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Treat discomfort with an ointment or cream containing 0.025 to 0.075% capsaicin four times a day over painful joints: make sure not to let capsaicin come in contact with the eyes.
Eat more fruits and vegetables and take 400 to 1,600 IU a day of vitamin E to put antioxidants to work protecting your joints.
Take 1,500 mg a day of glucosamine sulfate, 800 to 1,200 mg a day of chondroitin sulfate, or a combination of both supplements, for pain and to protect joints.
Start a gentle program of walking and strengthening exercise to reduce pain and improve joint function.
Achieve and maintain a healthy weight to reduce stress to joints and prevent osteoarthritis.
A gentle program of walking and strengthening exercise has been shown to benefit people with osteoarthritis—so get a jumpstart by staying active before problems start.
Osteoarthritis is a chronic disease of the joints, especially the weight-bearing joints that develops when the linings of joints degenerate, leading to lipping and spurring of bone, pain, and decreased mobility and function.
Osteoarthritis is a universal consequence of aging among animals with a bony skeleton. Many factors contribute to the development of osteoarthritis; the disease is primarily associated with aging and injury and was once called "wear-and-tear" arthritis. Osteoarthritis may occur secondary to many other conditions. However, in most cases, the true cause of osteoarthritis is unknown.
The onset of osteoarthritis is gradual and most often affects the hips, knees, fingers, and spine, although other joints also may be involved. Pain is the main symptom, which usually worsens with exercise and is relieved by rest. Morning stiffness is also common and diminishes with movement. As osteoarthritis progresses, joint motion is lost, and tenderness and grating sensations may develop. Osteoarthritis of the spine may lead to shooting pains down the arms or legs.
Obesity increases the risk of osteoarthritis developing in weight-bearing joints, and weight loss in women is associated with reduced risk for developing osteoarthritis.1, 2 Weight loss is also thought to reduce the pain of existing osteoarthritis.3
Several clinical trials have examined the efficacy of acupuncture for osteoarthritis, with mixed results. Some trials found acupuncture treatment to be no more effective than either placebo4 or sham acupuncture5 at relieving osteoarthritis pain. Other trials have demonstrated a significant effect of acupuncture on the relief of osteoarthritis pain compared to placebo.6, 7 A well-designed trial found that acupuncture treatments (twice weekly for eight weeks) significantly improved pain and disability in people with osteoarthritis of the knee compared to no treatment.8 When the group receiving no treatment was switched to acupuncture treatments, they experienced similar improvements.
In a controlled trial, a combination of manual physical therapy (by a qualified physical therapist) and supervised exercise significantly improved walking distance and pain in a group of people with osteoarthritis of the knee.9 The therapeutic regimen consisted of manual therapy to the knee, low back, hip, and ankle as necessary, as well as a standardized knee-exercise program performed at home and in the clinic. The treatments were given twice weekly at the clinic for four weeks.
In the 1950s through the 1970s, Dr. Max Warmbrand used a diet free of meat, poultry, dairy, chemicals, sugar, eggs, and processed foods for people with rheumatoid arthritis and OA, anecdotally claiming significant success. He reported that clinical results took at least six months to develop. The Warmbrand diet has never been properly tested in clinical research. Moreover, although the diet is healthful and might reduce the risk of being diagnosed with many other diseases, it is difficult for most people to follow. This difficulty, plus the lack of published research, leads many doctors who are aware of the Warmbrand diet to use it only if other approaches have failed.
Solanine is a substance found in nightshade plants, including tomatoes, white potatoes, all peppers (except black pepper), and eggplant. In theory, if not destroyed in the intestine, solanine may be toxic. One horticulturist hypothesized that some people might not be able to destroy solanine in the gut, leading to solanine absorption and resulting in OA. This theory has not been proven. However, eliminating solanine from the diet has been reported to bring relief to some arthritis sufferers in preliminary research. In a survey of people avoiding nightshade plants, 28% claimed to have a "marked positive response" and another 44% a "positive response." Researchers have never put this diet to a strict clinical test; however, the treatment continues to be used by some doctors with patients who have OA. As with the Warmbrand diet, proponents claim exclusion of solanine requires up to six months before potential effects may be seen. Totally eliminating tomatoes and peppers requires complex dietary changes for most people. In addition, even proponents of the diet acknowledge that many arthritis sufferers are not helped by using this approach. Therefore, long-term trial avoidance of solanine-containing foods may be appropriate only for people with OA who have not responded to other natural treatments.
