Updated 23 December 2015

Arthritis - from Natural Standard

The term arthritis literally means joint inflammation or swelling.


The term arthritis literally means joint inflammation or swelling. More than 100 different diseases fall under the general category of arthritis. Arthritis conditions affect the joints, the tissues surrounding the affected joints, and other connective tissues.

Common forms of arthritis include rheumatoid arthritis, osteoarthritis, and periarthritis.

Osteoarthritis, also called degenerative joint disease or osteoarthrosis, occurs when the cartilage in the joints starts to break down. The cartilage serves as a cushion between bones, allowing the joint to move without pain. Therefore, patients with osteoarthritis experience pain and reduced mobility in their joints. Osteoarthritis may affect any joint in the body.

Osteoarthritis occurs most often in individuals older than 45 years, but it may develop at any age. Females are more likely to develop the disorder than males, suggesting that heredity may play a role in the development of the condition. Individuals who are obese, have weak muscles, have cartilage disorders, and/or have malformed joints have an increased risk of developing osteoarthritis.

Rheumatoid arthritis is an autoimmune disorder that occurs when the body's immune system, which normally fights against disease and infection, attacks itself. Unlike osteoarthritis, which only affects the bones and cartilage, rheumatoid arthritis may also cause swelling in other areas of the body.

Women are two to three times more likely to develop rheumatoid arthritis than men. Most cases of rheumatoid arthritis occur in individuals who are 20-50 years old. However, rheumatoid arthritis may also develop in young children and older adults. Although there is currently no cure for osteoarthritis or rheumatoid arthritis, treatment can help reduce pain and help individuals remain active.

Periarthritis is a chronic inflammatory disease of a joint and the tissues surrounding it. The condition primarily affects patients who are 50 years old or older. Periarthritis most commonly affects the shoulder. Periarthritis of the shoulder is also called adhesive capsulitis or frozen shoulder. Patients typically receive cortisol injections, anti-inflammatories, and physical therapy. Without aggressive treatment, periarthritis of the shoulder can be permanent.


Osteoarthritis: The exact cause of osteoarthritis remains unknown. Most researchers believe that several factors, including obesity, age, joint injury or stress, genetics, and muscle weakness, may contribute to the development of osteoarthritis.

Some researchers believe that cartilage damage may occur when cartilage releases too many enzymes that allow for the natural breakdown and regeneration of cartilage. If the body releases too many of these enzymes, the cartilage will be destroyed faster than it can be regenerated. However, it is unknown exactly what causes an imbalance of the cartilage enzyme.

When individuals have osteoarthritis, their bodies try to repair the cartilage damage. However, the body cannot regenerate enough cartilage. Instead, new bone grows alongside the existing bone, causing small lumps to form. Although these lumps cause minimal if any pain, they may be disfiguring and limit the joint's mobility.

Rheumatoid arthritis: The exact cause of rheumatoid arthritis remains unknown. Rheumatoid arthritis is considered an autoimmune disorder because the immune system does not function properly. Normally, the immune system helps the body fight against harmful foreign invaders, such as bacteria, that may cause disease and infection. However, in rheumatoid arthritis patients, the immune system attacks body cells because they are mistaken for harmful invaders.

Patients with rheumatoid arthritis have high levels of white blood cells in the synovial membrane, which line the body's joints. As a result, the joints became painful and swollen. The inflammation causes proteins to be released over months or years, which then results in the thickening of the synovial membranes. This may also lead to damaged bones, cartilage, tendons, and ligaments.

Some researchers believe that this autoimmune process is triggered by an infection with a virus or bacterium. Heredity may also play a role in the development of rheumatoid arthritis.

Periarthritis: Periarthritis typically occurs after the joint becomes injured, which causes scarring, thickening, and shrinkage of the joint. It may also occur after exposure to cold temperatures. Periarthritis typically affects the shoulder.

Individuals who have other types of long-term arthritis that affect the shoulders have an increased risk of developing periarthritis of the shoulder, also called adhesive capsulitis or frozen shoulder.


Osteoarthritis: Because osteoarthritis develops slowly, many patients do not experience symptoms right away. Once symptoms develop, they are generally the worst during the first year of the disease. Common symptoms include joint pain, swelling and/or stiffness in a joint (especially after use), joint discomfort before or during a change in the weather, bony lumps on the fingers, and loss of joint flexibility. The joints that are most often affected by osteoarthritis include the fingers, spine, and weight-bearing joints, such as the hips, ankles, feet, and knees.

If patients overuse the affected joints and do not receive treatment, the cartilage in the joints may wear down completely. When this happens, the bone may rub against bone, causing severe pain.

Rheumatoid arthritis: Rheumatoid arthritis often affects many joints at the same time. The severity of symptoms varies among patients. Symptoms, which may come and go, typically include pain and swelling in the joints (especially in the hands and feet), generalized aching or stiffness of the joints and muscles (especially after periods of rest), loss of motion of the affected joints, weakness in the muscles near the affected joints, low-grade fever, and general feeling of discomfort. In general, both sides of the body are affected equally. For instance, if arthritis is in the hands, both hands will be equally affected. Early in the disease, the joints in the hands, wrists, feet, and knees are most frequently affected. Over time, arthritis may develop in the shoulders, elbows, jaw, hips, and neck.

Over time, the joints may become deformed. Small lumps, called rheumatoid nodules, may develop under the skin at pressure points. These lumps, which range from the size of a pea to a quarter, may be visible near the elbows, hands, feet, Achilles tendons, back of the scalp, knee, or lungs. Rheumatoid nodules are not painful. However, bone deformities or swelling may reduce the flexibility of the joints.

In addition to the joints, other areas of the body may also be affected. Rheumatoid arthritis may cause swelling in other parts of the body, including the tear ducts, salivary glands, the lining of the heart, the lungs, and occasionally, blood vessels.

Periarthritis: Periarthritis causes swelling and pain in the joint. Most patients develop periarthritis of the shoulder. When the shoulder is affected, the joint's mobility is significantly or completely reduced aggressive treatment is started.


Cosmetic concerns: Arthritis may cause small bumps, called nodules, to form on bones. These bumps can occur on any joint, but they are most common in the hands. These nodules may be disfiguring.

