Choosing the right supplement to ease your arthritis pain and inflammation can be confusing. Which supplements are most effective? Of the many types of supplements available in stores and online, the following 4 have been well-studied for their ability to treat arthritis pain:
1. Curcumin (from turmeric root)
Evidence suggests the turmeric root has anti-inflammatory properties. 1 Daily JW, Yang M, Park S. Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Med Food. 2016;19(8):717–729. doi:10.1089/jmf.2016.3705 The active component of turmeric, called curcumin, makes up only about 3% of turmeric, so you may need to eat a lot of turmeric to get noticeable benefits. An alternative to eating turmeric every day is to take a supplement.
Limited research indicates curcumin may inhibit the body’s ability to absorb iron, 2 Smith TJ, Ashar BH. Iron Deficiency Anemia Due to High-dose Turmeric. Cureus. 2019;11(1):e3858. Published 2019 Jan 9. doi:10.7759/cureus.3858 , 3 Chin D, Huebbe P, Frank J, Rimbach G, Pallauf K. Curcumin may impair iron status when fed to mice for six months. Redox Biol. 2014;2:563–569. Published 2014 Feb 28. doi:10.1016/j.redox.2014.01.018 so if you have iron deficiency, you may want to raise this concern with your doctor.
2. Vitamin D
If you have arthritis pain or are at high risk for arthritis, your doctor may recommend a vitamin D supplement. (I prefer vitamin D3.) A blood test can determine whether you have a vitamin D deficiency.
Vitamin D deficiency is associated with the development of osteoarthritis 4 Vaishya R, Vijay V, Lama P, Agarwal A. Does vitamin D deficiency influence the incidence and progression of knee osteoarthritis? - A literature review. J Clin Orthop Trauma. 2019;10(1):9–15. doi:10.1016/j.jcot.2018.05.012 as well as autoimmune arthritis, such as psoriatic arthritis 5 Pitukweerakul S, Thavaraputta S, Prachuapthunyachart S, Karnchanasorn R. Hypovitaminosis D is Associated with Psoriasis: A Systematic Review and Meta-Analysis. Kans J Med. 2019;12(4):103–108. Published 2019 Nov 25. and rheumatoid arthritis (RA). 6 Bellan M, Sainaghi PP, Pirisi M. Role of Vitamin D in Rheumatoid Arthritis. Adv Exp Med Biol. 2017;996:155–68. 10.1007/978-3-319-56017-5_13 Low vitamin D levels are also associated with more and/or worse rheumatoid arthritis symptoms. 7 Lin J, Liu J, Davies ML, Chen W. Serum Vitamin D Level and Rheumatoid Arthritis Disease Activity: Review and Meta-Analysis. PLoS One. 2016;11(1):e0146351 10.1371/journal.pone.0146351 , 8 Lee YH, Bae SC. Vitamin D level in rheumatoid arthritis and its correlation with the disease activity: a meta-analysis. Clin Exp Rheumatol. 2016 Sep-Oct;34(5):827-833. Epub 2016 Apr 6. Review. PubMed PMID: 27049238. Other medical conditions, such as osteoporosis, muscle weakness, hip fractures, diabetes, cancer, and heart disease, have also been linked to low vitamin D levels.
It’s not yet clear whether vitamin D supplementation can prevent arthritis from developing or alleviate arthritis symptoms. 4 Vaishya R, Vijay V, Lama P, Agarwal A. Does vitamin D deficiency influence the incidence and progression of knee osteoarthritis? - A literature review. J Clin Orthop Trauma. 2019;10(1):9–15. doi:10.1016/j.jcot.2018.05.012 , 9 Bragazzi NL, Watad A, Neumann SG, Simon M, Brown SB, Abu Much A, Harari A, Tiosano S, Amital H, Shoenfeld Y. Vitamin D and rheumatoid arthritis: an ongoing mystery. Curr Opin Rheumatol. 2017 Jul;29(4):378-388. doi: 10.1097/BOR.0000000000000397. Review. PubMed PMID: 28463872. , 10 Tang T, Zhang Y, Luo C, Liu M, Xu L, Tang X. Adjunctive vitamin D for the treatment of active juvenile idiopathic arthritis: An open-label, prospective, randomized controlled trial. Exp Ther Med. 2019;18(6):4921–4926. doi:10.3892/etm.2019.8133 People who have kidney disease, bone disease, certain cancers, or calcium disorders should talk to their doctors before taking a vitamin D supplement. 11 Vitamin D3 Supplement, Daily Med, US National Library of Medicine. Updated March 10, 2014, accessed January 10, 2019. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ad799f34-81df-460c-a760-2204ad776817
3. Omega-3 fatty acids
Research suggests omega-3 fatty acids have anti-inflammatory properties. Unless you eat fatty fish like salmon and mackerel two or more days a week, it can be challenging to get a therapeutic amount of omega 3 through food. Taking a supplement may help.
