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Managing Rheumatoid Arthritis: What You Need To Know

Written by Carlos Tello, PhD (Molecular Biology) | Last updated:
Puya Yazdi
Medically reviewed by
Puya Yazdi, MD | Written by Carlos Tello, PhD (Molecular Biology) | Last updated:

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In the following sections, we’ll outline complementary approaches that may help your rheumatoid arthritis. If you have rheumatoid arthritis, the below strategies are not meant to replace your standard medical treatment. Make sure to consult with your doctor before making any significant changes to your day-to-day routine.

Lifestyle

Avoid Cigarettes

Smoking is one of the strongest environmental risk factors for developing rheumatoid arthritis [1, 2].

An observational study of 296 people found that 88% of smokers tested positive for rheumatoid factor over a period of 10 years. Also, the rheumatoid factor-positive group of people contained more smokers than the rheumatoid factor-negative group [3].

The risk of high rheumatoid factor levels was 4 times higher in current smokers than in people who never smoked, according to an observational study of 7,124 people. In another study of 100 people with rheumatoid arthritis (RA), rheumatoid factors were more than twice as high in current and former smokers than in people who never smoked [4, 5].

Smoking the equivalent of 1 pack (20 cigarettes) a day for 25 years was linked to a 3-fold increase in the risk of elevated rheumatoid factor in a study of 336 RA patients. What’s more, rheumatoid factor levels were directly linked to the number of years smoked in two studies of 673 people with RA [6, 7, 2].

Aquatic Exercise

Aquatic exercise describes any type of physical activity that takes place either partially or fully submerged in water. These activities can allow people to maintain physical fitness and reap the benefits of exercise even when they are not fully mobile out of the water [8].

In 2 clinical trials of over 250 people with rheumatoid arthritis comparing the effects of different types of exercise, aquatic exercise produced the greatest pain reduction [9, 10].

Massage

In a review of 352 patients, researchers concluded that massage therapy could moderately reduce pain and increase function in joints affected by rheumatoid arthritis [11].

Massage therapy applying moderate pressure to tissues in the upper limbs was more effective than a light-pressure massage technique [12].

Massage therapy relieved pain and stiffness in 2 clinical trials on over 150 people with knee arthritis [13, 14].

As part of a broader physical therapy regimen, massage is used to improve flexibility and function in arthritic joints [15].

Acupuncture

Acupuncture as practiced in Traditional Chinese Medicine creates therapeutic effects through needling, pressure, or heat [16].

There is contradictory evidence about the effectiveness of acupuncture for rheumatoid arthritis. One study found no benefit for pain and tenderness in the joints; another study found improvements in reported pain, grip strength, and arm strength after four weeks of acupuncture [17, 18].

Moxibustion, another form of acupuncture, applies small pieces of burning dried mugwort (a flowering plant) to acupuncture points. One meta-analysis found that moxibustion reduced pain and markers of inflammation in 281 subjects; however, other reviews have found no significant benefit [19, 20, 21].

Sun Exposure

Vitamin D deficiency is more common in patients with rheumatoid arthritis than in the general population [22].

A study of nurses found that those with greater exposure to UVB rays from the sun had the lowest rates of rheumatoid arthritis. Another study found that people who live further from the equator (who are likely to be exposed to less sunlight on average) are more likely to develop rheumatoid arthritis [23, 24].

According to multiple studies, people with a higher intake of vitamin D appear less likely to develop rheumatoid arthritis. However, there are conflicting reports on whether supplementing with vitamin D can improve pain in existing rheumatoid arthritis cases [25, 26, 27].

Tai Chi

Tai chi may be a good form of exercise for people with chronic pain from rheumatoid arthritis. One clinical study found that rheumatoid arthritis patients who practiced tai chi reported less pain and better quality of life [28].

Whole Body Cryotherapy

Whole body cryotherapy (WBC) involves immersing the body in a cold chamber, which emits vapors at extremely low temperatures ranging from -110℃ to -160 ℃ (around -160℉ to -220℉). This is usually done for an interval of 2 to 4 minutes [29, 30].

In three studies of 168 rheumatoid arthritis patients, whole-body cryotherapy brought significant improvements in [31, 32, 33]:

  • Pain reduction
  • Functionality
  • Wellbeing
  • Disease activity
  • Inflammation

Cryo chamber treatment reduced pain and the need for medication in 50 patients with different forms of arthritis. Additionally, well-being and mobility of the patients improved [34].

