Natural remedies, supplements, and vitamins for RA

A variety of natural remedies including herbs, vitamins, minerals, and other supplements may be useful in the management of RA. Some of these substances have anti-inflammatory effects that may provide direct relief of RA symptoms and others may be useful in managing health complications and conditions that commonly affect individuals with RA.

Vitamins and minerals with potential benefit in RA include vitamins D, B6, B9 (folic acid), B12, C, A (beta carotene), and E and selenium, boron, calcium, and zinc. Several chemical supplements with potential benefits in RA include:

• Melatonin
• Chondroitin sulfate
• Dehydroepiandrosterone (DHEA)
• Dimethyl sulfoxide (DMSO)
• Glucosamine
• Methylsulfonylmethane (MSM)
• Sam-e

Herbal supplements and preparations with potential usefulness in RA include those with anti-inflammatory effects (alfalfa, angelica, bladderwrack, bowsellia, cat’s claw, curcumin, devil’s claw, sarsapareilla, evening primrose, and bromelain), anti-rheumatic effects (thunder god vine, meadowsweet, and celery), sedative effects to aid sleep (valerian and kava kava), and analgesic  effects for pain relief (capsaicin, fennel, burdock, aloe, ginger, black mustard, St. John’s Wort, and stinging nettle).

Always check with your doctor first

Because herbs and other plant-based products, vitamins, minerals, and other supplements, can react with pharmaceutical treatments for RA and may pose a risk when taken at too high a dosage, it is important to discuss your use of these substances with your doctor. Your doctor has the resources and tools to identify potential harmful interactions between treatments, both prescribed and non-prescribed, to ensure your safety. In addition, your doctor can help you determine the proper dosage for supplements that you decide to use.

Dosing is an important factor with vitamin or mineral supplements. Vitamins or minerals taken at a certain dose may be beneficial. However, taken at a higher dose, the same vitamin or mineral may be harmful. So, it is very important to work with your doctor and other members of your care team to determine which supplements you should take and what the proper dose should be.

Basics about vitamins and minerals

Vitamins are chemicals that our bodies need to maintain health. Except for vitamin D, which is produced in our bodies when we’re exposed to sun (we can also get vitamin D from different foods), we typically get our daily requirement of vitamins from dietary sources (foods and drinks).

Minerals are inorganic substances. Like vitamins, our bodies need certain minerals to stay healthy and we can get these from dietary sources. The Food and Nutrition Board of the US National Academy of Sciences has defined the amounts of different vitamins and minerals that we need to consume on a daily basis. These amounts are called the recommended daily allowance (RDA).

There is general agreement that consuming the RDA of basic vitamins and minerals is needed to stay healthy. There is controversy, however, about whether we should take more than the RDA of certain vitamins and minerals. We know that getting too much of some vitamins and minerals may be dangerous to our health. This is why it is important to talk to your doctor before you take any vitamin or mineral supplement (or any other type of supplement).

You can find out more information about RDAs for vitamins and minerals based on your age and gender by visiting the US Department of Agriculture Food and Nutrition Information Center.

Vitamins and minerals in RA

A variety of vitamins, minerals, and other related supplements have been evaluated for use in people with RA. The most important of these include vitamins D, B6, B9 (folic acid), and B12, antioxidant vitamins and minerals vitamins C, A, and E and selenium, and the minerals boron, calcium, and zinc.

Vitamin D

Vitamin D supplements are potentially important for people with RA for two reasons. Vitamin D is recognized as important in maintaining bone health and people with RA are at significantly increased risk for osteoporosis and bone loss due to RA disease processes and glucocorticoid use. Vitamin D also plays an important role in immune system function. Abnormalities in the way cells use vitamin D have been linked to various autoimmune diseases.¹

Adequate vitamin D intake also appears to protect against developing RA. One 11-year study that followed approximately 30,000 women who did not have RA at the beginning of the study found that those women who had a low vitamin D intake (less than 200 international units [IU] per day) were 33% more likely to develop RA than those with a higher daily intake of vitamin D.²