Most of the studies linking allergies to joint disease have focused on rheumatoid arthritis, although mention of what was called "rheumatism" in older reports (some of which may have been OA) suggests a possible link between food reactions and aggravations of OA symptoms. If other therapies are unsuccessful in relieving symptoms, people with OA might choose to discuss food allergy identification and elimination with a physician.
Our proprietary "Star-Rating" system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by some in the medical community, and whether studies have found them to be effective for other people.
For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.
3 StarsReliable and relatively consistent scientific data showing a substantial health benefit.
2 StarsContradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1 StarFor an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.
Boswellia has anti-inflammatory properties that have been compared to those of the NSAIDs used by many for inflammatory conditions. Clinical trials have found that boswellia is more effective than a placebo for relieving pain and swelling and preventing loss of function in people with osteoarthritis. Boswellia has also been found to be as effective as the anti-inflammatory drug valdecoxib (Bextra). In addition, while the improvements occurred more slowly in the boswellia group than in the valdecoxib group, they persisted for a longer period of time after treatment was discontinued. One clinical trial found that a combination of boswellia, ashwagandha, turmeric, and zinc effectively treated pain and stiffness associated with OA but did not improve joint health, according to X-rays of the affected joint. Unlike NSAIDs, long-term use of boswellia does not lead to irritation or ulceration of the stomach.
Chondroitin sulfate (CS) is a major component of the lining of joints. The structure of CS includes molecules related to glucosamine sulfate. CS levels have been reported to be reduced in joint cartilage affected by osteoarthritis. Possibly as a result, CS supplementation may help restore joint function in people with osteoarthritis. On the basis of preliminary evidence, researchers had believed that oral CS was not absorbed in humans; as a result, early double-blind CS research was done mostly by giving injections. This research documented clinical benefits from CS injections. It now appears, however, that a significant amount of CS is absorbable in humans, though dissolving CS in water leads to better absorption than swallowing whole pills.
Strong clinical evidence now supports the use of oral CS supplements for osteoarthritis. Many double-blind trials have shown that CS supplementation consistently reduces pain, increases joint mobility, and/or shows evidence (including X-ray changes) of healing within joints of people with osteoarthritis. Most trials have used 400 mg of CS taken two to three times per day. One trial found that taking the full daily amount (1,200 mg) at one time was as effective as taking 400 mg three times per day. Reduction in symptoms typically occurs within several months.
SAMe (S-adenosyl methionine) possesses anti-inflammatory, pain-relieving, and tissue-healing properties that may help protect the health of joints, though the primary way in which SAMe reduces osteoarthritis symptoms is not known. A very large, though uncontrolled, trial (meaning that there was no comparison with placebo) demonstrated "very good" or "good" clinical effect of SAMe in 71% of over 20,000 osteoarthritis sufferers. In addition to this preliminary research, many double-blind trials have shown that SAMe reduces pain, stiffness, and swelling better than placebo and equal to drugs such as ibuprofen and naproxen in people with osteoarthritis. These double-blind trials all used 1,200 mg of SAMe per day.
Lower amounts of oral SAMe have also produced reductions in the severity of osteoarthritis symptoms in preliminary clinical trials. A two-year, uncontrolled trial showed significant improvement of symptoms after two weeks at 600 mg SAMe daily, followed by 400 mg daily thereafter. This amount was also used in a double-blind trial, but participants first received five days of intravenous SAMe. A review of the clinical trials on SAMe concluded that its efficacy against osteoarthritis was similar to that of conventional drugs but that patients tolerated it better.
In the 1940s and 1950s, one doctor reported that supplemental niacinamide (a form of vitamin B3) increased joint mobility, improved muscle strength, and decreased fatigue in people with osteoarthritis. In the 1990s, a double-blind trial confirmed a reduction in symptoms from niacinamide within 12 weeks of beginning supplementation. Although amounts used have varied from trial to trial, many doctors recommend 250 to 500 mg of niacinamide four or more times per day (with the higher amounts reserved for people with more advanced arthritis). The mechanism by which niacinamide reduces symptoms is not known.
