Rheumatoid arthritis (RA) is a chronic inflammatory condition; it is an autoimmune disease, in which the immune system attacks the joints and sometimes other parts of the body.

Strict vegetarian diets that were very low in fat have also been found to be helpful.^{6 7} In the 1950s through the 1970s, Max Warmbrand, a naturopathic doctor, used a very low-fat diet for individuals with both rheumatoid arthritis and osteoarthritis. He recommended a diet free of meat, dairy, chemicals, sugar, eggs, and processed foods.⁸ Dr. Warmbrand claimed that his diet took at least six months to achieve noticeable results; a short-term (ten weeks) study with a similar approach failed to produce beneficial effects.⁹ In one trial, 14 weeks of a gluten-free (no wheat, rye, or barley), pure vegetarian diet, gradually changed to a lactovegetarian diet (permitting dairy), led to significant improvement in symptoms and objective laboratory measures of disease.¹⁰

Fasting has been shown to improve the symptoms and signs of rheumatoid arthritis, but most people relapsed after the reintroduction of an omnivorous diet.^{11 12} However, when fasting was followed by a 12-month vegetarian diet, the benefits of fasting appeared to persist.^{13 14} It is not known why the combination of these dietary programs might be helpful, and the clinical trial that investigated this combination¹⁵ has been criticized for its design and interpretation.^{16 17 18}

Rheumatoid arthritis may be linked to food allergies and sensitivities.¹⁹ In many people, RA is made worse when they eat foods to which they are allergic or sensitive, and made better by avoiding these foods.^{20 21 22 23} English researchers suggest that one-third of people with RA can control the disease completely through allergy elimination.²⁴ Finding and eliminating foods that trigger symptoms should be done with the help of a physician.

Lifestyle changes that may be helpful: Although exercise may increase pain initially, gentle exercises help people with RA.^{25 26} Many doctors recommend swimming, stretching, or walking.

Nutritional supplements and other natural therapies that may be helpful: The concentration of vitamin E has been found to be low in the joint fluid of individuals with rheumatoid arthritis.²⁷ This reduction in vitamin E levels is believed to be caused by utilization of the vitamin during the inflammatory process. In a double-blind study, approximately 1,800 IU per day of vitamin E was found to have a beneficial effect in people with RA.²⁸ Two other double-blind studies using similar high levels of vitamin E reported that vitamin E appeared to have approximately the same effectiveness as anti-inflammatory drugs used to treat RA.^{29 30} In other double-blind studies, 600 IU of vitamin E taken twice per day was significantly more effective than a placebo at reducing pain in people with RA, although laboratory measures of inflammation remain unchanged.^{31 32}

Research suggests that people with RA may be partially deficient in pantothenic acid (vitamin B5).³³ In one placebo-controlled trial, those with RA had less morning stiffness, disability, and pain when they took 2,000 mg of pantothenic acid per day.³⁴ Many doctors suggest pantothenic acid (sometimes in lower amounts such as 1,000 mg) for people with RA.

Zinc metabolism is altered in RA. Some studies have found zinc helpful,³⁵ whereas others have not.^{36 37} It has been suggested that zinc might help only those who are deficient.³⁸ Although there is no universally accepted test for zinc deficiency, some doctors check white blood cell zinc levels.

A low level of selenium in the blood may be a factor in the development of RA. A study of 87 patients with rheumatoid arthritis found that those with the disease had lower selenium levels than healthy individuals.³⁹ In a small double-blind trial, women with RA were given 200 mcg of selenium per day or a placebo for three months. 75% of those taking the selenium experienced a significant reduction in pain and joint inflammation, whereas there was no significant improvement in the placebo group.⁴⁰ However, an earlier double-blind study found no beneficial effect of selenium in people with rheumatoid arthritis.⁴¹ More controlled trials are required to confirm the efficacy of selenium for people with RA.

The relationship of copper to RA is complex. Copper acts as an anti-inflammatory agent, because it is needed to activate superoxide dismutase, an enzyme that protects joints from inflammation. People with RA tend toward copper deficiency⁴² and copper supplementation has been shown to increase SOD levels in humans.⁴³ The Journal of the American Medical Association quoted one researcher as saying that while "Regular aspirin had 6% the anti-inflammatory activity of [cortisone]. . . copper [added to aspirin] had 130% the activity."⁴⁴

Several copper compounds have been used successfully with RA,⁴⁵ and a single-blind trial using copper bracelets reported surprisingly effective results.⁴⁶ However, under certain circumstances, copper might actually increase inflammation in rheumatoid joints.⁴⁷ Moreover, the most consistently effective form of copper, copper aspirinate (a combination of copper and aspirin), is not readily available. Nonetheless, some doctors suggest a trial of 1–3 mg of copper per day for at least several months.