WBC significantly reduced pain and disease activity in two studies of 70 patients with various rheumatic disorders. Patients also had higher functionality in their joints and pain reduction lasting up to 2 months (especially in women) [35, 36].

Diet

Mediterranean Diet

The Mediterranean diet is a popular anti-inflammatory diet that may reduce swelling and pain in arthritic joints [37].

According to one study of 51 patients, those eating a Mediterranean diet had significantly higher vitality scores (a measurement of energy, quality of life, and general function) than those eating a typical western diet [37].

The anti-inflammatory effect of the Mediterranean diet may be due to its high content of olive oil. In fact, people whose diets include a lot of olive oil are significantly less likely to develop rheumatoid arthritis than those who use other types of cooking oils [38, 39].

Increased Omega-3 Intake

Studies suggest that increased dietary intake of omega-3 fatty acids may protect against rheumatoid arthritis. In a meta-analysis of 20 clinical trials, higher omega-3 consumption improved rheumatoid arthritis symptoms and lab markers [40, 41].

Good dietary omega-3 sources include [42]:

Plant-Based Diet

In a study of 53 rheumatoid arthritis patients, a vegetarian diet improved the severity of all measured symptoms and lab results after a year. However, some patients appeared to benefit a great deal from the diet change, while others did not benefit at all [43].

Researchers speculated that the patients who benefited from the vegetarian diet might have gut bacteria that are more sensitive to diet changes [43].

Garlic

In a study of 70 women with rheumatoid arthritis, those who consumed supplementary garlic had improved antioxidant status, pain scores, and general quality of life compared to those who were given a placebo. The effects were apparent at doses of 500 mg of garlic per day, which could be achieved through diet or supplements [44].

Pomegranate

In a small, open-label study, rheumatoid arthritis patients who drank a concentrated pomegranate juice extract once a day had improved inflammation and oxidative stress markers after twelve weeks. However, this study only had eight participants and no control group, so more research is needed to explore these effects [45].

In rat models of rheumatoid arthritis, pomegranate rind extract reduced pain and swelling. These effects were attributed to decreases in the activity of inflammatory markers, including NF-kB [46].

Supplements

Fish Oil

Supplementation with fish oil may lower the activity of chronic inflammatory and autoimmune diseases, including rheumatoid arthritis [47, 48].

A meta-analysis of 17 trials found that supplemental fish oil reduced inflammatory joint pain from rheumatoid arthritis and other inflammatory conditions [49].

In one study of 250 patients, fish oil was as effective as ibuprofen in reducing pain caused by arthritis [50].

Resolvins found in EPA and DHA appear to prevent certain inflammatory cytokines such as TNF-α from inducing pain [51].

Gamma Linolenic Acid (GLA)

Borage and black currant oil, two oils rich in gamma linolenic acid (GLA), reduced joint inflammation, pain, and stiffness in 4 trials on almost 150 people with rheumatoid arthritis, but low doses of evening primrose oil were ineffective in 2 trials on 58 people [52, 53, 54, 55, 56, 57].

GLA (from borage and evening primrose oil), fish oil (rich in EPA), and their combination reduced rheumatoid arthritis symptoms, painkiller use, and the risk of heart disease in 4 trials on almost 400 people [58, 59, 60, 61].

A meta-analysis concluded that GLA may reduce pain and disability in people suffering from rheumatoid arthritis [62].

Borage

Borage is a flowering herb whose oil is especially rich in the omega-6 PUFA gamma-linolenic acid.

In 2 trials of 187 people with rheumatoid arthritis, taking borage seed oil capsules for up to 18 months reduced the symptoms [63, 58].

Several studies demonstrated that borage seed oil reduced inflammation in the lining of joints (synovitis), thus reducing the need for anti-inflammatory drugs [64, 65, 66].

Thunder God Vine

In 2 clinical trials, thunder god vine (Tripterygium wilfordii) extract (60-360 mg/day) improved joint inflammation and pain from rheumatoid arthritis. It was more effective than the anti-rheumatic drug sulfasalazine in another trial on 62 people [67, 68, 69].

Similarly, its tincture applied on the skin improved rheumatoid arthritis in a trial on 61 people [70].

Thunder god vine and its active components also improved arthritis in multiple animal studies [71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82].

