. This dates back to the 1920s where it was used for a lot of inflammatory diseases. Then really became a standard therapy for rheumatoid arthritis and actually is considered a disease-modifying therapy. It can actually control inflammation. It has a lot of potential benefits. Now, we, as a rheumatology community, stopped using gold shots in generally the 1980s. That was largely because of the potential risks or toxicity related to gold. It can cause liver injury, reducing blood counts, skin and other reactions. And there were newer medications coming out at the time, in particular methotrexate, I think, replaced gold in a lot of ways. So, I'd put this in as beneficial, but we just don't use it as much, largely due to the risks.

Trina Wilcox: This one, too, is something that I think is everyone's very initial go-to — and that's aspirin.

Dr. Brian Andonian: Similar to gold, but we're going even further back in history here. For example, we've been chewing on willow bark since ancient times to get the benefits of salicylates, which is what aspirin is. And it really is an anti-inflammatory therapy. But these days we really don't use aspirin as much for the anti-inflammatory effects. There's a lot of risks to high-dose aspirin, including bleeding risk for strokes, kidney disease, and then hearing issues, or ringing in the ears.

Trina Wilcox: Yeah, I can speak from experience. I had a situation where my ears were ringing and my stomach was hurting and doctor said, “Let’s cut back on that.” (laughs) So, what about... Is it turmeric? I believe is also a supplement that people can get at their natural food store. Is this a benefit to us?

Dr. Brian Andonian: Yeah, turmeric and then other spices I think have growing amount of evidence and perhaps of the things we're discussing today, the spices, turmeric and ginger root. I think of turmeric and ginger as coming from similar roots and have a lot of potential benefits in my mind. They have anti-inflammatory properties, they've been studying in osteoarthritis and rheumatoid arthritis to be beneficial. There are risks though. You can take these as supplements, but too high doses can have potential risk for bleeding, or thinning of the blood.

It also could cause liver injury. And there rarely can be interactions with medications. So, you have to be somewhat cautious. But especially if you're using ginger or turmeric for cooking, as spices, I think it's a great way to go. But you also can take them as supplements. Generally, about a thousand milligrams a day for each of those is what is studied.

Trina Wilcox: Now, since we're talking about natural therapies: This one sounds a little bit of a stretch to me, but what about bee and snake venoms?

Dr. Brian Andonian: Well, these are good ones for Halloween, I think.

Trina Wilcox: Right.

Dr. Brian Andonian: Starting with bee venom, this is... I would put in the unproven but risky category. There is a fair amount of research done on the benefits of bee venom, but I would say the studies and the results are very mixed in terms of having benefit for pain and inflammation and arthritis versus not having benefit. And there is actually a very real risk of allergic reactions to bee venom.

Trina Wilcox: Alright. And then did same with snake…, snake-

Dr. Brian Andonian: Oh, sorry, snake venom. Also unproven but risky, I would say mainly because it hasn't been studied well enough, at least in humans. There are interestingly some potential anti-inflammatory properties in snake venom. But I would say we need a lot more evidence before we can recommend snake venom as a specific therapy for our patients.

Trina Wilcox: OK. Now, I'm guessing these are on the list due to helping with blood flow, and I want your thoughts on this. Let's talk about cupping, leeches and stinging nettle.

Dr. Brian Andonian: Yes. Cupping, we'll start with. Generally, I would say unproven but safe. I think it has to be performed correctly by a practitioner who understands what to do with cupping. The idea here is that you're putting cups on the skin as a suction to really stimulate blood flow, as you mentioned. I think this is primarily focused on targeting the muscles, so increasing blood flow to the muscles. You'll sometimes see athletes have these rings on their bodies, and that's probably from cupping, to try to increase blood flow, help with muscle healing.

And I think there is some potential benefit for the muscles in terms of stiffness and recovery. But if we're thinking about how that can affect, then, inflammation and arthritis, I just think we don't know. The stinging nettle is used a decent amount, but I also say it's still unproven. I say generally safe; it just depends on how we're using it. Nettle is a plant-derived compound from the nettle plant, generally used as a topical therapy, but it has some potential antioxidants and thus anti-inflammatory benefits. And some of the evidence is in osteoarthritis that it could be helpful. The issues are a couple.

One is that it really should be processed nettle that's not just freshly picked. Because I think there's more potential for reactions if you are using the nettle plant itself. And then if you're doing an oral intake of nettle, there's more potential for side effects like GI upset. And this can actually interfere with some of our medications, including blood thinners and blood pressure medications.