Depression: Some arthritis patients may suffer from depression. This may happen if the arthritis interferes significantly with the patient's lifestyle. Patients should consult their healthcare providers if they experience feelings of sadness, low self-esteem, loss of pleasure, apathy, and sometimes, difficulty functioning for two weeks or longer, with no known underlying cause. These may be signs of depression.

Joint damage: In some cases, arthritis can lead to severe joint damage. In such cases, surgery, such as a joint replacement, may be necessary. Patients should regularly visit their healthcare providers to monitor their conditions.

Limited mobility: Patients with arthritis may have limited mobility in their joints. Joint mobility decreases as the joint becomes more damaged. Patients with periarthritis of the shoulder, also called frozen shoulder, may be completely unable to move their joint without aggressive treatment. If arthritis is not properly managed with nonsteroidal anti-inflammatories, arthritis may interfere with a patient's daily life.

Pain: Arthritis may cause severe pain. Patients should stay in close contact with their healthcare providers to ensure that their medications are properly managing the pain. In some cases, the medication or dosage may need to be changed.


General: Once patients are diagnosed with arthritis, they should visit their healthcare providers regularly, at least once a year. Patients should stay in close contact with their physicians to ensure that their symptoms are managed and to monitor joint damage.

Osteoarthritis: X-rays are often the first test performed if a patient has symptoms of osteoarthritis. If the patient has osteoarthritis, the X-ray images will often show loss of cartilage in the affected joints, narrowing of the space between bones, and bumps called nodules.

A procedure called arthrocentesis may also be performed at a healthcare provider's office. During the procedure, a needle is inserted into the affected joint and a small sample of fluid is removed. The fluid is then analyzed to rule out other conditions, such as gout or infection. This test may also temporarily relieve some pain and inflammation in the joint.

A surgical procedure called arthroscopy may also be performed. During the surgery, a small incision is made into the affected joint. Then a tube called an arthroscope is inserted into the joint. This tube has a small light and camera, which allow the healthcare provider to see the inside of the joint. If abnormalities such as cartilage or ligament damage are seen, the patient is diagnosed with osteoarthritis.

Rheumatoid arthritis: A blood test may be performed to determine if an antibody called the rheumatoid factor is present. Most patients with rheumatoid arthritis eventually have this abnormal protein in their blood. However, it may not present when symptoms first develop. If rheumatoid factor is present, a positive diagnosis is made. If patients test negative but rheumatoid arthritis is suspected, a healthcare provider may recommend treatment to reduce symptoms. Another test may be performed in the future to confirm a diagnosis.

Periarthritis: Periarthritis is usually diagnosed after a healthcare provider takes a detailed medical history and performs a physical examination. The affected joint will have very limited mobility. In some cases, an X-ray may be needed to confirm a diagnosis. During the procedure, a contrast dye is injected into the affected joint and X-rays are taken. If the patient has periarthritis, the joint will appear shrunken and scarred.


General: Osteoarthritis, rheumatoid arthritis, and periarthritis are managed with medications that reduce pain and inflammation. Patients with rheumatoid arthritis may also require treatment with medications that weaken the immune system, such as corticosteroids or immunosuppressants. In severe cases, surgery may be necessary to repair damage.

In order to properly manage pain and prevent joint damage, patients should take their medications exactly as prescribed by their healthcare providers. Patients should also tell their healthcare providers if they are taking any other drugs (prescription or over-the-counter) because they may interfere with treatment.

Abatacept (Orencia©): Abatacept (Orencia©) is a type of drug called a costimulation modulator. Abatacept reduces inflammation and joint damaged caused by rheumatoid arthritis. The drug prevents white blood cells, called T-cells, from attacking the joints. Patients receive a monthly injection through a vein in the arms.

Side effects may include headache, nausea, and mild infections, such as upper respiratory tract infections. Serious infections, such as pneumonia, may develop.

Antidepressants: Some patients with arthritis may also suffer from depression. Commonly prescribed anti-depressants for arthritis patients include amitriptyline (Elavil©), nortriptyline (Aventyl©, Pamelor©), and trazodone (Desyrel©).

Arthroscopic lavage and/or debridement: In some cases, patients with osteoarthritis may suffer from severe joint damage. In such cases, surgical procedures called arthroscopic lavage and/or arthroscopic debridement may be recommended. During the surgery, a small incision is made near the joint. A small tubular instrument called an arthroscope is then inserted. The arthroscope has a small light and camera attached to it, allowing the surgeon to see inside the joint. During arthroscopic lavage, the surgeon squirts saline into the joint to remove any blood, fluid, or loose debris inside the joint. During arthroscopic debridement, loose fragments of bone or cartilage are removed from the joint. In some cases, built up scar tissue may also be removed.

Both of these procedures may provide temporary pain relief and improved joint function. However, recent studies suggest that they may not be effective in some patients with osteoarthritis. Therefore, patients should discuss the potential risks and health benefits of the procedure with their healthcare providers.

Corticosteroids: Corticosteroids, such as prednisone (e.g. Deltasone©) and methylprednisolone (Medrol©), have been used to reduce inflammation and pain and slow joint damage caused by rheumatoid arthritis. These drugs are generally very effective when used short-term. However, if these drugs are used for many months to years, they may become less effective and serious side effects may develop. Side effects may include easy bruising, thinning of bones, cataracts, weight gain, a round face, and diabetes.

Occasionally, corticosteroids are used to treat patients with severe osteoarthritis. The medication is injected into the affected joints to reduce pain and inflammation.

Patients with periarthritis typically receive corticosteroid injections into affected joints to reduce pain and inflammation.

Corticosteroids are usually prescribed for a certain amount of time and then the patient is gradually tapered off the medication. Patients should not stop taking corticosteroids suddenly or change their dosages without first consulting their healthcare providers.

Cool compress or ice pack: Applying a cool compress or ice pack to the affected joint during a flare-up may help reduce swelling and pain.

