Herbal Remedies, Supplements & Acupuncture for Arthritis

medication bottles

Fast Facts

  • The active ingredients of herbal remedies are similar to regular medications. There is no scientific proof that "natural" medications are gentler or safer than prescription or over-the-counter medications. Many herbal remedies/supplements can cause dangerous, and even fatal, side effects.
  • Herbal remedies are not checked by the Food and Drug Administration. Their ingredients are not monitored. The ingredients can be very different from product to product and may even contain small amounts of prescription medications or toxic metals.
  • There is no scientific proof that herbal remedies definitively work.
  • Most types of arthritis last for a long time. Arthritis may not be completely controlled by prescription or over-the-counter medications and herbal remedies/supplements may help with symptoms. However, because herbal remedies/supplements are not proven by scientific studies and are not regulated by a federal agency, the use of herbal remedies/supplements alone for treatment of arthritis is not recommended.
  • Acupuncture is safe and may provide pain relief for some patients with osteoarthritis.

Despite new and more effective treatments, many arthritis patients live with chronic pain and disability. Some people turn to herbal medicines and other "natural" remedies in the belief that they are effective and safer than conventional medications. Unfortunately, most information available to the public about these remedies in the media and on the internet is misleading. It is not based on the quality of scientific evidence required by the Food and Drug Administration (FDA) for approval of conventional medications. The purpose of this patient fact sheet is to provide you with objective, sound information so you can make informed decisions, and to enable you to discuss with your physician the benefits and risks of natural remedies.

The truth about “natural” remedies

What is a “natural” medicine and how does it differ from prescription and over-the counter (OTC) medications? Medicines are chemicals that change how the body functions, such as lowering blood pressure or blood sugar. These chemicals may produce beneficial or harmful effects. Prescription and OTC drugs are "cleaned up" chemicals whose ingredients, benefits, and possible side effects have been examined very closely.

Herbal medicines are chemicals taken from plants. The chemicals contain the herbal medication, but also includes many other chemicals whose actions are unknown. It is no more “natural” to swallow a mixture of plant chemicals than to swallow a single chemical: a drug is a drug. In fact, there is no scientific evidence for advertising claims that natural remedies are gentler and safer than conventional medications.

Placebo effects: How do we know if medicines are effective?

A placebo is a chemical that should have no effect on specific symptoms. Typically people will speak of a “sugar pill” which is another term for placebo. When a new drug is being studied, half the people in the trial take the drug and the other half of the people takes the placebo (which again should have no effect at all for their symptoms). The study then evaluates which people have improvement in their symptoms. In general, about 30 - 40% of the people taking the placebo report improvement in their symptoms. We think this is because the people trust their doctors and expect to improve after starting a new medication. Many medications were thought to be helpful until studied against a placebo and the results revealed the medications had no specific benefit.

What are the differences between “natural” and conventional (prescription and OTC) medicines?

Although natural and conventional medicines may work in similar ways, there are important differences between them.

  • Which is regulated? Prescription and OTC medications are monitored by the Food and Drug Administration (FDA), an agency of the United States government. Before prescription drugs are available to the public, the FDA requires the drugs be tested to make sure they are safe and will improve the symptoms/disease they are supposed to treat. Companies that make herbal drugs are not required to perform test/studies before selling them as "natural" products. They do not have to prove they are safe or good at treating what they are advertising. Until December 2007, they were not even required to maintain records of bad effects or require the companies to report the bad effects to the Food and Drug Administration.
  • What’s in the bottle? Prescription and OTC medications are purified chemicals. This means each medication is tested to make sure the dose is safe and that each pill contains the exact same dose of the medication. The herbal drugs are not required to meet this standard. Studies have shown that the ingredients of many herbal drugs do not match the ingredients listed on the labels. These plant chemicals can also contain many dangerous chemicals, including pesticides, lead, or mercury, which can have a bad effect on your body. Studies have shown that herbal products can contain cortisone-like hormones, diuretics, Viagra, aspirin, and/or tranquilizers. A number of “natural herbal” remedies for arthritis have been found to contain conventional arthritis medications, such as Indomethacin and prednisone.
  • Are herbal medicines safe? Although some people assume that herbal remedies used for centuries must be safe, we have learned in recent years that many traditional herbals have dangerous, and even deadly, side effects. For instance, herbal medicines called birthwort or snakewort, made from extracts of Aristolochia plants, have been used all over the world for more than 1,000 years. We now know that these plants contain aristolochic acids, chemicals that can cause kidney failure and cancer of the kidney. Yet herbal remedies that contain aristolochic acids can still be purchased in retail stores or on the Internet.
  • Do “natural” products work? Health benefits claimed for “natural” products are based mainly on tradition, and little or no scientific data. No health claims made for herbal drugs are based on the evidence required by the FDA for regulated medicines.