Leech is a great topic for Halloween. Surprisingly, there is some good evidence that this can be helpful for improving pain in osteoarthritis. But leeches in their saliva have anti-coagulant and anti-inflammatory compounds. So, if placed around the joint, I guess in theory this could have a benefit for arthritis. But honestly, I'm not convinced by the evidence yet that we should be doing this.

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Trina Wilcox: If anybody ever starts doing research on arthritis of any type, you're going to find a plethora of information on how you should be feeding yourself, what to do with your diet. So, let's talk a little bit about nightshade vegetables, exclusion diets, raw diets. Tell me your thoughts on all of that.

Dr. Brian Andonian: Alright. This is big topic, so let's dive in. Nightshade vegetables come up a lot in my clinic. These are a group of vegetables that include potatoes, tomatoes, eggplants and peppers. And they contain what we call glycoalkaloid compounds. These are theorized to have harm by disrupting our intestinal barrier and how we digest food. There's also theoretical potential for inducing mast cell activation, which could be triggering inflammation. My advice for any type of elimination diet, where you're trying to take something out of the diet for the benefit, is that it really should be considered over a short time.

Consider trying it over maybe three weeks at most to assess if that affected your symptoms. And then if it didn't, I would just reintroduce those foods back in. Because you think about things like tomatoes and peppers and eggplants, these can be really healthy foods with a lot of good nutrients. So, the fact that most people probably don't have any issues with these plants, I would say we would continue to have them as part of our diet. And there's a whole host of other exclusion diets. So, I think of gluten-free diets, lactose-free diets. There's a lot of people who do have gluten and lactose intolerances. So, to me, it's reasonable to try again for a period of time. But if you really don't have any change in your symptoms or how you feel like you're digesting food, then I would go back to what you were doing.

There's a whole host of other diets. The autoimmune protocol diet comes up a lot in terms of being a short-term diet. It's really always designed to be short term. You're eliminating a lot of things from the diet. I see problems when people continue on those diets long term. And when you take a lot of things from your diet, ultimately that could lead to things like nutritional deficiencies and ultimately cause more problems than you are trying to solve. Other diets you mentioned: the raw diet. It's not as common, but I am hearing more about it. So, I guess it is gaining popularity. The raw diet is kind of what it sounds like. You're just eating raw fruits and vegetables and nuts. The idea here is that there's maybe some potential downsides to cooking the foods that could decrease nutritional quality. But I would say this is not a complete dietary approach and goes against some nutritional science that actually cooking could be beneficial.

So, we know that cooking and just minimally processing fruits and veggies can actually improve nutrient and mineral bioavailability to actually allow us to digest and utilize these more. So, I'm a bit skeptical of the raw diet for that reason, because I think the science is not great. I think you mentioned what, the single food diets as well, like...

Trina Wilcox: Yeah, I'm curious about that. I had someone try to convince me that I needed to do as much meat as possible, and I have been vegan for years, which kind of made me raise a flag.

Dr. Brian Andonian: These are tricky, right? Because they go against a lot of dietary science and nutritional science and advice. The carnivore diet is the one that you're referring to, which is only eating meat. I think you can also eat eggs and dairy. So, it's a really high-protein, high-fat, essentially zero-carb diet. So, I think of this as a form of a ketogenic diet just because of the no carbs. The ketogenic diet can have some benefits in terms of actually having anti-inflammatory effect from ketone generation. And this has been studied in models of gout to have benefit for those patients. But to me, the science is not quite there yet. Because to me, if you're just having this one type of food group, you're missing out on a lot of potential nutrients from other good food groups. And again, you could have risk for nutritional deficiencies, which can cause immune dysfunction and more inflammation, and then cardiovascular disease and all the bad things that you're trying to avoid.

Trina Wilcox: OK. Raw milk.

Dr. Brian Andonian: I don't necessarily want to get too into the weeds of controversial topics, but this one comes up a lot lately. The problem with research currently on raw milk is that we don't really, fully understand the potential benefits. But there are real risks from drinking raw milk. And this includes contamination with potentially harmful bacteria. Think of things like listeria or E. coli that cause people to go to the hospital, have severe infections.

It could be that there might be some probiotics in raw milk, and so the good bacteria, it could be there, too. But if I argue, if that's your rationale for drinking raw milk, then perhaps you should just focus on fermented dairy products. For example, Greek yogurt or a fermented dairy drink called kefir, which can be used in place of milk in a lot of situations, because we know that probiotics and fermented foods can have a lot of benefit for inflammation and thus potentially arthritis of any kind.

