Alternatives and Supplements for Arthritis Joint Pain The right supplements can help control joint pain. By Jeanie Lerche Davis WebMD Feature Reviewed by Michael W. Smith, MD

Like many people with arthritis joint pain, you may have considered taking vitamins and supplements that promise to ease joint pain. And it's true -- the right ones could offer greater control of osteoarthritis (OA) joint pain. The problem is -- too many products advertised for arthritis don't measure up. In fact, it's important to steer clear of some supplements advertised as arthritis cures -- as they can actually be harmful. Here's what you should ask: Is there any science backing the claim? Is this a "secret formula" that has not been shared with scientific peers? Is this product made by a large company with strict quality controls? Can I purchase this product from a large pharmacy or health food chain? Is there a USP (United States Pharmacopoeia) notation on the product signifying a high standard? Arthritis Advice For advice on arthritis joint pain -- and supplements that can help -- WebMD turned to Sharon Plank, MD, an integrative medicine physician with the University of Pittsburgh Medical School Center for Integrative Medicine. Plank trained under Andrew Weil, MD, a pioneer in integrative medicine at the University of Arizona. "You've got to take a whole-body approach to treating arthritis pain," Plank tells WebMD. "Lifestyle is huge. It's important to start by losing weight if you're obese. Regular exercise will help strengthen muscles that support joints and keep joints flexible. The anti-inflammatory diet is also extremely important -- those wonderful omega-3 fatty acids." Medications can help ease arthritis joint pain, and "for some people, supplements provide that extra relief that drugs can't," she says. "There is certainly a place for supplements." However, always discuss these supplements with your doctor before taking them, as there can be drug interactions, allergy problems, or harmful side effects, she cautions. Plank recommends:        

Chondroitin sulfate Glucosamine sulfate Calcium Vitamin D3 Ginger Turmeric Omega-3 Green tea

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SAMe MSM Stinging nettle Bromelain Vitamin E Devil's claw

More good options:

It’s important to note, however, that supplements can have side effects, and some may interfere with medications. It’s critical to discuss any supplements with your doctor to learn whether they are safe for you, and the correct dose for you. Glucosamine/Chondroitin for Joint Pain Glucosamine is found naturally in the body's joint cartilage -- helping keep it healthy and lubricated. The shells of shrimp, lobster, and crab provide the basis for supplements. Glucosamine is believed to help slow deterioration of cartilage, relieve arthritis joint pain, and improve joint mobility. Chondroitin is also found naturally in cartilage and bone. Chrondroitin sulfate supplements are derived from cow trachea or pork by-products. Chondroitin is said to reduce joint pain and inflammation, improve joint function, and slow progression of osteoarthritis. Most studies have been done on knee arthritis. Chondroitin is believed to enhance the shock-absorbing properties of collagen and block enzymes that break down cartilage. Like glucosamine, this supplement is thought to help cartilage retain water, keep joints lubricated, and possibly reverse cartilage loss. The research on these supplements is mixed. In a 2005 review of glucosamine, 20 studies involving 2,570 patients were analyzed -- showing glucosamine to be safe, but not better than a placebo in reducing pain and stiffness and improving function. However, a World Health Organization review of evidence on glucosamine found that it relieves arthritis-related knee pain and improves joint function. In 2006, the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), funded by the National Institutes of Health, found the two supplements were more effective when combined. However, only people with moderate or severe pain from knee arthritis reported significant benefit. They got better pain relief than from an anti-inflammatory painkiller. In September 2008, a follow-up GAIT study compared people who took the supplements or medication for an additional 18 months. All those patients had moderate to severe osteoarthritis knee pain. After two years, there was no significant difference between the treatment and placebo groups. There was a slight trend toward improvement among those with milder osteoarthritis of the knee who were taking glucosamine alone -- but not enough to draw definite conclusions, according to the lead researcher. Robert Bonakdar, MD, director of pain management at Scripps Center for Integrative Medicine, takes issue with the NIH study, calling it "very flawed." The biggest problem, he tells WebMD, is that the study tested a relatively ineffective form of glucosamine. Glucosamine hydrochloride is more readily available over-the-counter in the U.S., but glucosamine sulfate works better at relieving pain, says Bonakdar. "All the European studies of glucosamine sulfate have shown it to be more effective than glucosamine hydrochloride," he tells WebMD. "The theory is that glucosamine sulfate is better absorbed, possibly because it is closer to the body's natural glucosamine." He advises his patients to take glucosamine sulfate. He also advises taking glucosamine sulfate alone -- rather than with chondroitin -- because the two seem to work against each other, Bonakdar explains. "Chondroitin seems to prevent glucosamine from being absorbed." Bottom line: Should you take glucosamine or chondroitin -- or not? "With glucosamine and chondroitin sulfate, you're trying to repair cartilage," Plank explains. "But cartilage isn't always the issue, not always the reason for arthritis joint pain. These supplements are safe enough to try. Just give it two or three months -- you have to give it a chance. It's an option, and people who get relief swear by it."

