Osteoarthritis: In Depth
What’s the Bottom Line?
What do we know about the effectiveness of complementary health approaches for osteoarthritis?
Natural Products
- Despite extensive research, it’s still uncertain whether glucosamine and chondroitin have a meaningful impact on symptoms or joint structure in osteoarthritis.
- The evidence on other natural products is too limited for any conclusions to be reached.
Mind and Body Practices
- Acupuncture may help relieve osteoarthritis pain.
- A small amount of evidence suggests that massage therapy may be helpful.
- Participating in tai chi may improve pain, stiffness, and joint function in people with knee osteoarthritis. Qi gong may have similar benefits, but less research has been done on it.
What do we know about the safety of complementary health approaches for osteoarthritis?
- Some natural products can have side effects or interact with drugs.
- Mind and body practices generally have good safety records when used correctly. However, some may need to be adapted to make them safe and comfortable for people with osteoarthritis.
- Magnetic therapies are not safe for people with some types of implantable medical devices.
About Osteoarthritis
Osteoarthritis (OA) is the most common type of arthritis. It occurs most often in the hands, knees, hips, and spine.
OA affects cartilage—the slippery tissue that covers the ends of bones in a joint. Cartilage allows bones to glide over each other and absorbs the shock of movement. In OA, the top layer of cartilage breaks down and wears away, allowing the bones under it to rub against each other. This can cause pain, swelling, and difficulty in moving the joint.
OA is most common in older people, but younger people can have it too, especially in joints that have been injured.
You may have OA if you have these symptoms. Check with your health care provider.
- Stiffness in a joint after getting out of bed or sitting for a long time.
- Swelling or tenderness in one or more joints.
- A crunching feeling or the sound of bones rubbing together.
If you feel hot or your skin turns red, or if your joint pain is accompanied by other symptoms such as a rash or fever, you probably have a different problem.
OA is usually managed with a combination of treatments, which may include exercise, weight loss to reduce strain on the hips and knees, rest and relief from stress on joints, and medications to control pain.
To find out more about OA, visit the National Institute of Arthritis and Musculoskeletal and Skin Diseases Web site.
What the Science Says About Complementary Health Approaches for Osteoarthritis
A variety of complementary approaches have been studied for osteoarthritis, including natural products, mind and body practices, and others. The following sections summarize the evidence on the effectiveness and safety of specific approaches.
Natural Products
Glucosamine and chondroitin are substances found in cartilage. Both are produced naturally in the body. They are also available as dietary supplements. Researchers have studied their effects, individually or in combination, in people with OA.
Studies of glucosamine for pain in knee OA have had conflicting results. Some, including a major National Institutes of Health (NIH)-sponsored study, found little or no evidence that glucosamine can relieve pain, but several other studies indicated that it can. Studies of chondroitin for pain from OA of the knee have had inconsistent results, but in general, the largest, highest quality studies have not shown an effect. There isn’t enough evidence to show whether glucosamine or chondroitin lessens pain from OA in other joints.
A few studies have looked at whether glucosamine or chondroitin or the combination can have beneficial effects on joint structure in people with OA. Some but not all of these studies found evidence that chondroitin or a glucosamine/chondroitin combination might help, but the improvements seen in most studies may be too small to make a difference to patients. There’s little evidence that glucosamine alone has beneficial effects on joint structure.
Glucosamine and chondroitin supplements may interact with the anticoagulant (blood-thinning) drug warfarin (Coumadin). Overall, studies have not shown any other serious side effects.
Dimethyl sulfoxide (DMSO) and methylsulfonylmethane (MSM) are two chemically related substances that have been studied for OA. DMSO is applied to the skin. MSM is used as a dietary supplement.
Very little research has been done on DMSO and MSM, so it’s uncertain whether they’re helpful for OA symptoms.
Both DMSO and MSM can have side effects. DMSO can cause digestive upset, skin irritation, and a garlic-like taste, breath, and body odor. MSM can cause allergic reactions, digestive upsets, and skin rashes.
S-Adenosyl-L-methionine (SAMe) is a molecule that is naturally produced in the body. It’s also sold in the United States as a dietary supplement.