Trina Wilcox: Very good. This one sounds like it would be harmless and even fun, but is there any benefit to eating gelatin? You know, Jell-O, as most of us know it.

Dr. Brian Andonian: Gelatin itself potentially has benefits. So, gelatin contains collagen and other amino acids that could be helpful for just repair of our connective tissue disease, say after exercise: repairing our tendons, our ligaments, and in a way this could be helpful for arthritis. The problem with the Jell-O itself is that there's gelatin in it, but there's just all the sugar. You have this high sugar plus gelatin. I feel like the sugar content is probably outweighing the potential benefits of the gelatin, because we know that sugar can be pro-inflammatory and cause problems for arthritis. So, I wouldn't recommend a daily dose of Jell-O.

Trina Wilcox: OK. Sounds good.

Dr. Brian Andonian: You can get collagen from other sources, including plants, you know, beans, nuts, seeds, spinach.

Trina Wilcox: What about alkaline diets, I guess, where you deliberately avoid acidic foods?

Dr. Brian Andonian: Another good one. Perhaps to me this is less about acidity. We think about acidity like our overall pH balance in our body. Beause there's just not a lot of evidence that our diet can impact our overall pH in our body. But perhaps the alkaline diet could work more through inclusion of what we call enzymatic foods and fruits in particular — I think of things like pineapple and mango, papaya, kiwi — and these actually can aid with digestion and help our gut health and, as a result, potentially help with inflammation. But I would put less focus on trying to say if a food is specifically alkaline or acidic.

Trina Wilcox: OK. Before we change to another topic, let's touch on cleanses and detoxes.

Dr. Brian Andonian: Yeah. Juice cleanses come up more and more these days. The idea of a juice cleanse is that you're only having, say, a fruit or vegetable juice as your only real nutritional source for a day or up to a week or 10 days or more. And the problem here is that to me, it's just a very low-calorie diet that's very nutritionally deficient. And so, people sometimes can feel better, at least initially, doing these quote-unquote detoxes. We know that fasting has some potential benefits for inflammation and arthritis, but could have a lot of harm if you do it too much and over a longer period. So, I'd be cautious with doing this too much.

Trina Wilcox: Alright. We've talked a little bit about what we put inside our bodies. Let's talk about what people will suggest topically. I've heard things from putting olive oil on your joints, Epsom salt, essential oils. What do you think about those things?

Dr. Brian Andonian: I've had patients swear by olive oil. I always thought olive oil's best put in the pan as opposed to our body. But I can't argue that if it's helped you, there could be some benefit. But I don't really understand how the olive oil can help from an anti-inflammatory benefit because we know that the good fatty acids from olive oil are best when they go through our gut and they're incorporated in our body that way. So, I'm all for cooking with olive oil, but less clear on the application topically.

Same with essential oils. I think there's not any real harm to topical essential oils. But also, again, a little less clear on how they help. I would say the Epsom salt baths also are something that some of my patients swear by with all forms of arthritis. Epsom salt contains magnesium sulfate as the key salt in it. And when used as a warm bath or as a compress, I think it could be helpful, maybe more with help with stress or relaxation, which is important and can be helpful with arthritis.

Trina Wilcox: Now what about CBD and cannabis? Now, those can be... I know they've got topicals that have CBD, I think some even have a touch of THC. What do you suggest when it comes to, let's just say topical first?

Dr. Brian Andonian: This is a hot topic. And we can kind of start with discussing what CBD is. And CBD is coming from a cannabis plant, generally hemp, you think of this as a plant with low THC. So, it doesn't have the psychoactive compound that you'll find in other cannabis like the sativa or where you get marijuana from. And there is evidence that CBD can be helpful for pain and inflammation as a whole. Whether topical CBD is more beneficial than if you take it by mouth is a little less clear.

But I would say topical is going to be overall safer, because you're not going to get the systemic absorption and the potential downsides, because I've seen a lot of problems with people taking too much CBD, even without having any of the psychoactive like THC in it. You can get liver injuries, you can get a lot of medication interactions. It's not regulated. So, CBD can have some contaminants in it. So, people often say, "Oh, CBD is natural, so it might be better than a medication." But the truth is, I would think of it the same way as I think of any medication that there's risks and benefits. The problem is that it's not really regulated, so you don't necessarily know what you're getting when you're using it. So, I'd always start low probably with anything we're talking about; start with small amounts and then slowly go from there. I think using high amounts, especially if you take a lot of it by mouth, could be a problem.

