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Rheumatoid Arthritis: In Depth

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What’s the Bottom Line?

  • Medical treatment for rheumatoid arthritis can delay or prevent joint damage—it doesn’t just treat symptoms. The sooner treatment starts, the better. If you have rheumatoid arthritis, follow your health care provider’s instructions on how to treat your condition. If you have joint symptoms that might be caused by rheumatoid arthritis, see your health care provider promptly. 
  • To get the best results, don’t substitute other approaches for treatments prescribed or recommended by your health care provider. Consult your provider about adding any complementary health products or practices to your treatment program.

What do we know about the effectiveness of complementary health approaches for rheumatoid arthritis?

  • The amount of research on mind and body approaches is too small for conclusions to be reached about whether they can help relieve rheumatoid arthritis symptoms.
  • Supplements containing omega-3 fatty acids, gamma-linolenic acid (GLA), or the herb thunder god vine may help relieve rheumatoid arthritis symptoms.

What do we know about the safety of complementary health approaches for rheumatoid arthritis?

  • The mind and body approaches discussed in this fact sheet generally have good safety records. However, some may need to be adapted to make them safe and comfortable for people with rheumatoid arthritis.
  • Thunder god vine may cause serious side effects, including male infertility and decreases in bone density.
  • The U.S. Food and Drug Administration (FDA) has warned consumers about dietary supplements promoted for arthritis pain that are tainted with prescription drugs.

What Is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is a disease that causes pain, swelling, and stiffness in the joints. It occurs when the immune system attacks the membrane lining the joints. RA is more common in women than men and often begins in middle age, although it can also occur in younger people.

More About Rheumatoid Arthritis and How It's Treated

  • RA is an autoimmune disease—a condition in which the immune system attacks the joints for unknown reasons. RA is different from other types of arthritis such as osteoarthritis, a wear-and-tear condition that most commonly occurs as people age. 
  • Early treatment to avoid permanent joint damage is key for preventing disability and progression of RA. Treatment for RA combines a variety of approaches and is aimed at relieving pain, reducing inflammation, slowing or stopping joint damage, and improving the person’s sense of well-being and ability to function. Medicines used for RA include disease-modifying antirheumatic drugs (DMARDs) to slow the progress of the disease and nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids to reduce inflammation.

For more information about RA, visit the National Institute of Arthritis and Musculoskeletal and Skin Diseases website.

What the Science Says About Complementary Approaches for Rheumatoid Arthritis

Mind and Body Approaches

Acupuncture

  • At least 11 studies of acupuncture for RA, with more than 1,300 total participants, have been completed. These studies have not shown clear evidence of a beneficial effect.
  • Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Improperly performed acupuncture can cause potentially serious side effects.
  • For more information, see the NCCIH webpage on acupuncture.

Massage

  • A single study with 42 participants, conducted in 2013, has indicated that moderate pressure massage therapy may reduce pain and increase grip strength in people who have RA that affects their arms and shoulders. 
  • The risk of harmful effects from massage therapy appears to be low. However, there have been rare reports of serious injuries. Some of the reported cases have involved vigorous types of massage, such as deep tissue massage, or patients who might be at increased risk of injury, such as elderly people.  
  • For more information, see the NCCIH webpage on massage therapy.

Mindfulness Meditation

  • Four studies (401 total participants) have looked at the effects of mindfulness-based interventions in people with RA, and all found evidence of some improvement in subjective symptoms such as pain or in the ability to cope with the illness.
  • Mindfulness meditation may involve staying in one position for a prolonged period of time. This can be difficult or painful for a person with arthritis. If you’re interested in trying mindfulness meditation, tell the instructor about your physical limitations so that the instructor can modify the practice to make it comfortable for you.
  • For more information, see the NCCIH webpage on meditation.

Relaxation Techniques

  • Autogenic training, biofeedback, and other relaxation techniques have been studied in people with RA, but only a small amount of research has been done on each approach. Some results have been promising, but the amount of research is so small that no definite conclusions can be reached.
  • Relaxation techniques generally don’t have side effects. However, rare harmful effects have been reported in people with serious physical or mental health conditions. 
  • For more information, visit the NCCIH webpage on relaxation techniques.

Tai Chi

  • Several studies have looked at the effects of practicing tai chi on people with RA. Some studies showed improvements in participants’ physical functioning, but others did not. Most of these studies are more than 10 years old (some much older than that), so the study participants would not have been taking the types of drugs used in RA treatment today. Because of the inconsistent findings and the changes in RA treatment over the years, it’s uncertain whether tai chi has benefits in RA.
  • Studies of tai chi for RA indicate that it doesn’t make symptoms worse. However, traditional forms of tai chi may need to be adapted so that people with RA can participate safely and comfortably.
  • For more information, visit the NCCIH webpage on tai chi.

Yoga

  • Yoga incorporates several elements of exercise that may be beneficial for arthritis, including activities that may help improve strength and flexibility. However, only a few studies have examined yoga for RA, and they have not been of high quality. They haven’t clearly shown whether it’s helpful. 
  • Yoga exercises should be performed with caution by people with RA who have limited mobility or spinal problems. People with RA may need assistance in modifying some yoga postures to minimize joint stress and may need to use props to help with balance. 
  • For more information, see the NCCIH webpage on yoga.