Disease-modifying antirheumatic drugs (DMARDs): During the early stages of rheumatoid arthritis, patients typically receive disease-modifying antirheumatic drugs (DMARDs) to limit the amount of permanent joint damage. These drugs may take weeks to months before they begin to take effect. Therefore, they are often used in combination with nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. Commonly prescribed DMARDs include the gold compound auranofin (Ridaura©), hydroxychloroquine (Plaquenil©), minocycline (Dynacin© or Minocin©), sulfasalazine (Azulfidine©), and methotrexate (Rheumatrex©).

Heat: Applying a hot pack to affected joints may help reduce pain, relax muscles, and increase blood flow to the joint. It may also be an effective treatment before exercise. Alternatively, patients may take a hot shower or bath before exercise to help reduce pain.

Immunosuppressants: Patients with rheumatoid arthritis may take prescription drugs called immunosuppressants. These medications weaken the body's immune system, which limits the amount of joint damage. Commonly prescribed immunosuppressants include leflunomide (Arava©), azathioprine (Imuran©), cyclosporine (Neoral©, Sandimmune©), and cyclophosphamide (Cytoxan©).

These medications may have serious side effects, including increased risk of infections, kidney problems, high blood pressure, and decreased levels of red blood cells. Other side effects may include increased hair growth, loss of appetite, vomiting, and upset stomach.

Fusing bones: If there is serious joint damage, the bones of a joint, such as the ankle, may be surgically fused to together in a procedure called arthrodesis. This surgery helps increase stability and reduces pain. However, the joint no longer has any flexibility and cannot bend or move.

Joint replacement surgery: In some cases, patients with osteoarthritis or rheumatoid arthritis suffer from permanent joint damage. In such instances, joint replacement surgery may be necessary. During the procedure, the damaged joint is surgically removed and it is replaced with a plastic or metal device called a prosthesis. The most commonly replaced joints are the hip and knee, but other joints, including the elbow, shoulder, finger, or ankle joints, can be replaced.

Joint replacement surgeries are generally most successful for large joints, such as the hip or knee. According to the American College of Rheumatology, most hip and knee replacements last for 20 years or longer. After a successful surgery and several months of rehabilitation, patients are able to use their new joints without pain.

As with any major surgery, there are risks associated with joint replacements. Patients should discuss the potential health risks and benefits of surgery with their healthcare providers.

Lifestyle: Many lifestyle changes, including regular exercise, weight management, and healthy diet may help reduce symptoms of osteoarthritis. A healthcare provider may recommend a physical therapist or nutritionist to help a patient determine the best treatment plan for him/her.

Individuals with osteoarthritis or rheumatoid arthritis should wear comfortable footwear that properly supports their weight. This may reduce the amount of strain put on the joints during walking.

Patients with osteoarthritis or rheumatoid arthritis may require canes, walkers, or other devices to help them get around. If the hands are severely affected, braces may be beneficial. Patients should talk to their healthcare providers about assistive devices that are available.

Individuals with osteoarthritis or rheumatoid arthritis should maintain good posture. This allows the body's weight to be evenly distributed among joints.

Non-selective Nonsteroidal anti-inflammatory drugs (NSAIDs): Nonsteroidal anti-inflammatory drugs (NSAIDs) have been used to relieve pain and inflammation caused by osteoarthritis, rheumatoid arthritis, and periarthritis. Commonly used over-the-counter NSAIDs include ibuprofen (Advil© or Motrin©) and naproxen sodium (Aleve©). Higher doses of these drugs are also available by prescription. Commonly prescribed NSAIDs include diclofenac (Cataflam© or Voltaren©), nabumetone (Relafen©), and ketoprofen (Orudis©). NSAIDs may be taken by mouth, injected into a vein, or applied to the skin. These medications are generally taken long term to manage symptoms.

The frequency and severity of side effects vary. The most common side effects include nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. The most serious side effects include kidney failure, liver failure, ulcers, heart-related problems, and prolonged bleeding after an injury or surgery. About 15% of patients who receive long-term NSAID treatment develop ulcers in the stomach or duodenum.

Pain relievers: Prescription pain relievers, including tramadol (Ultram©), have been used to reduce pain caused by osteoarthritis or rheumatoid arthritis. Although this drug, which is available by prescription, does not reduce swelling, it has fewer side effects than NSAIDs. Tramadol is generally taken as a short-term treatment to reduce symptoms of flare-ups.

Narcotic pain relievers, such as acetaminophen/codeine (Tylenol with Codeine©), hydrocodone/acetaminophen (Lorcet©, Lortab©, or Vicodi©), or oxycodone (OxyContin© or Roxicodone©), may be prescribed to treat severe arthritis pain. However, they do not reduce swelling. These medications are only used short-term to treat flare-ups. Common side effects include constipation, drowsiness, dry mouth, and difficulty urinating. Narcotic pain relievers should be used cautiously because patients may become addicted to them.

Rituximab (Rituxan©): A medication called rituximab (Rituxan©) has been used to treat patients with rheumatoid arthritis. This medication, which is injected into the patient's vein, reduces the number of B-cells in the body. This medication helps reduce swelling because the B-cells are involved in inflammation.

Side effects may include flu-like symptoms, such as fever, chills, and nausea. Some people experience extreme reactions to the infusion, such as difficulty breathing and heart problems.

Selective COX-2 inhibitors: Celecoxib (Celebrex©) has been taken by mouth to reduce pain and inflammation caused by osteoarthritis, rheumatoid arthritis, or periarthritis. Celecoxib is currently the only COX-2 inhibitor that is approved by the U.S. Food and Drug Administration (FDA). Celecoxib is generally taken long term to manage symptoms.

COX-2 inhibitors have been linked to an increased risk of serious heart-related side effects, including heart attack and stroke. Selective COX-2 inhibitors have also been shown to increase the risk of stomach bleeding, fluid retention, kidney problems, and liver damage. Less serious side effects may include headache, indigestion, upper respiratory tract infection, diarrhea, sinus inflammation, stomach pain, and nausea.

Topical pain relievers: Topical pain relievers are creams, ointments, gels, and sprays that are applied to the skin. Many over-the-counter pain relievers may temporarily help reduce the pain caused by osteoarthritis. Products such as Aspercreme©, Sportscreme©, Icy Hot©, and Ben-Gay© may help reduce arthritis pain. Capsaicin cream, which is made from the seeds of hot peppers, may reduce pain in joints that are close to the skin surface, such as the fingers, knees, and elbows.