Trina Wilcox: OK. This is one I know of as a topical and you can let me know if you can also ingest it, but: arnica.

Dr. Brian Andonian: Arnica and homeopathy in general… Homeopathy as a general concept, I'll be honest, doesn't fit well with current western medicine and science. The idea behind homeopathy is that if high amounts or high doses of whatever substance can cause a certain harm, for example, inflammation, then potentially lower doses or really diluting the substance to the point of not being detectable by traditional methods, that can actually help the problem. And a key example, at least in arthritis care, is arnica, which is derived from the mountain flower wolfsbane, and it can help with arthritis and inflammation. And there's been some studies showing that, and I have a lot of patients telling me that.

I would say overall it's safe because, if anything, the substance that could be harmful is diluted to the point where we really can't detect it. So, there's really not a lot there that could cause harm, and the fact that it could be helpful and is overall reasonably low cost, it could be useful. And I've seen benefit from both the topical therapy and taking the tablets. I think when we've tried a lot of other things, then homeopathy is reasonable to consider. But as long as we know that there's probably only marginal benefit, and it shouldn't replace any of our other therapies that were helping before.

Trina Wilcox: OK. Now this is one that we hear all the time, even to give it to our dogs: glucosamine.

Dr. Brian Andonian: These have been used for a long time. I put glucosamine and chondroitin supplements together here and long studied as a potential therapy for osteoarthritis to help with joint health. But the short answer is to say the evidence isn't great. There's just not a lot of great evidence saying that this could be helpful, but also I think it's safe. There's not a lot of potential interactions with those substances. So, I think it's reasonable to try glucosamine or chondroitin, but if it's not helping you, it's not something I would continue after at least a few weeks of trial.

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Trina Wilcox: What about — this is kind of Halloweenish — electrical nerve stimulation, or vagus nerve stimulation?

Dr. Brian Andonian: Very hot topic in rheumatology and arthritis care. Especially with the new, the SetPoint System and the vagus nerve implant that's now FDA-approved for rheumatoid arthritis. And we'll get to that in a sec... But thinking about electrical stimulation in general, we've had, for example, TENS units for a long time, Transcutaneous Electrical Nerve Stimulation, and these can be helpful for a variety of pain syndromes locally, but I don't think those are actually impacting inflammation or arthritis, just helping with pain superficially. Now, vagus nerve stimulation is a different concept where at least the approved device is actually a battery-sized device that's surgically implanted next to the vagus nerve, or right on the vagus nerve essentially. The idea here is that it's intermittently stimulating the vagus nerve, which will activate the parasympathetic nervous system.

The parasympathetic response actually can be helpful for directly impacting the way our immune system functions and inflammation. And the science is growing that this actually could be helpful. Now that we have FDA approval for the device, I think we're going to see it more and really start to see if this helps our patients with at least rheumatoid arthritis, potentially other conditions, moving forward. So, I'm excited about that.

Trina Wilcox: That is very interesting. That brings me to acupuncture and acupressure. When you're talking about stimulating the body and things like that, what are your thoughts on those?

Dr. Brian Andonian: Ultimately these are safe and effective, acupuncture, acupressure long studied, for example, in chronic back pain and chronic pain syndromes in general, and they can be helpful. When it comes to arthritis, the effect is likely small. That's based on the evidence we currently have and my experience. And it really should be best used in the hands of a practitioner who has experience treating patients with chronic diseases, because acupuncture can go wrong and you can have problems related to it.

Trina Wilcox: Now, what about massage? Would that be in the same direction?

Dr. Brian Andonian: I put that in the same company as acupuncture. Complementary therapy that's been used for a long time, really can help with muscle relaxation recovery, which could have a secondary benefit to arthritis. I also would caution my patients with fibromyalgia and arthritis with massage and those who have like active inflammatory disease. Because really deep tissue, intense massage actually can have a negative effect in terms of causing more stiffness and tightness and have more of a stress response to the body. So, I'd favor starting with more of a lighter massage, Swedish massage, for those patients.

Trina Wilcox: Meditation.

Dr. Brian Andonian: This is a huge topic. And we probably could spend an entire episode on. But in terms of stress management, mindfulness training, which includes meditation, there's a lot of potential benefit. There's a ton of apps that are available for patients to look into to learn meditation and to learn about mindfulness training. I would also put a plug-in for considering including mindfulness or meditation within a mind-body exercise program. Mind-body exercise to me includes things like yoga, tai chi, qigong. I think there's a lot of potential synergistic benefit, including exercise with meditation.