Herbal remedies for arthritis

Herbal remedies promoted for the treatment of arthritis include tumeric,ginger, Chinese Thunder God Vine, willow bark extract, feverfew, cat’s claw, and stinging nettle.

While there is some evidence that ginger and willow bark extract may relieve pain, these remedies contain chemicals that are similar to FDA-approved nonsteroidal anti-inflammatory compounds (NSAIDs) like naproxen (Aleve) and ibuprofen (Advil). NSAIDs in any form may cause problems of the stomach and intestines. They can also interfere with blood clotting and lead to fluid retention, causing problems for people with high blood pressure or heart failure.

Chinese Thunder God Vine also relieves pain and inflammation, but chronic use may cause weakening of the immune system and bones (osteoporosis).

Supplements for arthritis

Supplements are also marketed over the counter for treatment of rheumatologic symptoms. Patients should consider the best information available before taking these products.

S-adenosylmethionine (SAMe), a naturally occurring chemical in the body, has been used in Europe for some time as a prescription drug for depression as well as for relief of arthritis pain and inflammation. How it works in the body to relieve symptoms from arthritis remains unclear. When taken by mouth, SAMe is not well absorbed by the stomach to get the drug into the body. There are no large, well-controlled studies proving it works to help arthritis pain. Further, this very expensive supplement can cause upset stomach. Other side effects include reported extreme anxiety. Like other unregulated products, many commercial preparations of SAMe do not contain the quantity of drug indicated on the label.

Chondroitin sulfate and glucosamine sulfate supplements are promoted separately, or in combination, for patients with degenerative arthritis (osteoarthritis). Studies done by the companies making herbal drugs suggest that these products can relieve arthritis pain. A large study done by the National Institutes of Health found no benefit over the placebo group. A recent review by a government agency, the Agency for Healthcare Research and Quality, also concluded that there was no evidence that glucosamine, chondroitin, or injections of hyaluronic acid were beneficial for osteoarthritis.

Fish oils that contain omega-3 fatty acids have been reported to relieve pain and joint tenderness in patients with rheumatoid arthritis. The benefits are modest and may take several months to appear. Side effects may include gastrointestinal distress and a fishy odor to the breath. Those who consider fish oil supplements should be aware that some fish oil supplements may contain high levels of mercury or vitamin A, which could be toxic.

Acupuncture for arthritis

As developed in Asian countries over 2,000 years ago, acupuncture needles are inserted into the skin at specific points along meridians or channels. Selected groups of points are used to treat different diseases. In traditional Chinese medicine acupuncture is part of a comprehensive treatment plan that may also include herbal therapy, diet, and exercise, but it is increasingly used as a stand-alone treatment by Western health care providers.

There have been many studies of the use of acupuncture for relief of pain caused by osteoarthritis (degenerative arthritis) of the knee. Some early trials found that patients treated with acupuncture experienced less pain than patients who received only conventional treatment. However, in recent years traditional acupuncture has been compared to a variety of “sham” acupuncture controls. These sham procedure are like the placebo treatments discussed earlier. They included insertion of needles at non-acupuncture points, non-insertion of needles, and use of telescoping needles that appeared to be inserted into the skin. Sham and conventional acupuncture both provided significant relief of pain compared to no treatment. However, there was little or no difference between the benefit produced by conventional or sham acupuncture.

These studies suggest that the relief of pain resulted from placebo effects made by contact of the skin with needles, or their insertion at random points. The pain caused by osteoarthritis of the knee can be severe and may be incompletely relieved by conventional treatments. Acupuncture is considered to be a safe therapy and may be considered in addition to conventional treatment.

For more information

Many books, magazines, and websites provide information about using herbal medicines and other dietary supplements. Often the claims made by these publications are not proven by science and potentially bad side effects are not typically mentioned. Three recent books that provide more sound advice are listed below. The most reliable and accessible information is provided through health newsletters published by nonprofit consumer organizations and medical schools. Sources of more technical information are listed below.

The American College of Rheumatology has compiled this list to give you a starting point for your own additional research. The ACR does not endorse or maintain these websites, and is not responsible for any information or claims provided on them. It is always best to talk with your rheumatologist for more information and before making any decisions about your care.

Books

  • Hurley D. Natural Causes: Death, Lies, and Politics in America’s Vitamin and Herbal Supplement Industry. Broadway Books, NY, 2006.
  • Bausell, RB. Snake Oil Science: The Truth about Complementary and Alternative Medicine. Oxford University Press, New York, 2007.
  • Singh S, Ernst E. Trick or Treatment: Alternative Medicine on Trial. Bantam Press, London, 2008.
  • Offit, PA. Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine. HarperCollins, New York, 2013.

Websites

Updated May 2017 by Jennifer Murphy, MD and reviewed by the American College of Rheumatology Committee on Communications and Marketing.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

© 2017 American College of Rheumatology