Strong scientific evidence:

Acupuncture: Acupuncture is commonly used throughout the world. According to Chinese medicine theory, the human body contains a network of energy pathways through which vital energy, called chi, circulates. These pathways contain specific "points" that function like gates, allowing chi to flow through the body. Needles are inserted into these points to regulate the flow of chi. There has been substantial research into the efficacy of acupuncture in the treatment of osteoarthritis (OA). Most studies focus on knee, cervical, and hip OA symptoms. In recent years, the evidence has improved and is now considered strong enough to recommend trying acupuncture in OA of the knee, which is one of the most common forms of this condition.

Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, neurological disorders, or if taking anticoagulants. Avoid on areas that have received radiation therapy and during pregnancy. Avoid electroacupuncture with irregular heartbeat or in patients with pacemakers. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with a history of seizures.

Chondroitin: Multiple clinical trials have examined the use of oral chondroitin in patients with osteoarthritis of the knee and other joints (spine, hips, and finger joints). Most of these studies have reported significant benefits in terms of symptoms (such as pain), function (such as mobility), and reduced medication requirements (such as anti-inflammatory). The weight of scientific evidence points to a beneficial effect when chondroitin is used for six to 24 months. Longer-term effects are not clear. Preliminary studies of topical chondroitin have also been conducted.

Avoid with prostate cancer or an increased risk of prostate cancer. Use cautiously if allergic or hypersensitive to chondroitin sulfate products or with shellfish allergy. Use cautiously with bleeding disorders or if taking blood-thinners like warfarin (like Coumadin©). Avoid if pregnant or breastfeeding.

Glucosamine: Glucosamine is a natural compound that is found in healthy cartilage. Based on human research, there is strong evidence to support the use of glucosamine sulfate in the treatment of mild-to-moderate knee osteoarthritis. Most studies have used glucosamine sulfate supplied by one European manufacturer (Rotta Research Laboratorium), and it is not known if glucosamine preparations made by other manufacturers are equally effective. Although some studies of glucosamine have not found benefits, these have either included patients with severe osteoarthritis or used products other than glucosamine sulfate. The evidence for the effect of glycosaminoglycan polysulphate is conflicting and merits further investigation. More well-designed clinical trials are needed to confirm safety and effectiveness, and to test different formulations of glucosamine.

Avoid if allergic or hypersensitive to shellfish or iodine. Some reports suggest a link between glucosamine/chondroitin products and asthma. Use cautiously with diabetes or with a history of bleeding disorders. Avoid if pregnant or breastfeeding.

Willow bark: Willow (Salix alba) bark that contains salicin has been used to treat many different kinds of pain. Willow bark is a traditional analgesic (pain relieving) therapy for osteoarthritis. Several studied have confirmed this finding. Additional study comparing willow bark to conventional medicinal agents for safety and effectiveness is warranted.

Avoid if allergic/hypersensitive to aspirin, willow bark (Salix spp.), or any of its constituents, including salicylates. Avoid operating heavy machinery. Avoid in children with chickenpox and any other viral infections. Avoid with blood disorders or kidney disorders. Avoid if taking other NSAIDs, acetazolamide or other carbonic anhydrase inhibitors. Avoid with elevated serum cadmium levels. Use cautiously with gastrointestinal problems, such as ulcers, hepatic disorders, diabetes, gout, high blood pressure, hyperlipidemia, history of allergy or asthma, or leukemia. Use cautiously if taking protein-bound medications, antihyperlipidemia agents, alcohol, leukemia medications, beta-blockers, diuretics, Phenytoin (Dilantin©), probenecid, spironolactone, sulfonylureas, valproic acid, or methotrexate. Use cautiously if predisposed to headaches. Use cautiously with tannin-containing herbs or supplements. Avoid if pregnant or breastfeeding.

Good scientific evidence:

Avocado: A combination of avocado/soybean unsaponifiables (ASU) has been found beneficial in osteoarthritis of the knee and hip. Additional study using avocado (Persea Americana) alone in OA is needed.

Avoid if allergic or hypersensitive to avocado, banana, chestnut, or natural rubber latex. Avoid with monoamine oxidase inhibitors (MAOIs). Use cautiously with anticoagulants (like warfarin). Doses greater than found in a normal diet is not recommended if pregnant or breastfeeding. Some types of avocado may be unsafe when breastfeeding.

Borage seed oil: Preliminary evidence suggests that gamma linolenic acid (GLA) may have anti-inflammatory effects that may make it beneficial in treating rheumatoid arthritis. Additional research is needed to determine the optimal dose and administration.

Avoid if allergic or hypersensitive to borage, its constituents, or members of the Boraginaceae family. Use cautiously in patients with bleeding disorders or in those taking warfarin or other anticoagulant or antiplatelet (blood thinning) agents. Use cautiously in patients with epilepsy or in those taking anticonvulsants. Avoid in patients with compromised immune systems or similar immunological conditions. Avoid during pregnancy and breastfeeding.

Devil's claw: Devil's claw (Harpagophytum procumbens) originates from the Kalahari and Savannah desert regions of South and Southeast Africa. There is increasing scientific evidence suggesting that devil's claw is safe and beneficial for the short-term treatment of pain related to degenerative joint disease or osteoarthritis (8-12 weeks), and may be equally effective as drug therapies such as non-steroidal anti-inflammatory drugs like ibuprofen (Advil©, Motrin©), or may allow for dose reductions or stopping of these drugs in some patients. However, most studies have been small with flaws in their designs. Additional well-designed trials are necessary.

Avoid if allergic to devil's claw or to plants in the Harpagophytum procumbens family. Use cautiously with stomach ulcers or with a history of bleeding disorders, diabetes, gallstones, gout, heart disease, stroke, ulcers, or with prescription drugs used for these conditions. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.

Glucosamine: Several human studies and animal experiments report benefits of glucosamine in treating osteoarthritis of various joints of the body, although the evidence is less plentiful than that for knee osteoarthritis. Some of these benefits include pain relief, possibly due to an anti-inflammatory effect of glucosamine, and improved joint function. Overall, these studies have not been well designed. Although there is some promising research, more study is needed in this area before a firm conclusion can be made.

