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Supplements for RA: What to Know

Medically Reviewed by Melinda Ratini, DO, MS on April 02, 2022

Medication and other forms of treatment play a major role in managing rheumatoid arthritis. Supplements aren't a treatment -- they don't promise to cure or treat any condition, and they don't have to meet the same standards as medications. But if you're looking into trying some in addition to your treatment plan, here's what you should know.

First, be sure you talk to your doctor before you begin using any supplement or herbal medication. They may interact with other drugs, supplements, or herbal medicines you are taking and cause serious side effects. They may also put you at a higher risk for certain conditions.

Possible Vitamin and Mineral Deficiencies in RA

Folate: A common RA medication, methotrexate, destroys folate. That’s why doctors will often prescribe folate supplements for those on this medication. You also get folate in green leafy vegetables like kale and spinach as well as in orange juice, most fruits, dried beans, and peas.

Iron: Low red blood cell levels (anemia) is common in people with RA. It may be because inflammation from RA makes it harder to absorb iron or it could be due to bleeding in your digestive system from RA medications. Whatever the cause, you and your doctor will work to get to the bottom of it and come up with a solution, whether it is a diet change or supplements. You can get iron from beef, liver, fish, and turkey. It’s easier to absorb from animal sources, but you can also get it from spinach, raisins, beans, and peas.

Vitamin B2: Some research shows that the RA medication methotrexate may interfere with absorption of B2. You can get B2 from fortified cereals and grains, organ meat, yogurt, milk, and eggs.

Vitamin B6: Research seems to show inflammation from RA lowers B6 levels which in turn makes the inflammation worse. In addition, the NSAIDs that many people use to treat their inflammation lowers B6 levels in people with RA. You and your doctor should monitor B6 levels and supplement where needed. Get more from fish, chicken, turkey, chickpeas, potatoes, and non-citrus fruits.

Vitamin D: You’re more likely to be deficient in vitamin D if you have RA. And some research shows that people with the lowest vitamin D levels have the most serious symptoms and the worst response to treatment. Sunlight is the main source of vitamin D for most people, but you can get some from salmon, tuna, and sardines as well. Fortified foods like juice, cereal, and milk may also have it.

Zinc: Zinc levels are significantly lower in people with RA. And those with the most serious disease tend to have the lowest levels. It may be that zinc helps RA symptoms by supporting healthy cartilage growth and proper immune response. Get it from crab, lobster, oysters, red meat, chicken, turkey, fortified breakfast cereals, and whole grains.

Selenium: There is some evidence that selenium may help prevent RA in people who don’t have it yet. But research doesn’t yet show that it helps with symptoms or progression of RA once you already have the disease. Get it from Brazil nuts, tuna, shrimp, and turkey.

Keep in mind that food is almost always the best source of vitamins and minerals. If you do decide to take a supplement, it’s important to remember more is not always better. Just as too little of a vitamin or mineral can take a toll on your health, too much can be bad as well.

People who get too much, usually do so by taking supplements. Many supplements also can interfere with your other medications or cause other symptoms.

That’s why you should always talk to your doctor about which supplements to take and how much. Be sure and tell your doctor about any and all health conditions and all medications you take.

Borage Seed Oil

This is a plant-based oil. This supplement might help reduce joint swelling and tenderness if taken with a pain reliever or anti-inflammatory medication.

Borage seed oil can cause serious side effects. Your liver may not work as well, and you could have problems with bleeding.

Not Enough Research

Omega-3 fatty acids: Early research shows that some of these supplements may help with rheumatoid arthritis, but there haven’t been enough good studies to tell. In other cases, studies are too preliminary, or findings are conflicting or aren’t high quality.

You'll notice that some of these items -- like green tea, ginger, turmeric, and probiotics -- are found in foods. The research here is on their use as supplements.

Boswellia: The research on this is limited and conflicting.

Cat's claw: Though it's been used for more than 2,000 years for various health concerns, there haven't been enough high-quality clinical trials, and there's no conclusive evidence of any benefits.

Evening primrose: Research on the use of evening primrose oil is both preliminary and conflicting.

Ginger: Studies show that this herb has anti-inflammatory benefits in animals. In a study of 70 people with RA, using ginger powder helped their Disease Activity Score, a measure the researchers used to note how active RA is.

Green tea: Research shows that this supplement may be able to lower inflammation and protect cartilage. But it hasn't been tested for rheumatoid arthritis in people.

Moringa: Early studies done in lab animals show that this plant can reduce inflammation and swelling from fluid buildup. It's not clear if that would be true in people.

Probiotics: A type of probiotic called lactobacillus can slightly affect Disease Activity Score, which is a way researchers note how active RA is. But it doesn't seem to make a difference with joint swelling or signs of inflammation, which are factored into the Disease Activity Score. And there are many strains of probiotics, and they don't have enough research behind them.

Sesame (Sesamum indicum): Sesamin, a plant compound from sesame seeds, showed some promise in an early study of 44 women with RA. For 6 weeks, half of the women took the supplement; the rest got a placebo. They had less inflammation during the study period. But it's too early to know how that translates into symptoms.

Turmeric/curcumin: Some studies show that taking a substance within turmeric called curcumin in higher doses may help with symptoms like swelling and stiffness. Lower doses or different formulations may not help with joint swelling and tenderness or make rheumatoid arthritis less active, some researchers note.

Safety First

Arnica: Don't take it by mouth, as it's poisonous when used orally.

Chaparral: Don't take it by mouth. It can be toxic for your liver and kidneys if you take products with it by mouth.

Thunder god vine: Some early research suggests this supplement may be helpful for rheumatoid arthritis but can cause serious side effects -- and there haven't been enough studies of it. If the supplement isn't prepared correctly, it can be poisonous. The risks may outweigh the benefits, according to the National Center for Complementary and Integrative Health.

Show Sources

SOURCES:

Arthritis Foundation: “10 Supplements for Arthritis.”

UpToDate: “Patient education: Complementary and alternative therapies for rheumatoid arthritis (Beyond the Basics).”

National Rheumatoid Arthritis Society: “The DAS28 score.”

Harvard Health Publishing: “Ask the doctor: How does hot pepper cream work to relieve pain?”

Natural Medicines/ Natural Medicines Comprehensive Database.

National Institutes of Health, Osteoporosis and Related Bone Diseases National Resource Center: “What People With Rheumatoid Arthritis Need To Know About Osteoporosis.”

National Center for Complementary and Integrative Health: “Thunder God Vine.”

Cedars Sinai: “Corticosteroid-Induced Osteoporosis.”

FDA: “Information for Consumers on Using Dietary Supplements.”

Keck Medicine of University of South Carolina: “Can Vitamin D Help Relieve Your Rheumatoid Arthritis?

Beth Israel Lahey Health, Winchester Hospital: “Health Library, Rheumatoid Arthritis.”

Nutrients: “Phytomedicine in Joint Disorders.”

Nutrition Reviews: “Dietary lignans: physiology and potential for cardiovascular disease risk reduction.”

NPS Medicinewise: "Fish oil supplements: do they have a role in the management of rheumatoid arthritis?"

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