What is the Best Arthritis Treatment? Part 2: Supplements
What is the Best Arthritis Treatment? Part 2: SupplementsJune 11th, 2019 by Cindy Perlin, LCSW
This is the second part in my series on “What is the best arthritis treatment?” Because there is no one treatment that will address all the complex factors that affect the onset and progression of arthritis, the answer to “What is the best arthritis treatment” is a combination of treatments that address the problem at multiple levels. The first part dealt with “the basics” which includes diet, exercise and stress management. This part covers some natural supplements that reduce pain and inflammation and/or rebuild cartilage in joints.
As noted in the first part of this series, “What is the Best Arthritis Treatment? – The Basics”, anti-inflammatory drugs can have serious, even fatal, side effects, so using safer, natural supplements to reduce inflammation and pain is a better strategy.
There are many supplements that help with osteoarthritis and rheumatoid arthritis. Some of the most powerful are turmeric, fish oil, ginger, chondroitin sulfate and glucosamine. The first three are known for their anti-inflammatory action, while the latter two are helpful in rebuilding joints in osteoarthritis (OA). These are part of the answer to “what is the best arthritis treatment?”
Although OA was once considered primarily a degenerative and non-inﬂammatory condition, it is now recognized as having inﬂammatory aspects, including elevated cytokine levels, as well as potentially being connected with systemic inﬂammation,
Turmeric (Active Ingredient Curcumin)
Turmeric reduces pain, inflammation and stiffness related to rheumatoid arthritis and osteoarthritis (OA). Turmeric is traditionally used in Chinese and Indian Ayurvedic medicine to treat arthritis. Turmeric/curcumin blocks inflammatory cytokines and enzymes, including cyclooxygenase-2 (COX-2), the target of the anti-inflammatory prescription drug celecoxib (Celebrex).
In a small 2012 pilot study, curcumin reduced joint pain and swelling in patients with active RA better than diclofenac (Voltaren), a nonsteroidal anti-inflammatory drug (NSAID). Unlike NSAIDs, curcumin was not found to be associated with any adverse events.
A 2016 systematic review and meta-analysis provided scientific evidence that 8–12 weeks of standardized turmeric extracts (typically 1000 mg/day of curcumin) treatment can reduce arthritis symptoms (mainly pain and inflammation-related symptoms) and result in similar improvements of the symptoms as ibuprofen and diclofenac sodium without the gastrointestinal and cardiac risks of NSAIDs.
A 2018 study lasting 12 weeks found that both turmeric and turmeric combined with boswellic acid improved function and reduced joint pain, though the combination worked better to improve performance than curcumin alone.
So turmeric could be part of the answer to the question, “What is the best arthritis treatment?”
Arthritis Foundation recommended dosage: Capsules, extract (more likely to be free of contaminants) or spice. For OA: Capsule, typically 400 mg to 600 mg, three times per day; or 0.5 g to 1 g of powdered root up to 3 g per day. For RA: 500 mg twice daily. Curcumin is a key chemical in turmeric
Fish Oil (Omega-3 fatty acids)
Fish oil reduces inflammation and morning stiffness in rheumatoid arthritis and preliminary studies indicate it may have a similar effect on osteoarthritis. Fish oil is an excellent source of omega-3 fatty acids (including EPA and DHA), which block inflammatory cytokines and prostaglandins. The body converts them into powerful anti-inflammatory chemicals called resolvins. Resolvins are molecules that promote resolution of cellular inflammation, allowing inflamed tissues to return to a healthier state. EPA and DHA have been extensively studied for RA as well as many 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.
A 2005 study of people with RA showed enhanced positive effects when fish oil supplements were used in combination with olive oil.
A 2018 review of the evidence of the benefits of fish oil for RA found that consumption of Omega 3 fatty acids significantly improved eight disease-activity-related markers.
Fish oil is also important for brain, eye and heart health. It also helps with anxiety and depression. It is safe, with no significant adverse effects. So it just may be another answer to “What is the best arthritis treatment?”
Arthritis Foundation recommended dosage: Fish, capsules, softgels, chewable tablets or liquid. For general health, two 3-ounce servings of fish a week are recommended. However, it’s difficult to get a therapeutic dose of fish oil from food alone. To treat arthritis-related conditions, use fish oil capsules with at least 30 percent EPA/ DHA, the active ingredients. For RA and OA, up to 2.6 g, twice a day
Ginger decreases joint pain and reduces inflammation both in people with osteoarthritis (OA) and rheumatoid arthritis (RA) Ginger has been shown to have anti-inflammatory properties similar to ibuprofen and COX-2 inhibitors such as celecoxib (Celebrex). Ginger also suppresses inflammatory molecule called leukotrienes and switches off certain inflammatory genes, potentially making it more effective than conventional pain relievers. Side effects are limited to mild gastrointestinal upset in some patients.
