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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, information available to the public about these remedies in the media and on the internet can be 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 rheumatology provider the benefits and risks of 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 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 minimal or no scientific evidence for advertising claims that natural remedies are gentler and safer than conventional medications.
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.
Although natural and conventional medicines may work in similar ways, there are important differences between them.
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 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 or chondroitin 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.
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.
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.
Updated December 2020 by Mohammad Ursani, 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.
Herbal Remedies, Supplements, & Acupuncture for Arthritis in Spanish