Preliminary research suggests that boron supplementation at 3–9 mg per day may be beneficial, particularly in juvenile RA.⁶² However, more research on this is needed.

The D form of phenylalanine (DPA) has been used to treat chronic pain, including rheumatoid arthritis, with mixed effectiveness.⁶³ No research has evaluated the effectiveness of DL-phenylalanine (DLPA), a related supplement, on rheumatoid arthritis. Some doctors suggest that individuals with arthritis may benefit from cartilage; however, well-designed research is lacking and many experts question the use of cartilage in this regard.

The use of dimethyl sulfoxide (DMSO) for therapeutic applications is controversial, but there is some evidence that when applied directly to the skin, it has anti-inflammatory properties and alleviates pain, such as that associated with rheumatoid arthritis.^{64 65} DMSO appears to reduce pain by inhibiting the transmission of pain messages by nerves.⁶⁶ It comes in different strengths and degrees of purity and certain precautions must be taken when applying DMSO. For these reasons, DMSO should be used only under the supervision of a doctor.

There is limited evidence that some individuals with RA may have inadequate stomach acid.⁶⁷ Some doctors believe that when stomach acid is low, supplementing with betaine HCl can reduce food-allergy reactions by improving digestion. The amount of betaine HCl used varies with the size of the meal and with the amount of protein ingested. Typical amounts recommended by doctors range from 600 to 2,400 mg per meal. Use of betaine HCl should be monitored by a healthcare practitioner.

Bromelain has significant anti-inflammatory activity. Preliminary evidence in people with rheumatoid arthritis shows that bromelain might help reduce symptoms, such as joint swelling and impaired joint mobility.⁶⁸ The amount of bromelain used in that study was 20–40 mg, three or four times per day, in the form of enteric-coated tablets. Enteric-coating prevents the stomach juices from partially destroying the bromelain. Most commercially available bromelain products today are not enteric-coated, and it is not known how the potency of these different products compares.

New Zealand green-lipped mussel (Perna canaliculus) may be beneficial for people with rheumatoid arthritis. It significantly improved RA symptoms in 68% of participants in a double-blind trial.⁶⁹ Since this trial was published, other studies have been carried out, some of which confirmed these findings, while others did not.^{70 71 72 73} In a recent uncontrolled trial, a lipid extract (210 mg per day) or a freeze-dried powder (1,150 mg per day) of green-lipped mussel were equally effective for 76% of the participants after three months. Improvements included less joint tenderness, morning stiffness, and better overall function.⁷⁴ However, members of the Australian Rheumatism Association have reported side effects, such as stomach upset, gout, and skin rashes, occurring in people taking certain New Zealand green-lipped mussel extracts. There has also been one case of hepatitis reported in association with the use of a New Zealand green-lipped mussel extract.⁷⁵

Cetyl myristoleate (CMO) has been proposed to act as a joint "lubricant" and anti-inflammatory agent. In a double-blind study, individuals with various types of arthritis that had failed to respond to non-steroidal anti-inflammatory drugs received either cetyl myristoleate (540 mg per day orally for 30 days), or a placebo.⁷⁶ These individuals also applied cetyl myristoleate or placebo topically, according to their perceived need. About 64% of those receiving cetyl myristoleate improved, compared with 14% of those receiving the placebo (a statistically significant difference). Despite these promising results, confirmation by more formal research published in a peer-reviewed journal is needed.

Dehydroepiandrosterone (DHEA) is a hormone available as a supplement. Most studies find low levels of this substance in people with rheumatoid arthritis, but the meaning of this finding remains unclear. Arthritis patients should not take DHEA without the supervision of a healthcare professional.

Herbs that may be helpful: Boswellia, a traditional herbal remedy from the Indian system of Ayurvedic medicine, has been investigated for its effects on arthritis. A double-blind study using boswellia found a beneficial effect on pain and stiffness, as well as improved joint function.⁷⁷ Boswellia showed no negative effects in this study. The herb has a unique anti-inflammatory action, much like the conventional non-steroidal anti-inflammatory drugs (NSAIDs) used by many for inflammatory conditions. But unlike NSAIDs, long-term use of boswellia is generally considered safe and does not lead to irritation or ulceration of the stomach. Some doctors suggest using 400–800 mg of gum resin extract in capsules or tablets three times per day.