Trina Wilcox: And something that just came to mind when I think of meditation, I think of a lot of breath work. And I want to know your thoughts on how well that can benefit folks with arthritis and pain.

Dr. Brian Andonian: Yeah. It's one of, I think, the simplest ways of thinking about meditation and mindfulness. Just learning deep breathing techniques can be a good way to practice mindfulness, which is really just the idea of being present in the moment and not letting all the million things going on in your world affect you. So, deep breathing, just doing a couple deep breaths at one time can really be helpful.

Trina Wilcox: As we're talking about a lot of these remedies, potential remedies or helps for people with arthritis, the placebo effect comes to mind. So, what do you think about that?

Dr. Brian Andonian: This is powerful. Placebo is potentially why a lot of the therapies we've discussed have benefits. When there's a desire for something to work and a hope that this will cause real effects in our body, that can stimulate pathways that will give benefit. So, it's not a reason not to take them, because if placebo is working for you, I'm all for continuing that placebo.

Trina Wilcox: Very good. Something that I've read a lot about, I hear people talk about, and I think I want to learn more about, tell me: stem cell research.

Dr. Brian Andonian: Another big topic. Stem cells are derived from a variety of places. Ultimately, the evidence is growing, but still pretty weak. There's some evidence, for example, doing stem cell injections for knee osteoarthritis can be helpful, but it's really a pretty low benefit, at least the studies we have right now. So, currently, I'm not sure the cost of that and the potential risks outweigh what now I think of as fairly minimal benefit. But I think more to come. We're going to keep developing these therapies, which could be helpful in the future.

Trina Wilcox: Are there any unusual treatments you've heard of that we haven't covered today? And are any of them worth going out and trying right away?

Dr. Brian Andonian: I always put a plug in for how lifestyle modification in general should be included in our talk about alternative — or really integrative — care, meaning we're incorporating it as part of our general care. So, I think of things from exercise, having, increasing aerobic and resistance training exercise, diets that include Mediterranean or plant-based diets. Also fermented foods, which we talked about. Intermittent fasting, we talked about briefly. Mindfulness training. Then really incorporating sleep hygiene techniques.

Really putting that all together, I would say, because they really don't live in isolation. You should think about healthy diet and healthy sleep and healthy exercise and maintaining stress is really all working together synergistically. And then we talked about briefly: supplements. I already said that I think turmeric and ginger have a lot of potential benefit.

Trina Wilcox: You had mentioned to have a good exercise routine. Is there a certain exercise like running that is more beneficial for one type of arthritis, or should we all stick to tai chi? What are your thoughts on that?

Dr. Brian Andonian: Yeah, definitely in my wheelhouse. So, thanks for the question. Interesting, I think there's been a debate lately about: Is running or jogging better than walking? And I'm not sure why it became such a debate, because to me they're both great forms of exercise. But when you ask the question, "What's the best exercise?" It's really just about individualizing. It has to be right for that person.

So, running, for example, is great exercise to improve aerobic fitness, but it's not for everyone, especially those with arthritis and were previously not getting a lot of activities. I think you have to really, slowly build up to being able to run. The goal of any aerobic exercise is to get your heart rate up, to the point where you're getting the benefit of improving heart and lung function. And there actually could be improvement on our immune function, too. Exercise with walking is great. However, I would say it's also not for everyone. For some people with a lot of lower extremity arthritis, walking is a lot of stress on the joints, and that can be very difficult.

So, to get aerobic exercise, think about other modalities. I think about biking or cycling, getting in the pool, swimming, these are really the way to go. So, to me, there's not necessarily one form of exercise that's better, but finding what works. I would also put another plug for resistance training, because it's the thing that we don't do enough of. Doing exercise to improve our muscle strength, like lifting weights or doing resistance bands or doing body weight exercises designed to improve muscle health in general, are not added enough. So, I can only say that it's really a great way to go. And building muscle has really been shown to help arthritis of all kinds, including rheumatoid and osteoarthritis.

Trina Wilcox: I'm glad you brought that up. What are certain things people should absolutely not try?