Dietary Supplements

Omega-3 Fatty Acids

  • Omega-3 fatty acids are a kind of fat found in foods and in the human body. They are also sold as dietary supplements. Different types of omega-3s are found in different foods. Much research has focused on the long-chain omega-3s found in seafood (fish and shellfish).
  • A 2017 review of 22 studies (956 total participants) that tested supplements of long-chain omega-3s found a favorable effect on pain in patients with RA.
  • Omega-3 supplements usually produce only mild side effects, if any. There’s conflicting evidence on whether omega-3 supplements might influence the risk of prostate cancer. If you’re taking medicine that affects blood clotting or if you’re allergic to fish or shellfish, consult your health care provider before taking omega-3 supplements.
  • For more information, visit the NCCIH webpage on omega-3s.

Gamma-Linolenic Acid (GLA)

  • GLA is an omega-6 fatty acid found in the oils from some plants, including evening primrose (Oenothera biennis), borage (Borago officinalis), and black currant (Ribes nigrum). Oils containing GLA may have some benefit in relieving RA symptoms; however, only a few studies have been conducted on each of the oils.
  • In short-term studies, oils containing GLA produced only mild side effects, such as upset stomach or headache. The long-term safety of GLA supplements is uncertain. Some borage products may contain substances called pyrrolizidine alkaloids that can harm the liver.

Probiotics

  • A few preliminary studies have tested various probiotics in patients with RA, but the types of probiotics used differed from study to study, and the results differed as well. No conclusions about the effects of probiotics can be reached on the basis of the current evidence. 
  • In people who are generally healthy, probiotics have a good safety record. Side effects, if they occur at all, usually consist only of mild digestive symptoms such as gas. However, information on the long-term safety of probiotics is limited, and safety may differ from one type of probiotic to another. Probiotics have been linked to severe side effects, such as dangerous infections, in people with serious underlying medical problems. 
  • For more information, visit the NCCIH webpage on probiotics.

Thunder God Vine

  • Thunder god vine (Tripterygium wilfordii) is an herb used in traditional Chinese medicine. There have been only a few high-quality studies of oral thunder god vine for RA. These studies indicate that thunder god vine may improve some RA symptoms. In two studies, thunder god vine was at least as helpful as a conventional drug. Promising results have also been seen in studies in China where thunder god vine was used in combination with a conventional drug.
  • Thunder god vine can have serious side effects, including loss of bone density and male infertility. Thunder god vine can be extremely poisonous if the extract is not prepared properly. The risks of using this herb may exceed its benefits.
  • For more information, see the NCCIH webpage on thunder god vine.

Other Dietary Supplements

  • Other dietary supplements that have been studied for RA include cat’s claw, deer or elk antler velvet, feverfew, flaxseed oil, green-lipped mussel, rose hip, and willow bark extract. For all of these supplements, only a very small amount of research has been done in people, and it isn’t possible to reach any conclusions about their effects.

Tainted Arthritis Supplements

The FDA has warned the public about several dietary supplements promoted for arthritis or pain that were tainted with prescription drugs. The hidden ingredients in these products could cause side effects or interact in harmful ways with medicines.

You can find a list of tainted arthritis/pain products and general information about fraudulent dietary supplements on the FDA website. It’s also a good idea to talk with your health care provider about any dietary supplement you’re taking or considering.

Other Complementary Health Approaches

Ayurvedic Medicine

  • Ayurvedic medicine is a system of health care that originated in India. Two preliminary studies (161 total participants) have compared Ayurvedic herbal preparations with conventional drugs used to treat RA. Both indicated that some Ayurvedic preparations may be comparable in effectiveness to the drugs. However, the two studies used different Ayurvedic preparations and compared them with different drugs. 
  • Ayurvedic medicine uses a variety of products and practices. Some products may be harmful, particularly if used improperly or without the direction of a trained practitioner. 
  • For more information, see the NCCIH webpage on Ayurvedic medicine.

Balneotherapy

  • Balneotherapy is the technique of bathing in tap or mineral water for health purposes; it also includes related practices such as mud packs. A 2016 review of 8 studies of balneotherapy for RA (496 total participants) was unable to reach definite conclusions because of the variability in the types of balneotherapy used in different studies as well as variability in study designs. 
  • Balneotherapy has a good safety record.

Special Diets

  • The effects of special diets—such as vegetarian, Mediterranean, or elimination diets—on RA are uncertain because very little research has been done. 
  • In studies that tested special diets for RA, some people lost weight even though they didn’t intend to, an effect that is undesirable in people who are already at or below normal weight. Some special diets, especially those that eliminate one or more major food groups, are so restrictive that they may put people at risk of developing nutritional deficiencies.

More to Consider

  • If you’re considering dietary supplements, keep in mind that they can cause health problems if not used correctly, and some may interact with prescription or nonprescription medications or other dietary supplements. Your health care provider can advise you. If you’re pregnant or nursing a child, or if you’re considering giving a child a dietary supplement, it’s especially important to consult your (or the child’s) health care provider. To learn more, visit the NCCIH webpage on dietary supplements
  • Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.

For More Information

NCCIH Clearinghouse

The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 
1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 
1-866-464-3615

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

The mission of NIAMS is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases.

Toll-free in the U.S.: 
1-877-22-NIAMS

PubMed®

A service of the National Library of Medicine, PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. For guidance from NCCIH on using PubMed, see How To Find Information About Complementary Health Approaches on PubMed.

MedlinePlus

To provide resources that help answer health questions, MedlinePlus (a service of the National Library of Medicine) brings together authoritative information from the National Institutes of Health as well as other Government agencies and health-related organizations.

Key References

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Acknowledgments

NCCIH thanks D. Craig Hopp, Ph.D., and David Shurtleff, Ph.D., NCCIH, for their review of the 2019 update of this publication.

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NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.
NCCIH Pub No.: 
D441
Last Updated: 
January 2019

This page last modified January 14, 2019