Avoid if allergic or hypersensitive to shellfish or iodine. Some reports suggest a link between glucosamine/chondroitin products and asthma. Use cautiously with diabetes or with a history of bleeding disorders. Avoid if pregnant or breastfeeding.

Omega-3 fatty acids, fish oil, alpha-linolenic acid: Multiple randomized controlled trials report improvements in rheumatoid arthritis, including morning stiffness and joint tenderness, with the regular intake of fish oil supplements for up to three months. Benefits have been reported as additive with anti-inflammatory medications such as NSAIDs (like ibuprofen or aspirin). However, because of weaknesses in study designs and reporting, better research is necessary before a strong favorable recommendation can be made. Effects beyond three months of treatment have not been well evaluated.

People who are allergic to fish should avoid fish oil or omega-3 fatty acid products derived from fish. People who are allergic or hypersensitive to nuts should avoid alpha linolenic acid or omega-3 fatty acid products that are derived from the types of nuts to which they react. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure or drugs, herbs or supplements that treat any such conditions. Use cautiously before surgery. The Environmental Protection Agency (EPA) recommends that intake be limited in pregnant/nursing women to a single six-ounce meal per week and less than two ounces per week in young children. For farm-raised, imported or marine fish, the U.S. Food and Drug Administration (FDA) recommends that pregnant/nursing women and young children avoid eating types with higher levels of methylmercury and less than 12 ounces per week of other fish types. Women who might become pregnant are advised to eat seven ounces or less per week of fish with higher levels of methylmercury or up to 14 ounces per week of fish types with about 0.5 parts per million (such as marlin, orange roughy, red snapper or fresh tuna).

Physical therapy: The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injuries. Several techniques, including exercises, stretches, traction, electrical stimulation, and massage, are used. Physical therapy for osteoarthritis of the knee may provide short-term benefits, but long-term benefits do not appear better than standard treatments. Physical therapy, either as an individually delivered treatment or in a small group format, appears effective. Limited available study compared physical therapy to a sham group (sub therapeutic ultrasound) and found that a combination of manual physical therapy and supervised exercise was beneficial for patients with osteoarthritis of the knee.

Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature, although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy, and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.

Psychotherapy: Although group therapy may somewhat decrease pain in people with rheumatoid arthritis and depression, individual therapy coupled with anti-depressants may be more effective.

Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases symptoms may worsen if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings.

Rose hip: Rose hips have traditionally been used by herbalists as an anti-inflammatory and antiarthritic agent. A constituent isolated from dried and milled fruits of Rosa canina has demonstrated anti-inflammatory properties, and Hyben Vital©, a standardized rose hips extract, has been shown to have anti-oxidant properties. Rose hip extracts have been studied in patients with osteoarthritis, with some evidence of benefit. Additional high quality clinical research is needed in this area to confirm early study results.

Avoid if allergic to rose hips, rose pollen, their constituents, or members of the Rosaceae family. Use cautiously if taking anticoagulant or antiplatelet agents, anticancer agents, anti-HIV medications, anti-inflammatory agents, antilipemics, aluminum-containing antacids, antibiotics, salicylates or salicylate-containing herbs, or laxatives. Use cautiously in patients who are avoiding immune system stimulants.

SAMe: S-adenosyl-L-methionine (SAMe) is a naturally occurring molecule that is found in humans. SAMe is present in almost every tissue and fluid in the body, and has been studied extensively in the treatment of osteoarthritis. SAMe reduces the pain associated with osteoarthritis and is well tolerated in this patient population. Although an optimal dose has yet to be determined, SAMe appears as effective as non-steroidal anti-inflammatory drugs (NSAIDS). Additional study is warranted to confirm these findings.

Avoid if allergic or hypersensitive to SAMe. Avoid with bipolar disorder. Avoid during the first trimester of pregnancy or if breastfeeding. Use cautiously with diabetes, anxiety disorders, or during the third trimester of pregnancy.

TENS (transcutaneous electrical nerve stimulation): Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. Preliminary studies of TENS in knee osteoarthritis report improvements in joint function and pain. However, most research is not well designed or reported, and better studies are necessary before a clear conclusion can be reached.

Avoid with implantable devices, such as defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation (such as neuropathy) or with seizure disorders. Avoid if pregnant or breastfeeding.

Yoga: There is promising early evidence that yoga therapy may help treat rheumatoid arthritis. More research is needed to confirm these results.

Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, risk for blood clots, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction (the popular Lamaze techniques are based on yogic breathing). However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.

Unclear or conflicting scientific evidence:

Acupuncture: Further research is needed before acupuncture can be recommended for the treatment of rheumatoid arthritis.

Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders or with drugs that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, or neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.

Alpinia: Alpinia, also known as Chinese ginger, has been studied in combination with another ginger species for the treatment of osteoarthritis. Although alpinia shows promise for the reduction in knee pain, more studies using alpinia alone would strengthen the evidence for this indication.

Avoid if allergic/hypersensitive to alpinia, ginger, or other members of the Zingiberaceae family. Use cautiously with diabetes or if taking hypoglycemic agents. Use cautiously with electrolyte imbalance and low blood pressure. Avoid if pregnant or breastfeeding.

Aromatherapy: Aromatherapy refers to many different therapies that use essential oils. The oils are sprayed in the air, inhaled or applied to the skin. Essential oils are usually mixed with a carrier oil (usually a vegetable oil) or alcohol. There is not enough scientific evidence to determine if aromatherapy improves wellbeing in arthritis patients.

Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if driving/operating heavy machinery. Use cautiously if pregnant.

Arnica: Arnica (Arnica montana) gel has been used on the skin for osteoarthritis pain and stiffness, due to its anti-inflammatory constituents. Although early study is promising, additional study is needed.

Avoid if allergic or hypersensitive to arnica or any member of the Asteraceae or Compositae families (sunflowers, marigolds, or any related plants like daisies, ragweed, or asters). Use cautiously with blood thinners, protein-bound drugs, cholesterol or heart medications, or diabetes drugs. Use cautiously with a history of stroke. Avoid contact with open wounds or near the eyes and mouth. Avoid if pregnant or breastfeeding.