A 2010 study of 247 patients with knee OA found that ginger reduced knee pain when standing and walking and improved quality of life.
In a 2012 in vitro study, a ginger extract called Eurovita Extract 77 reduced inflammatory reactions in RA synovial cells as effectively as steroids.
For OA, In one trial of more than 200 patients, Eurovita Extract 77 improved OA pain after standing and walking.
A 2015 study found that using ginger extract nanoparticals in a cream 3x a day for 12 weeks improved knee joint pain, daily activities, sports activities and quality of life. There were no adverse effects.
A 2017 study of twice a week self-knee massage with ginger oil in patients with OA found patients had reduced pain and improved function after one and five weeks.
A 2019 study found that ginger can alter gene expression in people with RA to improve disease manifestation.
Arthritis Foundation recommended dosage: Powder, extract, tincture, capsules and oils, up to 2 g in three divided doses per day or up to 4 cups of tea daily. In studies, 255 mg of Eurovita Extract 77 (equivalent to 3,000 mg dried ginger) twice daily.
Glucosamine is a major component of joint cartilage. Natural glucosamine levels drop as people age. Glucosamine helps keep the cartilage in joints healthy and may have an anti-inflammatory effect. Glucosamine produced in the body provides natural building blocks for growth, repair and maintenance of cartilage. Glucosamine may lubricate joints, help cartilage retain water and prevent its breakdown. It is often combined with chondroitin (see below).
Supplements are derived from the shells of shellfish (such as shrimp, lobster and crab) or from animal bones or fungi.
The largest study to date, the 2006 Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) looked at 1,600 people with knee OA. The first phase found that patients with moderate-to-severe arthritis experienced significant pain relief from combined glucosamine and chondroitin. The 2008 phase found that glucosamine and chondroitin, together or alone, did not slow joint damage. In the two-year-long 2010 phase, glucosamine and chondroitin were found as effective for knee OA as celecoxib (Celebrex).
Other research has suggested that glucosamine does slow joint damage. A 2008 retrospective study of nearly 275 patients found those using glucosamine for at least 12 months underwent half as many joint replacement surgeries as those on placebo.
In a small 2012 study, an improvement in symptoms after 12 weeks was seen with combined glucosamine and NSAIDs, and a smaller but still significant improvement with glucosamine alone. Study authors speculate that long-term treatment with glucosamine may reduce dependence on NSAIDs and delay disease progression.
Glucosamine may cause mild gastrointestinal symptoms, as well as increased blood glucose, cholesterol, triglyceride and blood pressure. Glucosamine supplements can increase eye pressure in people with glaucoma.
Arthritis Foundation recommended dosage: Capsules, tablets, liquid or powder (to be mixed into a drink); 1,500 mg once daily or in three divided doses to prevent stomach upset. Often combined with chondroitin. May take up to one month to notice effect.
Chondroitin is a component of human connective tissues found in cartilage and bone. In supplements, chondroitin sulfate usually comes from animal cartilage. Reduces pain and inflammation, improves joint function and slows progression of osteoarthritis (OA). Chondroiton is believed to enhance the shock-absorbing properties of collagen and block enzymes that break down cartilage. Helps cartilage retain water and may reverse cartilage loss when used with glucosamine.
The largest study to date, the 2006 Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) looked at 1,600 people with knee OA. (See above under glucosamine for results.)
A separate 2011 study showed a significant improvement in pain and function in patients with hand OA using chondroitin alone.
A 2013 review of the evidence on use of chondroitin for OA concluded that chondroitin has a beneficial effect on different kinds of cells involved in osteoarthritis and that it is an effective and safe treatment option for patients with OA.
Chondroitin and glucosamine supplements appear to be safe and constitute another good answer to the question, “What is the best arthritis treatment?”
Chondroitin taken with blood-thinning medication like NSAIDs may increase the risk of bleeding. If you are allergic to sulfonamides, start with a low dose of chondroitin sulfate and watch for any side effects. Other side effects include diarrhea, constipation and abdominal pain.
Arthritis Foundation Recommended Dosage: Capsules, tablets and powder; 800 mg to 1,200 mg daily in two to four divided doses. Often combined with glucosamine. Allow up to one month to notice effect.
Other supplements that have evidence of effectiveness for arthritis include: Borage oil, Boswellia, Bromelain, Cat’s Claw, CBD, Devil’s claw, DMSO, Ginkgo, GLA, MSM, Pycnogenol, St. John’s Wort and Stinging Nettle. Look for reviews of these other supplements in future articles in the series, “What is the best arthritis treatment?”.
There are many supplements that can reduce arthritis pain and functional limitations. All of them are less risky than using pharmaceuticals for pain relief. The supplements not only reduce pain, they appear to have a beneficial overall biological effect on the disease process.
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