For those looking for natural arthritis treatments or joint pain remedies the task can be daunting. Chances are if you’re searching Google for joint pain supplements, you’re going to land on a page that’s trying to sell you something… This isn’t one of those pages.
Osteoarthritis (not to be confused with rheumatoid arthritis, an autoimmune condition), the most common form of joint disease, affects roughly 20 million Americans. Once thought to be a natural consequence of aging, it’s now understood to result from a number of different factors.
Formerly referred to as degenerative joint disease, this type of arthritis occurs when the (hyaline) cartilage in your (articular) joints breaks down. However, our current understanding of arthritis suggests that it’s not limited to just the cartilage in your joints. In fact, it also affects the entire joint organ including the tissue lining the joint (synovium) as well as the subchrondral bone.
For those who suffer from arthritis, the pain can be debilitating and ultimately result in the need for joint replacement (total arthroplasty).
Given that joint pain is essentially a condition related to aging and elderly patients often have reasons to avoid using antiiflammatory drugs such as NSAIDs (concern over gastric bleeding or increased risk of heart attacks and stroke), many choose to look toward natural remedies such as glucosamine.
For those looking to natural remedies, one key question is whether or not they actually work? One unfortunate reality for those looking for products to promote joint health is the simple reality that with severe arthritis, anything outside of a joint replacement is unlikely to provide much pain relief.
One common theme I’ve noticed is that many doctors are reluctant to give corticosteroid injections to patients with moderate/severe arthritis out of the irrational fear that corticosteroids cause joint damage. Even if that were the case, for those who’re already at the point that they’re suffering in daily pain from severe arthritis, it would still be worth considering if it worked. Yet, there is no recent compelling evidence that they actually cause joint damage (excluding rare side effects such as avascular necrosis) when used appropriately (pubmed).
Osteoarthritis vs. Rheumatoid Arthritis
Natural Joint Pain Relief?
Grade: A (Strong Scientific Evidence)
Despite the problem with the lack of any of the concepts of traditional Chinese medicine being validated themselves by scientific inquiry, acupuncture has been shown in clinical trials to be effective at reducing arthritic pain and improving level of function. Though these benefits may largely be related to placebo effects, patients who used acupuncture founding meaningful benefits (Manheimer E et al 2010). As a side note, while I personally don’t buy into the concept of “chi” espoused by traditional Chinese medicine, acupuncture’s safe and worth considering.
Exercise / Weight Loss
Exercise has been studied including both cardio and resistance training programs. Typically, exercise is more effective for relieving pain and improving function in those with mild arthritis rather than moderate or severe forms. (Christensen et al 2005). Specific recommendations made for those who are significantly overweight:
- Reduce body weight by at least 5% over a 20 week period (combined with exercise).
Glucosamine sulfate, a naturally occurring chemical (amino sugar), is found in the fluid surrounding joints. Dietary supplements containing glucosamine can either be from shellfish sources or derived synthetically.
Despite recent controversy (Wandel et al, 2010), there’s reasonable scientific evidence to support the use of glucosamine sulfate. Part of the reason for the mixed results in clinical trials is that the data mixes studies on glucosamine sulfate with other types of glucosamine such as glucosamine hydrochloride or n-acetyl glucosamine.
- Dose: 1500 mg/day total taken in three divided doses of 500 mg
Cautions: glucosamine can theoretically elevate blood sugar levels and depending on the manufacturer may contain allergens that affect those with shellfish allergies. In theory, it may also increase your risk of bleeding particularly when taken with blood thinners.
Important: Only buy products containing glucosamine sulfate NOT glucosamine hydrochloride or n-acetyl glucosamine.
While there’s reasonably good evidence that willow bark is effective for treating arthritis pain (Vlachojannis JE et al, 2009), this is one supplement that I wouldn’t personally recommend. It’s basically a natural version of aspirin which means that it carries all of the risks of NSAIDs while probably being not as effective.
Containing salicylates, this means that you should NOT take willow bark if you have an allergy or sensitivity to Aspirin, are currently taking blood thinners, or are under the age of 18. It also means that you should take this supplement if you’re already using an over-the-counter anti-inflammatory (such as Ibuprofen®) or a prescription NSAID (such as Arthrotec®) etc.
- Typical doses in studies are 240 mg of salicin per day
Grade: B (Good Scientific Evidence)
Avocado and Soybean Usaponifiables – ASU
Avocado and soybean unsaponifiables are derived from certain oils found in avocados and soybeans.
A fairly recent meta-analysis concluded that a three-month trial of avocado and soybean usaponifiables is recommended for patients with osteoarthritis (Christensen R et al, 2008).
- Dose: typical studies include 300-600 mg/d of ASU
Devil’s Claw Extract (harpagophytum procumbens)
Devil’s claw is a herb which is sold in dietary supplements in the form of devil’s claw extract. The plant itself is native to Africa. The extract has been studied primarily for decreasing osteoarthritis and lower back pain (Vlachojannis J et al, 2008).
Possibly safe rating for taken up to 1 year. Most common side effect is diarrhea.