An extract of avocado and soybean oils, known as avocado/soybean unsaponifiables (ASU), was found in a double-blind trial to reduce joint pain and improve overall functioning in people with osteoarthritis of the knee or hip. The amount used was 300 mg per day for six months. In a three-month double-blind trial, 71% of people taking ASU, but only 36% of those taking a placebo, were able to decrease their pain medicine or anti-inflammatory medicine by more than 50%. In a longer-term double-blind trial (two years), ASU treatment did not improve symptoms when compared with a placebo, and did not slow the progression of osteoarthritis (as determined by the amount of joint cartilage lost). However, in the subgroup of patients with the most severe disease, ASU treatment did significantly decrease the loss of joint cartilage. ASU is believed to work by reducing inflammation and by aiding in the repair of damaged cartilage tissue. ASU is approved as a prescription drug in France and is available over the counter in some other countries.
In a double-blind study, collagen hydrolysate was compared with gelatin and egg protein as a treatment for osteoarthritis of the hip and/or knee. When subjects took 10 grams per day either of gelatin or collagen hydrolysate for two months, they reported significantly more pain relief than when they took a similar amount of egg protein. More research is needed to confirm the benefits of gelatin or collagen hydrolysate in osteoarthritis. In a double-blind trial, individuals with osteoarthritis of the knee received 40 mg per day of a particular type of collagen known as undenatured type II collagen (derived from chickens) or placebo for six months. Compared with the placebo, undenatured type II collagen significantly improved pain, stiffness, and overall functioning.
Cetyl myristoleate (CMO) has been proposed to act as a joint "lubricant" and anti-inflammatory agent. In a double-blind trial, people with various types of arthritis who had failed to respond to nonsteroidal anti-inflammatory drugs (NSAIDs) received CMO (540 mg per day orally for 30 days), while others received a placebo. These people also applied CMO or placebo topically, according to their perceived need. A statistically significant 63.5% of those using CMO improved, compared with only 14.5% of those using placebo.
Devil's claw extract was found in one clinical trial to reduce pain associated with osteoarthritis as effectively as the slow-acting analgesic/cartilage-protective drug diacerhein. The amount of devil's claw used in the trial was 2,610 mg per day. The results of this trial are somewhat suspect, however, as both devil's claw and diacerhein are slow-acting and there was no placebo group included for comparison.
In a double-blind study, a group of people with painful osteoarthritis of the knee received an oral enzyme-flavonoid preparation or a nonsteroidal anti-inflammatory (NSAID) for six weeks. While both treatments relieved pain and improved joint function, the enzyme-flavonoid product appeared to be slightly more effective than the NSAID. No serious side effects were seen. The enzyme-flavonoid product used in this study was Phlogenzym (Mucos Pharma, Geretsried, Germany). Each enteric-coated tablet contained 90 mg of bromelain, 48 mg of trypsin, and 100 mg of rutosid (a derivative of the flavonoid rutin); one tablet was given three times a day.
The effects of New Zealand green-lipped mussel supplements have been studied in people with osteoarthritis. In a preliminary trial, either a lipid extract (210 mg per day) or a freeze-dried powder (1,150 mg per day) of green-lipped mussel reduced joint tenderness and morning stiffness, as well as improving overall function in most participants. In a double-blind trial, 45% of people with osteoarthritis who took a green-lipped mussel extract (350 mg three times per day for three months) reportedly had improvements in pain and stiffness. Another double-blind trial reported excellent results from green-lipped mussel extract (2,100 mg per day for six months) for pain associated with arthritis of the knee. Side effects, such as stomach upset, gout, skin rashes, and one case of hepatitis have been reported in people taking certain New Zealand green-lipped mussel extracts.
In a double-blind trial, 100 mg per day of Pycnogenol reduced pain and other osteoarthritis symptoms, improved walking performance, and reduced the use of pain-relieving medication. Another double blind trial found that 150 mg per day also improved symptoms and reduced use of pain-relieving medication.
People who have osteoarthritis and eat large amounts of antioxidants in food have been reported to exhibit a much slower rate of joint deterioration, particularly in the knees, compared with people eating foods containing lower amounts of antioxidants. Of the individual antioxidants, only vitamin E has been studied as a supplement in controlled trials. Vitamin E supplementation has reduced symptoms of osteoarthritis in both single-blind and double-blind research. In these trials, 400 to 1,600 IU of vitamin E per day was used. Clinical effects were obtained within several weeks. However, in a six-month double-blind study of patients with osteoarthritis of the knee, 500 IU per day of vitamin E was no more effective than a placebo.