Studies of SAMe for OA have had inconsistent results. In some studies, SAMe appeared to be as effective as nonsteroidal anti-inflammatory drugs (NSAIDs) in relieving symptoms associated with OA, but in others it was no more helpful than a placebo (an inactive substance).
Side effects of SAMe are uncommon and usually mild. However, little is known about the long-term safety of SAMe because most studies have been brief. SAMe may have special risks for people with bipolar disorder and those who are HIV positive. It also may interact with drugs, including some antidepressants and levodopa, a drug used for Parkinson’s disease.
A variety of herbal products that are taken orally (by mouth) have been studied for OA. A 2014 evaluation of oral herbal remedies for OA found enough evidence to conclude that avocado-soybean unsaponifiables (ASUs) and Boswellia serrata, an herb used in Ayurvedic medicine, may produce slight improvements in pain and function; however, the improvements were so small that patients might not consider them meaningful. For all other herbal products, the amount of research is too small to allow any conclusions to be reached.
Little information is available on the safety of most herbal products used for OA, including ASUs and Boswellia serrata. Herbs and other dietary supplements may cause health problems if not used correctly, and some may interact with prescription or nonprescription medications or other dietary supplements. To learn more, visit the National Center for Complementary and Integrative Health’s (NCCIH) Web page on dietary supplements and interactive module on drug-supplement interactions.
Some herbal products have been used topically (applied to the skin) for OA. A 2013 evaluation of the evidence on topical herbal products concluded that arnica gel and comfrey extract gel might be helpful, and capsicum extract gel probably is not. The evidence on other products was insufficient to allow conclusions to be reached.
There’s not much information on the safety of topical herbal therapies for OA, but it’s been reported that some products, such as capsicum extract gel, can cause skin irritation or other side effects.
Tainted Arthritis Supplements
U.S. Food and Drug Administration (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 Web site. It’s also a good idea to talk with your health care provider about any dietary supplement you’re taking or considering.
Mind and Body Practices
A 2012 combined analysis of data from several studies indicated that acupuncture can be helpful and a reasonable option to consider for OA pain. A 2013 analysis using different statistical methods also concluded that acupuncture may help relieve knee OA pain. After these analyses were completed, a 2014 Australian study showed that both needle and laser acupuncture were modestly better at relieving knee pain from OA than no treatment but not better than simulated (sham) laser acupuncture. These results are generally consistent with previous studies, which showed that acupuncture is consistently better than no treatment but not necessarily better than simulated acupuncture at relieving OA pain. A 2016 review of U.S. studies found evidence that acupuncture, as practiced in the United States, may help some patients with knee OA manage their pain.
How acupuncture works to relieve pain is unclear. Current evidence suggests that many factors—like expectation and belief—that are unrelated to acupuncture needling may play important roles in the beneficial effects of acupuncture on pain.
Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Improperly performed acupuncture can cause potentially serious side effects.
In addition to acupuncture, other traditional Asian practices that have been used for OA include cupping (applying a cup to the skin and creating suction either mechanically or by using heat) and moxibustion (burning an herb above the skin to apply heat to acupuncture points). Only a small amount of research has been done on the use of these practices for OA. A single study evaluated cupping for OA; its results were promising, but it’s a very preliminary study. Several studies evaluated moxibustion for OA symptoms and found that it might be helpful; however, because the amount of research was small and the studies may have been biased, definite conclusions cannot be reached.
Both cupping and moxibustion can leave marks on the skin, which are usually temporary. Because cupping may draw blood, it could expose people to disease-causing microorganisms if the same device is used on more than one person without being sterilized after each use. Moxibustion has been linked to allergic reactions, burns, and infections.
Very few studies have evaluated massage therapy for OA. The small amount of available evidence suggests that massage may help to reduce symptoms in people with knee OA.
Massage therapy appears to have few risks when performed by a trained practitioner. However, arthritis-stressed joints are sensitive, so massage therapists who treat people with OA need to be familiar with the special needs of people with this condition.
Tai chi and qi gong are traditional mind and body practices of Chinese origin. They combine certain postures and gentle, dance-like body movements with mental focus, breathing, and relaxation.