Most omega 3 supplements come in the form of fish oil. However, I recommend an omega 3 supplement derived from plants, such as flax seeds. A plant-based supplement helps avoid the risk of mercury contamination found in some poorly manufactured fish oil supplements. A plant-based omega-3 supplement may also be preferable if you follow a vegetarian or vegan diet. Keep in mind that omega 3 fatty acids in fish oil can be different than those in plant-based sources. (Fish oil contains eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA] while flax seeds, for example, contain alpha-linolenic acid [ALA].) This difference may affect the dosage.
See The Difference Between Omega-3 and Omega-6 and Knee Arthritis Pain
A daily intake of omega 3 may increase your risk of bleeding and may not be appropriate if you take a blood thinner, such as warfarin. 12 Qato DM, Wilder J, Schumm LP, Gillet V, Alexander GC. Changes in Prescription and Over-the-Counter Medication and Dietary Supplement Use Among Older Adults in the United States, 2005 vs 2011. JAMA Intern Med. 2016;176(4):473–482. doi:10.1001/jamainternmed.2015.8581 Not all physicians agree this risk is supported by evidence. 13 Harris WS. Fish Oils and Bleeding-Where Is the Evidence?. JAMA Intern Med. 2016 Sep 1;176(9):1405-6. doi: 10.1001/jamainternmed.2016.3968. PubMed PMID: 27598751.
4. Glucosamine and chondroitin sulfate
Many supplement products aiming to treat arthritis contain both glucosamine and chondroitin sulfate. These substances are found naturally in human cartilage. Research regarding glucosamine and chondroitin sulfate supplements is mixed, 14 Hochberg MC, Martel-Pelletier J, Monfort J, et al. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib. Ann Rheum Dis. 2016;75(1):37–44. doi:10.1136/annrheumdis-2014-206792 , 15 McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, Hawker GA, Henrotin Y, Hunter DJ, Kawaguchi H, Kwoh K, Lohmander S, Rannou F, Roos EM, Underwood M. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014 Mar;22(3):363-88. doi: 10.1016/j.joca.2014.01.003. Epub 2014 Jan 24. PubMed PMID: 24462672. , 16 Sawitzke AD, Shi H, Finco MF, et al. The Effect of Glucosamine and/or Chondroitin Sulfate on the Progression of Knee Osteoarthritis: A Report from the Glucosamine/Chondroitin Arthritis Intervention Trial. Arthritis & Rheumatism, 2008; 58(10):3183–3191. and doctors’ opinions of them vary. Positive clinical studies suggest they may provide modest pain relief by helping to rebuild worn-out cartilage in your arthritic joints.
See Glucosamine and Chondroitin Sulfate Supplements for Osteoarthritis
Glucosamine should be avoided by anyone allergic to shellfish since it is derived from shrimp, crab, and other crustaceans.
See How Glucosamine and Chondroitin Help with Osteoarthritis
In general, if you take any supplement for 2 to 6 months and don’t notice any relief from arthritis symptoms, check with your doctor for other options.
Opinions about the recommended doses for supplements can vary. Before starting a new one, talk to your doctor or pharmacist to make sure the supplement’s contents and the dosage is right for your condition and won’t interact with any other medications and supplements you take. Some supplements can cause serious health problems if they are taken at high doses or combined with other supplements and medications. 17 Andrew I. Geller, M.D., Nadine Shehab, Pharm.D., M.P.H., Nina J. Weidle, Pharm.D. et al. "Emergency Department Visits for Adverse Events Related to Dietary Supplements." N Engl J Med 2015; 373:1531-1540. October 15, 2015. DOI: 10.1056/NEJMsa1504267
Also, keep in mind that supplements are not a quick fix for your arthritis pain. They may take effect gradually—over weeks or months--and provide only a modest decrease in pain. When you combine supplements with other treatments, such as an anti-inflammatory diet and exercise, there may be more significant pain relief.
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