Ash: The use of ash as an herbal remedy can be traced to Native Americans and the early settlers of the Americas. Ash has been historically noted for its anti-inflammatory and pain-relieving properties. There is currently little scientific evidence currently available to support its use for gouty arthritis. Future randomized, placebo controlled studies are necessary to confirm these initial results.

Avoid if allergic or hypersensitive to ash (Fraxinus species), its constituents, or to members of the Oleaceae family. Reviews note ash pollen allergic cross-reactivities with pollen from the Fagales order (birch, alder, hazel, hornbeam, oak, and chestnut), Scrophulariales order (olive, ash, plantain, privet, and lilac), Coniferales order (cedar, cypress, and pine), and fruits and vegetables. Use cautiously if sensitive to anticoagulants (blood thinners). Use cautiously if susceptible to hypouricemia (condition where the level of uric acid is below a certain threshold), including but not limited to hyperthyroidism, inflamed kidneys, multiple sclerosis, and Fanconi syndrome. Avoid if immunocompromised. Avoid if pregnant or breastfeeding.

Ashwagandha: The use of ashwagandha in osteoarthritis has been suggested based on its reported anti-inflammatory and anti-arthritic properties. Well-designed human research is needed in this area.

Avoid if allergic or hypersensitive to ashwagandha. Dermatitis (allergic skin rash) has been reported. There are few reports of adverse effects associated with ashwagandha, but there are few human trials using ashwagandha and most do not report the doses or standardization/preparation used. Avoid with peptic ulcer disease. Ashwagandha may cause abortion based on anecdotal reports. Avoid if pregnant or breastfeeding.

Astaxanthin: More well-designed clinical trials are necessary before astaxanthin can be recommended for the treatment of rheumatoid arthritis.

Avoid if allergic/hypersensitive to astaxanthin, related carotenoids, or astaxanthin algal sources. Use cautiously if taking 5-alpha-reductase inihibitors, hypertensive agents, asthma medications, cytochrome P450 metabolized agents, menopause agents or oral contraception, or Helicobacter pylori agents. Use cautiously with hypertension, parathyroid disorders, and osteoporosis. Avoid with hormone-sensitive conditions, immune disorders, or if taking immunosuppressive therapies. Avoid with previous experience of visual changes while taking astaxanthin and with low eosinophil levels. Avoid if pregnant or breastfeeding.

Ayurveda: There is some evidence that a traditional Ayurvedic herbal formula RA-1 may reduce joint swelling but not other symptoms in rheumatoid arthritis. RA-1 contains Withania somnifera (ashwagandha), Boswellia serrata (gugulla), Zingiberis officinale (ginger) and Curcuma longa (turmeric). A resin that is extracted from Boswellia serrata (H15, indish incense) is regarded in Ayurvedic medicine as having anti-inflammatory properties. However, evidence from one study showed no benefit in patients with rheumatoid arthritis. More studies are needed to determine efficacy of these treatments for rheumatoid arthritis.

There is early evidence that an Ayurvedic formula containing roots of Withania somnifera, the stem of Boswellia serrata, rhizomes of Curcuma longa, and a zinc complex (Articulin-F©) may significantly improve symptoms of osteoarthritis. Other research suggests that taking guggul (Commiphora mukul) daily as a powder capsule supplement may reduce pain and improve functioning in OA. Further research is needed before a recommendation can be made.

Ayurvedic herbs should be used cautiously because they are potent and some constituents can be potentially toxic if taken in large amounts or for a long time. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking.

Beta carotene: Beta-carotene is a member of the carotenoids, which are highly pigmented (red, orange, yellow), fat-soluble compounds naturally present in many fruits, grains, oils, and vegetables (green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers). Beta-carotene supplementation does not appear to prevent osteoarthritis, but it may slow progression of the disease. Well-designed clinical trials are needed before a conclusion can be drawn.

Avoid if sensitive to beta-carotene, vitamin A, or any other ingredients in beta-carotene products.

Beta sitosterol: Beta-sitosterol and beta-sitosterol glucoside have been observed to lower blood levels of IL-6 and, therefore, have been studied as a treatment for rheumatoid arthritis. Larger populations of patients with rheumatoid arthritis should be evaluated in well-conducted clinical study if conclusions are to be made.

Avoid if allergic or hypersensitive to beta-sitosterol, beta-sitosterol glucoside, or pine. Use cautiously with asthma or breathing disorders, diabetes, primary biliary cirrhosis (destruction of the small bile duct in the liver), ileostomy, neurodegenerative disorders (like Parkinsonism or Alzheimer's disease), diverticular disease (bulging of the colon), short bowel syndrome, celiac disease and sitosterolemia. Use cautiously with a history of gallstones. Avoid if pregnant or breastfeeding.

Black cohosh: There is not enough human research to make a clear recommendation regarding the use of black cohosh for rheumatoid arthritis pain.

Use cautiously if allergic to members of the Ranunculaceae family such as buttercups or crowfoot. Avoid with hormone conditions (breast cancer, ovarian cancer, uterine cancer, endometriosis). Avoid if allergic to aspirin products, non-steriodal anti-inflammatories (NSAIDs, Motrin©, ibuprofen, etc.), blood-thinners (like warfarin) or with a history of blood clots, stroke, seizures, or liver disease. Stop use before surgery/dental/diagnostic procedures with bleeding risk and avoid immediately after these procedures. Avoid if pregnant or breastfeeding.

Black currant: Early study shows promise for the use of black currant seed oil in reducing the signs and symptoms of rheumatoid arthritis. However, additional study is needed to confirm these findings.

Avoid if allergic or hypersensitive to black currant, its constituents, or plants in the Saxifragaceae family. Avoid in patients with hemophilia or those on blood thinners unless otherwise recommended by a qualified healthcare provider. Use cautiously with venous disorders or gastrointestinal disorders. Use cautiously if taking MAOIs (antidepressants) or vitamin C supplements. Avoid if pregnant or breastfeeding.