Boron affects calcium metabolism, and a link between boron deficiency and arthritis has been suggested. Although people with osteoarthritis have been reported to have lower stores of boron in their bones than people without the disease, other minerals also are deficient in the bones of people with osteoarthritis. One double-blind trial found that 6 mg of boron per day, taken for two months, relieved symptoms of osteoarthritis in five of ten people, compared with improvement in only one of the ten people assigned to placebo.This promising finding needs confirmation from larger trials.
Several trials have suggested that people with osteoarthritis may benefit from supplementation with bovine cartilage, which contains a mixture of protein and molecules related to chondroitin sulfate. In one preliminary trial, use of injected and topical bovine cartilage led to symptom relief in most people studied. A ten-year study confirmed improvement with long-term use of bovine cartilage. Optimal intake of bovine cartilage is not known.
The omega-3 fatty acids present in fish oil, EPA and DHA, have anti-inflammatory effects and have been studied primarily for rheumatoid arthritis, which involves significant inflammation. However, osteoarthritis also includes some inflammation. In a 24-week controlled but preliminary trial studying people with osteoarthritis, people taking EPA had "strikingly lower" pain scores than people who took placebo. However, in a double-blind trial by the same research group, supplementation with 10 ml of cod liver oil per day was no more effective than a placebo.
Horsetail is rich in silicon, a trace mineral that plays a role in making and maintaining connective tissue. Practitioners of traditional herbal medicine believe that the anti-arthritis action of horsetail is due largely to its silicon content. The efficacy of this herb for osteoarthritis has not yet been evaluated in controlled clinical trials.
Hyaluronic acid is a normal component of joint fluid, but its amount and molecular structure are altered in osteoarthritic joints. Injection of hyaluronic acid compounds into osteoarthritic joints, primarily the knee, has been investigated in many double-blind trials with some improvement demonstrated. However, no research has been done to determine whether oral supplementation with hyaluronic acid is an effective treatment for osteoarthritis.
Supplementation with D-phenylalanine (DPA), a synthetic variation of the amino acid, L-phenylalanine (LPA), has reduced chronic pain due to osteoarthritis in a preliminary trial. In that study, participants took 250 mg three to four times per day, with pain relief beginning in four to five weeks. Other preliminary trials have confirmed the effect of DPA in chronic pain control, but a double-blind trial found no benefit. DPA inhibits the enzyme that breaks down some of the body's natural painkillers, substances called enkephalins, which are similar to endorphins. An increase in the amount of enkephalins may explain the reported pain-relieving effect of DPA. If DPA is not available, a related product, D,L-phenylalanine (DLPA), may be substituted (1,500 to 2,000 mg per day). Phenylalanine should be taken between meals, because protein found in food may compete for uptake of phenylalanine into the brain, potentially reducing its effect.
According to arthritis research, saponins found in the herb yucca appear to block the release of toxins from the intestines that inhibit normal formation of cartilage. A preliminary, double-blind trial found that yucca might reduce symptoms of osteoarthritis. Only limited evidence currently supports the use of yucca for people with osteoarthritis.
1. Felson DT, Zhang Y, Anthony JM, et al. Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study. Ann Intern Med 1992;116:535-9.
2. Felson DT, Zhang Y, HanNan MT, et al. Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham Study. Arthritis Rheum 1997;40:728-33.
3. Altman RD, Lozada CJ. Practice guidelines in the management of osteoarthritis. Osteoarthritis Cartilage 1998;6(Suppl A):22-4 [review].
4. Gaw AC, Chang LW, Shaw L-C. Efficacy of acupuncture on osteoarthritic pain. A controlled, double-blind study. N Engl J Med 1975;293:375-8.
5. Takeda W, Wessel J. Acupuncture for the treatment of pain of osteoarthritic knees. Arthritis Care Res 1994;7:118-22.
6. Thomas M, Eriksson SV, Lundeberg T. A comparative study of diazepam and acupuncture in patients with osteoarthritis pain: a placebo controlled study. Am J Chin Med 1991;19:95-100.
7. Christensen BV, Iuhl IU, Vilbek H, et al. Acupuncture treatment of severe knee osteoarthrosis. A long-term study. Acta Anaesthesiol Scand 1992;36:519-25.
8. Berman BM, Singh BB, Lao L, et al. A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee. Rheumatology (Oxford) 1999;38:346-54.
9. Deyle GD, Henderson NE, Matekel RL, et al. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med 2000;132:173-81.
Last Review: 06-08-2015
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