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What is the best supplement for joint pain and stiffness?

Glucosamine and chondroitin are two of the most commonly used supplements for arthritis. They're components of cartilage—the substance that cushions the joints.

arthritis.org - Vitamins and Supplements for Arthritis - Arthritis Foundation

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Several nutritional supplements have shown promise for relieving pain, stiffness and other arthritis symptoms. Glucosamine and chondroitin, omega-3 fatty acids, SAM-e and curcumin are just some of the natural products researchers have studied for osteoarthritis (OA) and rheumatoid arthritis (RA). Some of these natural remedies may offer arthritis symptom relief, especially when you use them in conjunction with traditional treatments. Here’s the evidence on some of the most popular supplements used to treat arthritis, and how they work.

Glucosamine and Chondroitin

Glucosamine and chondroitin are two of the most commonly used supplements for arthritis. They’re components of cartilage—the substance that cushions the joints. Research on these supplements has been mixed, in part because studies have used varying designs and supplement types. A large National Institutes of Health study called the GAIT trial compared glucosamine and chondroitin, alone or together, with an NSAID and inactive treatment (placebo) in people with knee osteoarthritis (OA). Glucosamine improved symptoms like pain and function, but not much better than a placebo. Yet a 2016 international trial found the combination to be as effective as the NSAID celecoxib at reducing pain, stiffness and swelling in knee OA. Studies have also differed on which form of the supplements is most effective. Some evidence suggests glucosamine sulfate is best. Others find glucosamine hydrochloride to be more effective. One study that compared the two forms head to head showed they offered equivalent pain relief. Mayo Clinic researchers say evidence supports trying glucosamine sulfate – not hydrochloride – with or without chondroitin sulfate for knee OA.

Fish oil

The polyunsaturated omega-3 fatty acids found in fish have potent anti-inflammatory properties. “Omega-3 fats seem to work better for rheumatoid arthritis than for osteoarthritis, most likely because rheumatoid arthritis is mainly driven by inflammation,” says Chris D’Adamo, PhD, director of Research & Education at the University of Maryland School of Medicine Center for Integrative Medicine. A 2017 systematic review of studies found that omega-3 supplements reduced joint pain, stiffness and swelling in RA. Taking these supplements might help some people cut down on their use of pain relievers -- and avoid their side effects. “For mild cases of arthritis, it may be better to reach for the supplements before you go for the ibuprofen,” says Farshad Fani Marvasti, MD, MPH, director of Public Health, Prevention, and Health Promotion at The University of Arizona. Omega-3s have the added benefit of protecting against heart disease and dementia, he says. Plant-based sources such as flax and chia seeds also contain omega-3s, but in the form of short-chain alpha-linolenic acid (ALA). “It’s the long-chain omega-3 fatty acids -- eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) -- that have the majority of the health benefits,” D’Adamo says. When you buy fish oil, make sure the supplement lists the EPA and DHA content, and that you take at least one gram each of EPA and DHA, he adds. Vegans can get these omega-3s from an algae-based supplement.

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SAM-e

S-adenosyl-methionine (SAM-e) is a natural compound in the body that has anti-inflammatory, cartilage-protecting and pain-relieving effects. In studies, it was about as good at relieving OA pain as NSAIDs like ibuprofen and celecoxib, without their side effects. SAM-e has a bonus benefit, too. “The supplement is most useful when you also have depression, because it has a mild to moderate antidepressant effect,” Marvasti says. The typical SAM-e dose is 1,200 mg daily. If you plan to try this supplement, be patient. “It’s going to take a few weeks to see the full effects,” D’Adamo says.

Curcumin

Curcumin is the active compound in the yellow-hued spice, turmeric, which is a staple of Indian curries. In the body, it acts as a powerful anti-inflammatory agent, blocking the same inflammation-promoting enzyme as the COX-2 inhibitor drug, celecoxib. In a study of 367 people with knee OA, a 1,500 mg daily dose of curcumin extract was as effective as 1,200 mg a day of ibuprofen, without the gastrointestinal side effects. This supplement also appears to relieve RA swelling and tenderness. One downside to curcumin is that it’s hard for the body to absorb. “You want to take it with a source of fat. Some of the supplements will be in an oil base, which is really important,” D’Adamo says. Black pepper also increases the absorption. Some supplements add the black pepper extract, piperine. However, piperine could potentially cause liver damage, and it can increase the absorption of medications like carbamazepine (Tegretol) and phenytoin (Dilantin), making them more potent.

Vitamins

Several vitamins have been studied for their effects on arthritis, including the antioxidant vitamins A, C, and E, and vitamins D and K. So far there’s no evidence that taking antioxidant vitamins improves arthritis symptoms, although eating a diet rich in these nutrients is healthy overall. Vitamins D and K are both important for bone strength, and vitamin K is involved in cartilage structure. Supplementing these two nutrients may be helpful if you’re deficient in them.

Supplement Risks

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When you take supplements as directed and under your doctor’s supervision, they’re generally safe. Yet even though they’re labeled “natural,” supplements can sometimes cause side effects or interact with the medicines you take. For example, high-dose fish oil supplements can thin the blood and may interact with anticoagulant medicines such as warfarin (Coumadin). Sometimes you can overdo it and take too much, especially when it comes to vitamins. Some vitamins -- like B and C -- are water soluble. That means if you take too much of them, your body will flush out the extra. Yet fat-soluble vitamins such as A, D, E and K can build up in your body to the point where they become harmful, so check with your doctor about safe amounts. Finally, supplements don’t go through the same rigorous approval process from the Food and Drug Administration (FDA) as medicines. The FDA has to review and approve every medication to make sure it works and that it’s safe. With supplements, the ingredients listed on the label may not be the same ones that are in the bottle.

How to Take Supplements Safely

If you do want to try supplements, use them as an add-on to arthritis drugs, not as a replacement. They should never take the place of medications, which are the only proven way to slow joint damage. Always check with your doctor before you try any new supplement to make sure that it’s right for you, and that you’re taking a safe dose. “I do recommend for the consumer who’s anticipating using a lot of supplements either to find an integrative physician who can help them or invest in a [subscription with an] independent testing company like Consumer Labs and check with their physician,” Marvasti advises. Also go through your entire supplement and medication list with your pharmacist to check for possible interactions.

arthritis.org - Vitamins and Supplements for Arthritis - Arthritis Foundation

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