Boron: Boron is a trace element, which is found throughout the global environment. Based on human population research, individuals who eat foods rich in boron (including green vegetables, fruits, and nuts) appear to have fewer joint disorders. It has also been proposed that boron deficiency may contribute to the development of osteoarthritis. However, there is a lack of human evidence that supplementation with boron is beneficial as prevention against or as a treatment for osteoarthritis.

Avoid if allergic or sensitive to boron, boric acid, borax, citrate, aspartate, or glycinate. Avoid with a history of diabetes, seizure disorder, kidney disease, liver disease, depression, anxiety, high blood pressure, skin rash, anemia, asthma, chronic obstructive pulmonary disease (COPD), or hormone-sensitive conditions (e.g., breast cancer or prostate cancer). Avoid if pregnant or breastfeeding.

Boswellia: Boswellia has been noted in animal and laboratory studies to possess anti-inflammatory properties. Based on these observations, boswellia has been suggested as a potential treatment for rheumatoid arthritis and osteoarthritis. However, data is conflicting, and combination products were used in some studies. Therefore, there is currently insufficient evidence to recommend for or against the use of boswellia for rheumatoid arthritis.

Avoid if allergic to boswellia. Avoid with a history of stomach ulcers or stomach acid reflux disease (GERD). Use cautiously if taking lipid-soluble medications, agents metabolized by the liver's cytochrome P450 enzymes, or sedatives. Use cautiously with impaired liver function or liver damage or lung disorders. Use cautiously in children. Avoid if pregnant due to potential abortifacient effects or if breastfeeding.

Bowen therapy: Bowen therapy is a technique that involves gentle but precise soft tissue manipulation. Early research suggests that Bowen therapy may improve the range of motion in patients with frozen shoulder.

Bowen therapy is generally believed to be safe in most people. However, safety has not been thoroughly studied. Bowen therapy should not be used for severe conditions or in place of more proven treatments. Use cautiously in patients with cancer or in those who are undergoing surgery.

Bromelain: Results of a study found a combination supplement called ERC (enzyme-rutosid combination -rutosid, bromelain, trypsin) may be considered as an effective and safe alternative to prescription anti-inflammatory drugs (NSAIDs), such as diclofenac, in the treatment of knee pain associated with osteoarthritis. Further well-designed clinical trials of bromelain alone are needed to confirm these results. Bromelain also cannot be recommended for the treatment of rheumatoid arthritis until further research is conducted.

Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or members of the Bromeliaceae family. Use cautiously with history of a bleeding disorder, stomach ulcers, heart disease, or liver or kidney disease. Use caution before dental or surgical procedures or while driving or operating machinery. Avoid if pregnant or breastfeeding.

Cat's claw: Several laboratory and animal studies suggest that cat's claw may reduce inflammation, and this has led to research of cat's claw for conditions such as rheumatoid arthritis. Early research also suggests that cat's claw may reduce pain from osteoarthritis of the knee. Large, high-quality human studies are needed before a conclusion can be drawn.

Avoid if allergic to cat's claw, Uncaria plants, or plants in the Rubiaceae family such as gardenia, coffee, or quinine. Avoid with a history of conditions affecting the immune system. Use cautiously with bleeding disorders or with a history of stroke, or if taking drugs that may increase the risk of bleeding. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Cat's claw may be contaminated with other Uncaria species. Reports exist of a potentially toxic Texan grown plant, Acacia gregii, being substituted for cat's claw. Avoid if pregnant, breastfeeding, or trying to become pregnant.

Chiropractic: Chiropractic is a healthcare discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) and body function (as coordinated by the nervous system), and how this relationship affects the preservation and restoration of health. Further research is needed to determine if chiropractic therapy is an effective treatment for hip pain or osteoarthritis.

Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis, or arthritis. Avoid with agents that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data. Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders, or migraines. Use cautiously with the risk of tumors or cancers.

Chlorophyll: Diets high in chlorophyll have been hypothesized to modify intestinal flora resulting in improved management of immune disorders including rheumatoid arthritis. More evidence is needed to support the use of chlorophyll in autoimmune diseases.

Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressant agents or antidiabetes agents. Avoid if pregnant or breastfeeding.

Copper: The use of copper bracelets in the treatment of arthritis has a long history of traditional use, with many anecdotal reports of effectiveness. There are research reports suggesting that copper salicylate may reduce arthritis symptoms more effectively than either copper or aspirin alone. Further study is needed before a recommendation can be made.

Avoid if allergic/hypersensitive to copper. Avoid use of copper supplements during the early phase of recovery from diarrhea. Avoid with hypercupremia, occasionally observed in disease states, including cutaneous leishmaniasis, sickle-cell disease, unipolar depression, breast cancer, epilepsy, measles, Down syndrome, and controlled fibrocalculous pancreatic diabetes (a unique form of secondary diabetes mellitus). Avoid with genetic disorders affecting copper metabolism such as Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis. Avoid with HIV/AIDS. Use cautiously with water containing copper concentrations greater than 6mg/L. Use cautiously with anemia, arthralgias, or myalgias. Use cautiously if taking oral contraceptives. Use cautiously if at risk for selenium deficiency. The U.S. Recommended Dietary Allowance (RDA) is 1,000 micrograms for pregnant women. The U.S. RDA is 1,300 micrograms for nursing women.

DHEA: Preliminary evidence suggests that DHEA (dehydroepiandrosterone) may not offer benefit to individuals with rheumatoid arthritis. Further research is needed in this area.

Avoid if allergic to DHEA. Avoid with a history of seizures. Use with caution in adrenal or thyroid disorders or anticoagulants, or drugs, herbs or supplements for diabetes, heart disease, seizure or stroke. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.

DMSO (dimethyl sulfoxide): Applying DMSO to the skin may help treat rheumatoid arthritis. More research is needed before a conclusion can be drawn.

Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.

Dong quai: Dong Quai (Angelica sinensis), also known as Chinese angelica, has been used for thousands of years in traditional Chinese, Korean, and Japanese medicine. Dong quai is traditionally used to treat arthritis. However, there is insufficient reliable human evidence to recommend the use of Dong quai alone or in combination with other herbs for osteoarthritis or rheumatoid arthritis.