Curcumin

Curcumin, an active compound found in the yellow spice turmeric, reduced some symptoms of rheumatoid arthritis in multiple studies. At high doses, it improved pain, morning stiffness, joint inflammation, and mobility [83, 84, 85].

However, curcumin does not appear to be effective at lower doses. In the available studies, patients only benefited when consuming at least 500 mg per day [86].

Glucosamine

According to preliminary research, glucosamine may reduce the pain from rheumatoid arthritis, while its effects on joint inflammation are less convincing [87].

In 51 patients, 3-month treatment with glucosamine notably improved RA symptoms [88].

On the other hand, a combination of glucosamine, chondroitin, and quercetin had no effect on 22 RA patients [89].

In mice with rheumatoid arthritis, both glucosamine and N-acetyl-glucosamine (NAG) suppressed joint inflammation and enhanced joint function [90].

Lactobacillus casei

In 2 clinical trials on over 100 people with rheumatoid arthritis, supplementation with a Lactobacillus casei strain for 8 weeks reduced joint pain and inflammation [91, 92].

This strain also relieved rheumatoid arthritis in mice and rats [93, 94, 95].

Vitamin E

One study found that vitamin E supplements (600 mg twice a day for twelve weeks), when added to conventional rheumatoid arthritis therapy, improved pain but not inflammation [96].

In multiple studies of animals with rheumatoid arthritis, vitamin E slowed the progression of joint destruction [97, 98, 99].

Cat’s Claw

Cat’s claw’s anti-inflammatory effects have been commonly used to treat both rheumatoid arthritis and osteoarthritis [100].

In a clinical trial on 40 rheumatoid arthritis patients, cat’s claw combined with conventional treatments (sulfasalazine/hydroxychloroquine) reduced tender and painful joints [101].

CBD Oil

In a small study of 58 rheumatoid arthritis patients, a cannabis extract containing both CBD and THC significantly reduced pain and increased quality of sleep. Some research suggests that the combination of CBD and THC is more effective than CBD alone; however, CBD oil is much more readily available and considered non-psychoactive [102].

In mice with this condition, oral and injected CBD relieved inflammation and slowed the joint damage progression. CBD also prevented T cells and joint cells (synoviocytes) from reproducing and releasing pro-inflammatory cytokines (TNF-alpha and IFN-gamma) [103].

Similarly, a topical CBD gel reduced joint swelling, pain, and the levels of inflammatory markers (such as TNF-alpha) in the nerves of rats with rheumatoid arthritis [104].

Additionally, synthetic CBD-like compounds reduced inflammation, pain perception, and joint damage in mice and rats with this type of arthritis [105, 106, 107].

Two studies in humans and dogs found that animals with rheumatoid arthritis or osteoarthritis had higher levels of both CB receptors and several cannabinoids in the joints. This suggests that the body activates the endocannabinoid system to fight arthritis. In line with this, increasing cannabinoids may be a good therapeutic strategy [108, 109].

Superoxide Dismutase (SOD)

Superoxide dismutases (SOD) are enzymes that transform the superoxide (O2-) radical into either ordinary oxygen (O2) or hydrogen peroxide (H2O2) [110].

Scientists think that SOD plays a protective role against oxidative stress, ionizing radiation, and inflammatory cytokines [110, 111].

Superoxide dismutase treatments reduced the pain associated with osteoarthritis and rheumatoid arthritis in a handful of studies. However, in all of these, superoxide dismutase was administered as an injection into the problem joints; there is no data supporting the use of superoxide dismutase as a supplement for arthritis [112, 113, 114, 115].

Bacillus coagulans 

In a study of 45 rheumatoid arthritis patients, supplementing with Bacillus coagulans probiotics decreased overall pain, but not the number of painful or swollen joints, after 60 days. In this group, B. coagulans improved pain, improved self-assessed disability, reduced CRP levels, and improved the ability to walk 2 miles, reach, and participate in daily activities [116].

B. coagulans significantly inhibits fibrinogen, blood amyloid A, and pro-inflammatory cytokine production in arthritic rats [117].

Mango (Mangiferin)

Mangiferin has shown promise in cell studies for reducing the type of inflammation that causes rheumatoid arthritis. According to one study, mangiferin may prevent the destruction of joint tissues by promoting cell death in certain destructive immune cells [118, 119].