- Dose: 2600 mg/d total taken in 3 divided doses. Total of 50-100mg of harpagoside (active ingredient) daily
Neither ultrasound therapy or TENS (transcutaneous electrical nerve stimulation) have been shown to offer much benefit. However, physical therapy combined with exercise can improving flexibility and strengthening the muscles surrounding joints.
S-adenosyl Methionine or SAMe
SAMe is a natural chemical found throughout the human body. It’s also made synthetically and sold as dietary supplements marketed towards those with depressive disorders and osteoarthritis. It has a long history of use in Italy dating back to 1979. (Najm WI et al 2004).
Cautions: avoid use by those with diagnosed bipolar disorder as it can possibly convert depression to mania (in those with bipolar disorder).
- Dose: 200 mg taken three times daily for a total daily dose of 600 mg/d
Green-lipped muscle (Perna canaliculus)
Green-lipped muscle or Perna Canaliculus is a shelfish of economic importance to New Zealand. As some point, it was discovered that people who consumed GLM suffered less arthritis than their inland relatives. However, as exciting as the research is on GLM, I’m not certain that these supplements contain anything of benefit outside of their high quantities of omega-3 fatty acids. Recently, researchers have speculated that furan fatty acids found in GLM may confer an anti-inflammatory effect (Wakimoto T et al 2011).
From Brien et al 2008 (pubmed):
“The data from the two more rigorous trials, in conjunction with our re-analysis of original data suggests that GLM may be superior to placebo for the treatment of mild to moderate OA. As a credible biological mechanism exists for this treatment, further rigorous investigations are required to assess efficacy and optimal dosage.”
- No established standardized doses exist for GLM.
Outside of common dietary supplements, there are a range of other natural or non medicinal alternatives including physiotherapy, weight reduction, exercise, and also tai chi. At least some evidence suggests that Tai Chi may be beneficial for providing some element of pain control for those who suffer from arthritis pain.
Also known as Marine Pine Bark extract, Pycnogenol® has been study for its effectiveness in treating conditions including not only arthritis, but also ADHD, Cancer, Glaucoma and others. The extracts of pinus pinaster have a long history of use dating back to Hippocrates. Part of their benefits are thought to be related to antioxidant activity.
- Typical doses of 150 mg/day have been shown to be effective at reducing pain and improving function in patients with arthritis.
Grade C (Unclear or Conflicting Scientific Evidence)
While boswellia serrata, also known as Indian Frankincense, has a long tradition in Ayurvedic medicine for treating arthritis, the current research supporting its use is not compelling. While there is a growing body of research published on boswellia serrata for the treatment of conditions including arthritis, this recent review (Christmas 2008 et al) notes the following shortcomings:
“The evidence evaluated here may be encouraging, but it is not convincing. Not enough large randomised clinical trials have been published for any condition. The medications used in these trials cannot be directly compared in terms of contents and strength. The pharmacokinetics and optimal dose of B serrata extracts are largely unknown; usually 600-3000 mg gum resin per day or equivalents are recommended for oral intake.Source of funding or sponsorship was undisclosed in all but one trial.”
“Many of the medical, quasimedical, or cosmetic claims made implicitly or explicitly for B serrata products are not supported by the available evidence. Their trade names speak for themselves: regeneration body balm, intensive eye serum, supernatural instant youth serum, lifting and firming body lotion, joie de vivre face lotion, radiance anti-ageing, joint and muscle balm, ultra inflammactin, to name a few.”
On positive note, the authors did mention that the safety profile of boswellia serrata appears to be quite good with no known serious drug interactions or irreversible adverse effects.
- Dosing is not well-established. Currently, most preparations are standardized to boswellic acid. Typical doses of 330 mg of boswellia serrata extract (standardized to 40% boswellic acid) taken 3 times per day.
Researchers from the United Kingdom (Brien et al, 2006) concluded that Bromelain is not effective as an adjuvant treatment for arthritis:
“This study suggests that bromelain is not efficacious as an adjunctive treatment of moderate to severe OA, but its limitations support the need for a follow-up study.”
- Typical doses are 800 mg of Bromelain taken daily.
This is one supplement, in particular, where my personal opinion of the evidence differs from published recommendations from Natural Standard. They recently concluded:
“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.”
In contrast, a meta-analysis published in the Archives of Internal Medicine offered this opinion (Reichenbach S et al, 2007):
“Large-scale, methodologically sound trials indicate that the symptomatic benefit of chondroitin is minimal or nonexistent. Use ofchondroitin in routine clinical practice should therefore be discouraged.”
A more recent meta-analysis offered this viewpoint:
“Overall, chondroitin sulfate at a dose of 800 mg orally once daily appears to have a significant but small effect of slowing the rate of joint space narrowing over a period of 2 years in patients with symptomatic radiographic knee OA. Hence, given the safety of chondroitin sulfate, it appears reasonable to administer chondroitin sulfate to patients with symptomatic radiographic knee OA for its possible structural benefit.”
Of note, the above meta-analysis relied on three studies–two of which were funded by the manufacturer of the chondroitin sulfate (CS) studied. Joint space narrowing is a feature of osteoarthritis which is seen on x-rays. While the meta-analysis of the above three studies found that taking CS for two years resulted in roughly a tenth of a millimeter less joint space narrowing, it did not show any benefit on pain or function.