Although Dong quai is accepted as being safe as a food additive in the United States and Europe, its safety in medicinal doses is unknown. Long-term studies of side effects are lacking. Avoid if allergic/hypersensitive to Dong quai or members of the Apiaceae/Umbelliferae family (like anise, caraway, carrot, celery, dill, parsley). Avoid prolonged exposure to sunlight or ultraviolet light. Avoid before dental or surgical procedures. Use cautiously with bleeding disorders or if taking drugs that may increase the risk of bleeding. Use cautiously with diabetes, glucose intolerance, or hormone-sensitive conditions (like breast cancer, uterine cancer or ovarian cancer). Avoid if pregnant or breastfeeding.

Eucalyptus oil: Aromatherapy using eucalyptus has been studied for its effects on pain, depression, and feelings of satisfaction in life in arthritis patients. Aromatherapy may help reduce pain and depression, but does not appear to alter the feeling of satisfaction in life. Additional study is needed to clarify these findings.

Avoid if allergic to eucalyptus oil or with a history of seizures, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Avoid with a history of acute intermittent porphyria. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.

Evening primrose oil: Benefits of evening primrose oil in the treatment of rheumatoid arthritis have not clearly been shown. More research is needed before a conclusion can be made.

Avoid if allergic to plants in the Onagraceae family (willow's herb, enchanter's nightshade) or gamma-linolenic acid. Avoid with seizure disorders. Use cautiously with mental illness drugs. Stop use two weeks before surgery with anesthesia. Avoid if pregnant or breastfeeding.

Feverfew: There is currently not enough evidence to support the use of feverfew for rheumatoid arthritis. Further research is warranted.

Avoid if allergic to feverfew and other plants of the Compositae family (chrysanthemums, daisies, marigolds, ragweed). Stop use prior to surgery and dental or diagnostic procedures. Avoid with drugs that increase bleeding risk. Avoid stopping feverfew use all at once. Avoid if history of heart disease, anxiety or bleeding disorders. Caution is advised with a history of mental illness, depression and headaches. Avoid if pregnant or breastfeeding.

Gamma linolenic acid (GLA): Several clinical studies indicate significant therapeutic improvements in rheumatoid arthritis symptoms with use of gamma linolenic acid (GLA). Additional study is needed before a conclusion can be made.

Use cautiously with drugs that increase the risk of bleeding like anticoagulants and anti-platelet drugs. Avoid if pregnant or breastfeeding.

Ginger: Well-designed clinical trials are necessary before ginger can be recommended for the treatment of rheumatoid arthritis or osteoarthritis.

Avoid if allergic to ginger or other members of the Zingiberaceae family. Avoid with anticoagulation therapy. Avoid large quantities of fresh cut ginger with inflammatory bowel disease or a history of intestinal obstruction. Use cautiously prior to surgery and with gastric or duodenal ulcers, gallstones, cardiovascular disease, and diabetes. Use cautiously long-term and in underweight patients. Use cautiously if taking heart medications or sedatives and if driving or operating heavy machinery. Use cautiously if pregnant or breastfeeding.

Glucosamine: Preliminary human research reports benefits of glucosamine in the treatment of joint pain and swelling in rheumatoid arthritis patients. However, additional research is needed before a conclusion can be made.

Avoid if allergic or hypersensitive to shellfish or iodine. Some reports suggest a link between glucosamine/chondroitin products and asthma. Use caution with diabetes or a history of bleeding disorders. Avoid if pregnant or breastfeeding.

Green lipped mussel: The green-lipped mussel is native to the New Zealand coast and is a staple in the diet of the indigenous Maori culture. There is conflicting evidence of the effect of green-lipped mussel supplementation for treating osteoarthritis. Reliable evidence is needed to determine whether green-lipped mussel is effective for this use.

Green-lipped mussel is generally considered safe. Avoid with allergy or sensitivity to green-lipped mussel or other shellfish. Avoid with liver disease. Use cautiously with anti-inflammatory agents. Use cautiously with asthma. Avoid if pregnant or breastfeeding.

Green tea: Green tea is made from the dried leaves of Camellia sinensis, an evergreen shrub. Research indicates that green tea may benefit arthritis by reducing inflammation and slowing cartilage breakdown. Further studies are required before a recommendation can be made.

Avoid if allergic or hypersensitive to caffeine or tannins. Use cautiously with diabetes or liver disease.


Rheumatoid arthritis: Currently, there is no known method of prevention for rheumatoid arthritis (RA).

Osteoarthritis: Individuals who maintain a healthy body weight have a decreased risk of developing osteoarthritis. Eating a healthy and well-balanced diet may help individuals control their weight. The U.S. government issued a revised food pyramid in 2005 in an effort to help Americans live healthier. The new pyramid provides 12 different models, which are based on daily calorie needs, ranging from the 1,000-calorie diets for toddlers to 3,200-calorie diets for teenage boys.

Regular exercise may also help patients control their weight. There are many ways for people to exercise including gardening, walking, sports activities, and dancing. Patients who are beginning an exercise program should choose activities that fit their levels of strength and endurance. The type of exercise is not as important as a consistent exercise schedule. Most experts today agree that burning calories should not be the goal of exercise. Exercise that causes extreme pain or discomfort is considered by many experts as unhealthy and may even cause permanent damage to the body.

Periarthritis: Patients can reduce their risks of developing periarthritis by avoiding injuries. In order to reduce the risk of injury, all workouts should begin with a warm-up routine and end with a cool-down segment that includes stretching exercises. Patients should talk to their healthcare providers before starting new exercise programs.

Copyright © 2011 Natural Standard (


Read Health24’s Comments Policy

Comment on this story
Comments have been closed for this article.

Ask the Expert

Arthritis expert

Professor Asgar Ali Kalla completed his MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 1975 at the University of Cape Town and his FRCP in 2003 in London. Professor Ali Kalla is the Isaac Albow Chair of Rheumatology at the University of Cape Town and also the Head of Division of Rheumatology at Groote Schuur Hospital. He has participated in a number of clinical trials for rheumatology and is active in community outreach. Prof Ali Kalla is an expert in Arthritis for Health24.

Still have a question?

Get free advice from our panel of experts

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

* You must accept our condition

Forum Rules