In a small randomized controlled trial, a standard rheumatoid arthritis medication combined with mango stem bark extract reduced disease activity and symptoms after a year of supplementation. However, the effects on disease activity were similar to that of the medication alone [120].

It may not be feasible to get the mangiferin needed by eating mangoes. However, mango leaf extract is available as a supplement.

Stinging Nettle

Stinging nettle contains anti-inflammatory compounds that may improve pain and swelling in rheumatoid arthritis [121].

These arthritis-relieving properties may be due to nettle’s ability to block a protein called NF-κB, which would otherwise increase the production of inflammatory compounds. NF-κB is often overactive in people with arthritis [122, 123].

Stinging nettle is often used by traditional practitioners to improve arthritis symptoms. Urtication, also known as ‘flogging with nettles,’ is a technique where users apply raw, unprocessed stinging nettle leaves or stems to the body to generate inflammation. This has been used since Ancient Roman times for relieving chronic rheumatism, but researchers have only just begun to investigate its effectiveness [124].

Ashwagandha

Ashwagandha reduced pain, stiffness, and disability in 60 people with knee joint pain. Ayurvedic treatment containing ashwagandha reduced pain, joint tenderness, and swelling in a study of 86 people with rheumatoid arthritis [125, 126].

B Vitamins

A product containing a combination of vitamins B1, B6, and B12 improved inflammation and blood flow in a study of 24 patients with severe rheumatoid arthritis [127].

In another study, a combination of vitamins B6 and B12 and folic acid (vitamin B9) reduced inflammatory markers in 62 patients with rheumatoid arthritis [128].

Menaquinone (Vitamin K2)

Menaquinone, also known as vitamin K2, improved the effectiveness of conventional medication in 84 rheumatoid arthritis patients [129].

Note that vitamin K1 (phytonadione) did not have the same benefit [130].

Boswellia serrata

In a meta-analysis of 260 patients with rheumatoid arthritis, 400 mg of Boswellia serrata (Indian frankincense) extract reduced swelling, pain, and stiffness. Patients were also able to reduce painkiller intake and required fewer emergency treatments [131].

Note that boswellic acids may only become detectable in the blood when administered with a high-fat meal [132].

Ginger

In a study of 70 rheumatoid arthritis patients, taking 1500 mg of ginger powder per day led to significantly reduced disease markers after 12 weeks. The authors suggested that the benefit might come from alterations in gene expression: the group taking ginger supplements had increased levels of FOXP3 and decreased RORC expression [133].

Blackcurrant Seed Oil

Rheumatoid arthritis patients who supplemented with blackcurrant seed oil for 24 weeks experienced a reduction in disease symptoms. However, a very large dose (15 capsules daily) was required to see a benefit [134].

The authors of the study suggested that the benefits of blackcurrant seed oil were due to its high content of gamma linolenic acid (GLA) and alpha linolenic acid (ALA) [134].

Black Seed Oil

Black seed oil (500mg, 2x daily) reduced joint stiffness and swelling in 40 women with rheumatoid arthritis [135].

In rats with arthritis, the active ingredient, thymoquinone lowered numerous pro-inflammatory cytokines (including IL-6, IL-1β, TNF alpha, all Th1 cytokines) while increasing anti-inflammatory ones (IL-10) [136].

Conjugated Linoleic Acid

Conjugated linoleic acids (CLA) are poly-unsaturated fatty acids found primarily in meat and dairy products, but also available in supplement form.

In a study of 87 patients, three months of CLA supplementation resulted in reduced pain and stiffness compared to the control group. Researchers concluded that CLA may be useful in addition to conventional rheumatoid arthritis therapies [137].

Quercetin

In one study, people with Rheumatoid Arthritis who consumed lots of raw berries, fruits, vegetables, nuts, roots, seeds, and sprouts rich in quercetin and other antioxidants had fewer symptoms [138].

Quercetin supplements (500 mg/day) had no effect on some inflammatory markers (CRP) but did reduce others (TNF-alpha and IL-6) in an 8-week study of 51 women. But in a later 8-week follow up study in 50 women, the same dose did reduce joint stiffness, morning pain, after-activity pain and the inflammatory marker TNF-alpha [139, 140].

In a cellular study, Quercetin triggered the death of inflammatory joint cells that contribute to the development of rheumatoid arthritis. In another study, it also stopped these cells from dividing and prevented neutrophil activation, which worsens the autoimmune response [141, 142].