Dr. Brian Andonian: Yeah, there's a few out there. One thing that comes to mind is kratom or kratom, however you say it. This is a supplement that has been out there in terms of having pain benefits, as like an opioid-type medication, but also has a stimulant effect that also can have a lot of risks. And there's really unclear benefits, so I would say stay away from kratom. And then just in general, I would say just these undisclosed paid supplements that you're seeing being on social media and then just product placements in general. Anyone touting that this is a cure-all powder or a magic like natural weight loss pill, you'll always have to be skeptical.

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Trina Wilcox: For this episode, we asked folks: What is the most unusual arthritis remedy you've heard of and how did it work? So, Jeremy Elder said, "My maternal grandfather swore by (laughs) WD‑40 on stiff joints." That has to be a joke.

Dr. Brian Andonian: I don't know. We're rubbing olive oil on our joints now, too. So, is there something about just how these can help our joints just move more fluidly? I don't know if that's helpful. I feel like there could be some potential downsides to that, too.

Trina Wilcox: I would think so. So, Val Taylor said that her grandmother used to swear by vinegar and brown paper for sore joints. She came from a family of Cornish tin miners, and she can't say she's ever tried it though. I have never heard of this.

Dr. Brian Andonian: Yeah, that's another one. Overall vinegar, I can't say it's going to be harmful. Think about vinegar being included in a lot of fermented foods, so maybe there's some benefit, but I wouldn't say that rubbing it on your body is also going to be too helpful.

Trina Wilcox: Makes you wonder if just the stimulation of the circulation or so, I don't know. Another response from Liva Krieke says the Latvian folk method, which is cabbage leaves.

Dr. Brian Andonian: This is something I’ve got to look up. I’m not sure if this is also putting it over the affected area. And that also gives benefit. Cabbage is a great thing in terms of our diet, so I can't argue with that one either.

Trina Wilcox: Brianna Reeves Ramos said, "Red light therapy."

Dr. Brian Andonian: Yeah. Another one I'm not entirely sure here. There's a lot of thought how just different light affects us in a lot of ways. So, potentially this is a great field to study more.

Trina Wilcox: I will agree with Jenn Tullman-Botzer, who says for her it was getting a dog. "He takes me out to get exercises even when I don't feel like it, sleeps on my knees to keep them warm."

Dr. Brian Andonian: This is a great one. When I think of lifestyle medicine, one aspect is maintaining healthy relationships. And that can include our pets and animals. Anything that gives us positive feedback and moves our lives in healthier directions, I'm all for that.

Trina Wilcox: Absolutely. Well, thank you for spending time and going through these. What would you say your three takeaways from this episode would be?

Dr. Brian Andonian: I think a lot of takeaways. There's a lot of good things we talked about. I'll go back to my point that lifestyle integrative therapies should be considered as key therapies for arthritis. And maybe that leads into the second point that integrative is the key here. That especially those with inflammatory types of arthritis or autoimmune diseases, integrative therapies, like lifestyle change, can work with our medications to potentially give even better effect than the medications alone.

But the third point really is that you have to discuss with your provider and rheumatologist. That every therapy we consider has potential risks and benefits. And just because it's natural does not mean it's safe. And we have to make sure we're understanding those potential risks. And I hope that your provider, even if they don't know about the therapy, will be willing to look into the potential risks and then really come up with a good treatment plan that includes medications and the integrative therapies.

Trina Wilcox: Yes. Thank you. I would agree that definitely one of my takeaways is, I've even said it before and want to reiterate: Just because it's natural doesn't mean it's safe. Make sure you have a good relationship with your doctor, your team, and you can talk about the risks and benefits of certain medications or supplements and see if there are any interactions. And I always like bringing up exercise because I think it's a mind, body, spirit, you know, benefit to any lifestyle, especially if you have arthritis. So, thank you so much, Brian Andonian, for spending some time on our Happy Halloween episode. I appreciate it.

Dr. Brian Andonian: Yeah. I hope this episode wasn't too scary for everyone. And thanks again for having me.

Trina Wilcox: Not at all. Thank you. Please check out the resources that we have at arthritis.org. And you can even look for a chapter near you.

PODCAST CLOSE: Thank you for listening to the Live Yes! With Arthritis podcast, produced as a public service by the Arthritis Foundation. Get show notes and other episode details at arthritis.org/podcast. Review, rate and recommend us wherever you get your podcasts, on Apple, Spotify and other platforms. This podcast and other life-changing Arthritis Foundation programs, resources and services are made possible in part by generous donors like you. Consider making a gift to support our work at arthritis.org/donate. We appreciate you listening. And please join us again!