Turmeric is a yellow spice that is often used to make brightly colored curry dishes. The active principle is curcumin, a potent anti-inflammatory compound, which protects the body against the ravages of free radicals.⁷⁸ A preliminary double-blind study found that 400 mg curcumin three times per day was as effective as the drug phenylbutazone (an NSAID) for people with rheumatoid arthritis.⁷⁹ Many doctors recommend 400 mg of curcumin in capsules or tablets three times per day.

Ginger has been used in Ayurvedic medicine as an anti-inflammatory. Several published case studies of people with RA taking 6–50 grams of fresh or powdered ginger per day indicated that ginger might be helpful.⁸⁰

A cream containing small amounts of capsaicin, a compound found in cayenne pepper, can help relieve pain when rubbed onto arthritic joints, according to the results of a double-blind study.⁸¹ It does this by depleting the nerves of a pain-mediating neurotransmitter known as substance P. Although application of capsaicin cream may initially cause a burning feeling, the burning will lessen with each application and soon disappear for most people. A cream containing 0.025–0.075% of capsaicin can be applied to the affected joints three to five times a day.

The historical practice of intentionally applying nettle topically with the intent of causing stings to relieve arthritis was recently assessed by a questionnaire study.⁸² The nettle stings were reported to be safe except for causing a sometimes painful, sometimes numb rash lasting 6 to 24 hours. Further studies are required to determine if this practice is therapeutically effective.

Yucca, a traditional remedy, is a desert plant that contains soap-like components known as saponins. Yucca tea (7 or 8 grams of the root simmered in a pint of water for 15 minutes) is often drunk for symptom relief three to five times per day.

Burdock root has been used historically both internally and externally to treat painful joints. Horsetail is thought in traditional medicine to exert a connective tissue strengthening and anti-arthritic action, possibly because of the high silicon content of this herb.

Devil’s claw has anti-inflammatory and analgesic actions. Several open and double-blind studies have been conducted on the anti-arthritic effects of devil’s claw.⁸³ The results of these studies have been mixed, so it is unclear if devil’s claw lives up to its reputation in traditional herbal medicine for people with rheumatoid arthritis. A typical amount used is 800 mg of encapsulated extracts or 2–4 ml of tincture three times per day.

Sarsaparilla has anti-inflammatory properties that may be helpful for people with rheumatoid arthritis. White willow bark has anti-inflammatory and pain-relieving effects; extracts providing 60–120 mg salicin per day are approved for people with rheumatoid arthritis by the German government.⁸⁴ Although the analgesic actions of willow are typically slow-acting, they last longer than aspirin.

Topical applications of several botanical oils are approved by the German government for relieving symptoms of rheumatoid arthritis.⁸⁵ These include primarily cajeput (Melaleuca leucodendra) oil, camphor oil, eucalyptus oil, fir (Abies alba and Picea abies) needle oil, pine (Pinus spp.) needle oil, and rosemary oil. A few drops of oil or more can be applied to painful joints several times a day as needed.

The German government’s Commission E has stated that mistletoe injections around joints can help alleviate problems due to rheumatoid or other inflammatory forms of arthritis.⁸⁶ It is unlikely that taking mistletoe orally would help arthritis.

Open-label studies conducted in India with the herb picrorhiza show a preliminary benefit for persons with primarily rheumatoid arthritis.⁸⁷ Much more study is needed before any conclusions can be drawn, given the low quality of this research and lack of availability of details about the studies.

Southwestern Native American and Hispanic herbalists have long recommended use of chaparral topically on people’s joints affected by rheumatoid arthritis. The anti-inflammatory effects of chaparral found in the test tube suggests this practice could have value, though studies have not yet confirmed chaparral’s usefulness in humans. Chaparral should not be used internally for this purpose.

Cat’s claw has been used traditionally for rheumatoid arthritis but no human studies have investigated this practice.

Information about the effects of a particular supplement or herb on a particular condition has been qualified in terms of the methodology or source of supporting data (for example: clinical, double blind, meta-analysis, or traditional use). For the convenience of the reader, the information in the table listing the supplements for particular conditions is also categorized. The criteria for the categorizations are: "Primary" indicates there are reliable and relatively consistent scientific data showing a health benefit. "Secondary" indicates there are conflicting, insufficient, or only preliminary studies suggesting a health benefit or that the health benefit is minimal. "Other" indicates that an herb is primarily supported by traditional use or that the herb or supplement has little scientific support and/or minimal proven health benefit.

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