Several studies have evaluated the effects of tai chi on knee OA. In general, they showed short-term improvements in pain, stiffness, and physical function. Some studies also showed other desirable changes, such as improved balance or reduced depression. In a 2016 study in which tai chi was compared with physical therapy for knee osteoarthritis and patients were encouraged to continue their exercises after the 12-week study period ended, patients in both the tai chi and physical therapy groups showed improvement in pain for a full year. Much less research has been done on qi gong, but the few studies that have been completed showed improvements in some OA symptoms.
Tai chi and qi gong are generally considered to be safe practices. However, side effects, such as temporarily increased knee pain, have been reported in some people with OA.
Yoga incorporates several elements of exercise that may be beneficial for arthritis, including activities that may help improve strength and flexibility. However, very little research has been done on yoga for OA, so it’s uncertain whether it’s helpful.
Before starting to do yoga, people with OA should discuss their special needs with their health care provider and the yoga instructor. Props and modifications may be necessary to make yoga safe and comfortable for people with OA.
Other Complementary Health Approaches for Osteoarthritis
Balneotherapy is the technique of bathing in mineral water for health purposes; it also includes related practices such as mud packs. Although some studies have reported that balneotherapy can reduce pain in OA, the amount of high-quality research is too small for definite conclusions to be reached.
Balneotherapy has a good safety record.
There’s little evidence to support homeopathy as an effective approach for OA symptoms, particularly pain. There’s been no recent research on the effects of homeopathy on OA.
Although most homeopathic products are highly dilute and therefore considered to be safe, some contain ingredients in amounts large enough that they could cause harmful effects. There have also been instances when potentially harmful contaminants have been found in homeopathic products.
The available scientific evidence does not support using static magnets for pain relief. Static magnets are magnets often sold in shoe insoles, wrist wraps, headbands, and similar products. A small amount of evidence suggests that electromagnetic field therapy, which involves the use of small machines or mats to deliver an electromagnetic field to a joint or to the whole body, may provide some pain relief in OA, but it’s unclear whether it has a meaningful effect on physical function or quality of life for OA patients.
Static magnets are generally considered safe. Information about the safety of electromagnetic field therapy is limited, but few adverse effects have been reported in studies of this technique. Magnetic devices of any kind may be hazardous for people with certain types of implanted medical devices, such as pacemakers.
Guidelines for Treating Osteoarthritis
National health professional organizations have issued guidelines for treating OA. Some mention the use of complementary approaches.
The American College of Rheumatology’s guidelines
- Conditionally recommend tai chi for knee OA
- Conditionally recommend acupuncture for knee OA patients who are candidates for knee replacement but who cannot or will not have the surgery
- Conditionally recommend against the use of glucosamine and chondroitin for knee or hip OA
- Conditionally recommend topical capsaicin for hand OA but conditionally recommend against its use for knee OA.
The American Academy of Orthopaedic Surgeons’ guidelines for treating OA of the knee
- Strongly recommend against acupuncture
- Strongly recommend against glucosamine and chondroitin.
For more information, see the list of clinical practice guidelines on NCCIH’s Web page on arthritis.
NCCIH-Funded Research
NCCIH is funding a variety of studies on OA. Topics include:
- A comparison of the effectiveness and cost-effectiveness of tai chi and standard physical therapy in patients with OA of the knee
- The effects of a chair yoga program on elderly people with OA
- An investigation of brain activity patterns associated with pain relief in people with knee OA who are receiving acupuncture or simulated acupuncture treatments.
More To Consider
- Don’t use complementary health approaches to postpone seeing your health care provider about joint symptoms or any other health problem.
- Keep in mind that dietary supplements may interact with medications or other supplements and may contain ingredients not listed on the label. Your health care provider can advise you. To learn more about using dietary supplements, see the NCCIH fact sheet Using Dietary Supplements Wisely.
- Tell all your health care providers about any complementary or integrative health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.
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
Website: https://nccih.nih.gov/
Email: info@nccih.nih.gov (link sends e-mail)
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
Website: https://www.niams.nih.gov
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.
Website: https://pubmed.ncbi.nlm.nih.gov/
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Acknowledgments
NCCIH thanks Partap Khalsa, D.C., Ph.D., NCCIH, for his contributions to the 2016 update of this publication.
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