Resveratrol

In a study of 100 rheumatoid arthritis patients, 1 g of resveratrol per day significantly improved swelling, tenderness, and disease activity scores and decreased lab markers of inflammation and disease severity. The authors suggested that resveratrol could make a good addition to conventional treatment plans [143].

Selenium

People whose diets contain low levels of selenium appear to develop rheumatoid arthritis more often than those who consume higher levels of selenium [144].

However, selenium may or may not help people with existing cases of rheumatoid arthritis. In one study, 3 months of selenium supplementation improved joint swelling, tenderness, and mobility, but other studies found no benefit [145, 146].

Sesamin

Sesamin is an active compound found in sesame, camphor, and other plants. In a study of 44 rheumatoid arthritis patients, sesamin supplements reduced joint pain and tenderness and improved lab markers of inflammation [147, 148].

Bromelain

Bromelain is an enzyme found in pineapples. In 77 patients with rheumatoid arthritis or osteoarthritis, bromelain (400 mg) improved overall symptoms, reduced stiffness, and improved physical function [149].

Baicalin

In one study of 374 patients with rheumatoid arthritis and coronary artery disease (which frequently occur together), 500 mg of baicalin per day significantly reduced blood lipids and markers of inflammation [150].

Horsetail

Horsetail improved symptoms and regulated the immune response in most cases in a study of 60 patients with rheumatoid arthritis. It increased IL-10 and decreased TNF-alpha, which may make it a good add-on to conventional therapies [151].

Giant horsetail extract reduced pain, inflammation, and autoimmune response in a mouse model of rheumatoid arthritis and osteoarthritis. The medicinal benefits of the compounds in horsetail are promising, but more research is needed [152].

Cod Liver Oil

In a pilot study of 43 people with rheumatoid arthritis, cod liver oil (1 g/day for 3 months) decreased morning stiffness, painful and swollen joints, and pain intensity [153].

In another trial on 30 people with this condition, cod liver oil (five 300 mg capsules, 2x/day) reduced the use of arthritis medications (Diclofenac Sodium) and had fewer side effects [154].

In a follow-up study of 58 patients with rheumatoid arthritis, 10 g cod liver oil (with 2.2 g of omega 3s) over 9 months reduced the use of painkillers (diclofenac, naproxen, and ibuprofen) [155].

Collagen

In 60 patients with severe rheumatoid arthritis, three months of chicken type II collagen reduced the number of swollen and tender joints compared to placebo (DB-RCT). Four patients in the collagen group saw all symptoms disappear and a halt in the progression of the disease [156].

A larger study of 274 rheumatoid arthritis patients found that a range of doses (20, 100, 500, and 2,500 μg) reduced swollen and tender joint counts [157].

Zinc

People with rheumatoid arthritis have lower average zinc levels in their hair, which may indicate a tendency to have low zinc over a long period of time [158].

Zinc is available in supplement form, and the richest dietary sources are oysters, other seafood, and beef [159].

Sweet Wormwood

Before taking sweet wormwood (artemisia annua), discuss this supplement with your doctor.

Sweet wormwood is an herb used in traditional Chinese medicine. Due to its potent antiviral and anti-inflammatory properties, a compound of sweet wormwood (artemisinin) and its derivative drugs have been recommended by the World Health Organization as treatments for malaria [160].

Artemisinin and its derivatives were reported to suppress the release of inflammatory proteins from joint cells of rheumatoid arthritis patients [161].

In a randomized controlled trial, a combination of standard rheumatoid arthritis drugs and a sweet wormwood extract was more effective at reducing joint swelling, pain, and tenderness than standard drugs alone [162].

Multiple studies have found that compounds derived from sweet wormwood may reduce production of the inflammatory protein NF-kB [163, 164, 165].

To avoid adverse effects and unexpected interactions, only use sweet wormwood as directed by a medical professional.

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About the Author

Carlos Tello

Carlos Tello

PhD (Molecular Biology)
Carlos received his PhD and MS from the Universidad de Sevilla.
Carlos spent 9 years in the laboratory investigating mineral transport in plants. He then started working as a freelancer, mainly in science writing, editing, and consulting. Carlos is passionate about learning the mechanisms behind biological processes and communicating science to both academic and non-academic audiences. He strongly believes that scientific literacy is crucial to maintain a healthy lifestyle and avoid falling for scams.

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