Calcium for Joint Health Because we're talking about bones, we must discuss calcium, Plank tells WebMD. "It's not just because calcium builds bones. It's because every time your heart pumps or a muscle contracts, your body has to use calcium. You have to have adequate calcium on board." When your body is short on calcium, it takes calcium from bones. By getting enough calcium in your diet -and in supplements -- you ensure adequate calcium in your blood and in bones. Most people need 1,000 to 1,200 milligrams of calcium a day, and can easily get that calcium from dairy foods (303 milligrams in 1 cup of skim milk), fortified juices and foods, and from supplements. Vitamin D3 for Healthy Bones Vitamin D has long been known to promote healthy bones by helping them absorb calcium. You'll find it easily in many foods, like fortified milk and orange juice. The body also produces a critical form of vitamin D - vitamin D3 -- when the skin is exposed to sunlight, Plank explains. Vitamin D3 is now available in supplement form. One study in Australia showed that when women took vitamin D3 and calcium during winter months (when they had less sun exposure) they had less bone loss. One research group in the U.K. reviewed nine studies of vitamin D3; it reported that people with osteoporosis who took the supplement had an increase in bone density compared to those taking placebo. "People are looking more closely at vitamin D3 these days," Plank says. "Your body needs vitamin D3 for immunity. If you don't have enough vitamin D3, your body is not going to absorb calcium -- which it needs for function of bones and joints." Ginger for Joint Pain and Inflammation Ginger has been used in Chinese, Japanese, and Indian medicine for hundreds of years. The roots and stems are the basis for powders, extracts, tinctures, capsules, and oils. The claims are that ginger decreases arthritis joint pain and inflammation. There is little scientific evidence to support ginger for arthritis, but a 2008 study in the British journal Food and Chemical Toxicology showed that ginger acts as an anti-inflammatory, among many other positive qualities. At least two additional studies have found similar effects in ginger extract. People on blood thinners or undergoing surgery should use caution when taking ginger as one study suggested it may increase the risk of bleeding. Turmeric for Joint Pain and Stiffness The turmeric plant grows in India and Indonesia, and its roots (when ground) serve as the basis for curry seasoning. The active ingredient in turmeric is curcumin; it is used in traditional Chinese medicine and Indian Ayurvedic medicine to treat arthritis. The claims are that turmeric reduces arthritis joint pain, inflammation, and stiffness related to arthritis. Turmeric is also known as a digestive aid. Several studies have shown that turmeric works as an anti-inflammatory and that it modifies the immune system. In a 2006 study, turmeric was more effective at preventing arthritis joint inflammation rather than reducing inflammation. But studies in humans are lacking, so the benefit of turmeric on arthritis is unclear. People on blood thinners should use caution when taking turmeric as animal studies indicate it may increase the risk of bleeding. It may also cause stomachache. Omega-3 (Fish Oil) for Joint Health Omega-3 fatty acids are found in walnuts, canola and soybean oils, and coldwater fish like salmon and tuna. Fish oil supplements are also a good source of omega-3s -- a fat that plays a vital role in maintaining healthy cells throughout the body, including the joints. They encourage the production of chemicals that help control inflammation in the joints, bloodstream, and the tissues. Due to its anti-inflammatory properties, a fair amount of research has been done looking at the effects of omega-3s on rheumatoid arthritis, an inflammatory type of arthritis. Multiple studies have reported

improvements in morning stiffness and joint tenderness with the regular intake of fish oil supplements for up to three months. Fish oil supplements are derived from real fish -- so mercury content is an issue. Make sure you purchase brands that have been tested for mercury. Also, make sure fish oil supplements contain both DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid). Experts suggest you take 1 to 3 grams a day, but no more than 3 grams a day of fish oil. Green Tea: Can It Help Joints? The phytochemicals in green tea have been shown to reduce heart disease risk -- mostly in laboratory and rat studies. Can green tea also help relieve arthritis-related inflammation and cartilage breakdown? Some early research indicates that it does. Further studies are needed, experts say. In the meantime, there's no harm -- and possibly great health value -- in sipping a cup of green tea daily. Bromelain: A Natural Anti-inflammatory The enzyme bromelain, found in the pineapple plant, helps digest proteins when taken with food. When taken on an empty stomach, bromelain acts as an anti-inflammatory agent -- decreasing arthritis joint pain and swelling, and increasing mobility. Indeed, there is some early evidence that bromelain can relieve pain and reduce inflammation. One study showed a combination of enzymes including bromelain may be an effective and safe alternative to antiinflammatory drugs for people with knee osteoarthritis. Before you take bromelain, however, check your allergies. Allergic reactions may occur in people allergic to pineapples, latex, honeybees, and birch, cypress, and grass pollens. Devil's Claw: Herbal Relief This herb is a traditional South African medicine used to relieve joint pain and inflammation, back pain, and headache. Although more research is needed, there is scientific evidence that devil’s claw can help reduce osteoarthritis joint pain and may work as well as anti-inflammatory drugs, such as ibuprofen or naproxen. In one study, 227 people with low back pain -- or knee or hip osteoarthritis -- were treated with devil's claw extract. After eight weeks of taking 60 milligrams daily, from 50% to 70% reported improvements in joint pain, mobility, and flexibility. Devil’s claw can affect the heart, so anyone with a heart problem, including abnormal heart rhythm, should not take devil’s claw. For others, studies indicate it is safe when taken short term -- for three to four months -but long-term safety isn’t known. SAMe (S-adenosyl-L-methionine) to Reduce Inflammation and Pain SAMe is a naturally occurring chemical in the body -- and is said to improve mobility, rebuild cartilage, and ease symptoms of osteoarthritis, fibromyalgia, bursitis, tendonitis, chronic low back pain, and depression. In fact, SAMe is effective in reducing osteoarthritis-related inflammation and joint pain. SAMe acts quickly, with results in one week's time. "SAMe is expensive," says Plank, "but it works with cartilage and may help build joints back up." The Journal of Family Practice reviewed 11 studies on SAMe, showing it to be as effective as antiinflammatory painkillers in reducing pain and improving function in people with OA. SAMe was also less likely to cause side effects. To get the maximum benefit from SAMe, make sure you're getting enough B vitamins (B12, B6, folate) as well. MSM (Methylsulfonylmethane): Limited Research The sulfur compound MSM is found naturally in the body and in animals, fruits, vegetables, and grains. The claim is that MSM reduces joint pain and inflammation. MSM contains sulfur, which the body needs to form connective tissue. MSM also seems to act as a painkiller by quieting nerve impulses that transmit pain.

One 2006 study of 50 adults with osteoarthritis of the knee showed that 6,000 milligrams of MSM daily reduced pain and improved physical function -- without major side effects. However, no large studies comparing MSM to placebo have been performed, and more research is needed to determine the true effect of MSM on osteoarthritis. Stinging Nettle: Folk Remedy for Arthritis Symptoms Stinging nettle is a stalk-like plant found in Europe and North America; it is widely used as a folk remedy to treat arthritis symptoms throughout Europe and Australia. The leaves and stems are processed into tea, capsules, tablets, tinctures, and extracts -- and are also found in whole-leaf form. The claim is that stinging nettle reduces inflammation, aches, and joint pains of arthritis. Preliminary evidence suggests that certain compounds in the nettle plant help reduce inflammation and modifies the immune system. A German study of hox alpha (a new stinging nettle extract) identified a substance that worked as an antiinflammatory in joint diseases. A Turkish study showed stinging nettle's painkilling, anti-microbial, and antiulcer activities. However, evidence supporting the use of stinging nettle for arthritis is unclear and conflicting. More research is needed to determine its true effectiveness. Lifestyle Solutions for Arthritis Joint Pain Supplements can't solve the whole problem of arthritis joint pain. Some people have a genetic predisposition to developing joint cartilage problems. However, lifestyle factors make the risk worse for them -- and for everyone. Obesity and athletic injuries are the top two reasons people develop knee and hip arthritis. A variety of treatments help relieve joint pain -- medications, removing joint fluid, crutches and canes, even surgery. Getting your weight under control -- and getting the right kind of exercise -- are also key. Lose weight: Obesity increases the stress on your joints -- on your entire body -- which decreases circulation in the body, Plank explains. "That cuts off blood supply to all the organs." When you lose weight, you increase circulation plus take the stress off the painful joint -- all of which eases pain. Exercise: Exercise helps you shed pounds. It also improves joint flexibility. Plus, exercise helps maintain strength in muscles and tissues supporting the joint, Plank says. "Physical therapy, massage, water aerobics, gentle yoga, tai chi are good -- anything to make the tissue surrounding the inflamed joint strong enough to support it." Eat smart: The anti-inflammatory diet is also key, she adds. "When you eat processed foods -- the packaged stuff off grocery store shelves -- your body gets trans fats. It doesn't understand what that is. It can't use those fats to repair anything, which starts the inflammatory process." Here's what you need: Whole grains, organic fruits and vegetables, and omega fatty acids (omega-3, omega6, omega-9). Good sources of healthy fats include:   

Omega-3s: Flaxseed oil, canola oil, fatty fish (salmon, tuna), walnuts. Omega-6s: Pine nuts, sunflower seeds, pistachios. Omega-9s: Extra-virgin olive oil, avocados, peanuts, almonds.

With a whole-body approach to treating arthritis joint pain, you can find relief, says Plank.