Your doctor can check your vitamin D level with a simple blood test called 25 hydroxyvitamin D (250HD, for short). This test measures vitamin D levels in blood as either nanograms per milliliter (ng/mL) or in IUs (nanomoles per liter [nmol/L]), with 1 ng/mL equal to 2.496 nmol/L or IUs.  While there is no formal definition for vitamin D deficiency, there are some values that are generally used as a guide for what normal and deficient mean.¹

• Normal: 250HD level higher than 30 ng/mL (75 nmol/L)
• Insufficient: 250HD level between 20 and 30 ng/mL (50-75 nmol/L)
• Deficiency: 250HD level less than 20 ng/mL (50 nmol/L)
• Toxic: 250HD level greater than 150 ng/mL (375 nmol/L)

Two forms of vitamin D are available in supplements, vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Vitamin D3 is the recommended rather than vitamin D2 because the former is the naturally occurring form of the vitamin and may be more effective at raising blood levels.¹

The upper limit of vitamin D3 daily dosing for adults is 10,000 IU (250 micrograms [mcg or μg]). For bone health, the goal of vitamin D supplementation is to achieve a 250HD level in the range of 30 to 60 ng/mL. The optimal vitamin D3 250HD range for immune system effects is less clear. Remember to consult with your doctor before you take any supplement. This is especially important with vitamin D, because taking too much of this vitamin can pose a danger to your health.¹

Antioxidant vitamins

The idea behind taking antioxidant vitamins, which include vitamin A (usually taken as beta-carotene, which is a safer form of the vitamin), and vitamins C and E, is that these vitamins reduce damage caused by free radicals. A free radical (also called an oxidant) is a molecule in the body that has an unpaired electron. These molecules are very unstable because they are constantly trying to pair their unpaired electron. This causes them to react with other substances in the body, causing what is sometimes called oxidative damage. You can get the RDA of antioxidant vitamins by eating 3 to 4 servings of vegetables and 2 to 4 servings of fruits every day. However, you can also take supplements to ensure that you are getting adequate amounts of these vitamins.³

Vitamin E, which is available in vegetables, nuts, meats, vegetable oils, and fruits, prevents oxidative damage in the body.⁴

Vitamin A is an important vitamin for eye health as well as normal cell growth throughout the body. Sources of vitamin A include liver, eggs, and cod liver oil. Fat soluble vitamins such as vitamin A are stored in the body and are not eliminated as quickly as water soluble vitamins.  Excess vitamin A may accumulate in body tissues over time and become toxic. Therefore, you should avoid taking too much of this vitamin.⁵

The RDA of vitamin A for men and women ranges from 2,300 to 3,000 international units (IU). If you are pregnant, you should not consume high amounts of vitamin A, because intake of excessive amounts of this vitamin may result in birth defects. Pregnant women should limit vitamin A intake to the safer form of the vitamin called beta-carotene found in fruits and vegetables.⁵

B vitamins

Whole grains, such as rye, barley, and wheat, fish (salmon and tuna), chicken and pork, and bananas provide dietary sources for B vitamins, including vitamin B6 (pyridoxine), vitamin B3 (niacin), vitamin B5 (pantothenic acid), and vitamin B12 (cobalamin). Dietary sources for vitamin B9 (folic acid) include leafy vegetables (spinach, broccoli, lettuce), okra, asparagus, cereals, fruits (lemons, melons, bananas), organ meat, legumes, yeast, mushrooms, and orange and tomato juice.⁶

There is some evidence that B vitamins provide benefits in people with RA. For instance, vitamin B6 has been shown to reduce levels of inflammatory markers, including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), in patients with RA.⁷

In select studies, vitamin B6 has been shown to be potentially useful in relieving stiffness and pain associated with carpal tunnel syndrome, a common comorbidity with RA.⁸

Vitamin B12 supplementation has been shown to improve joint pain in the elbow.⁹

In addition to its potential benefits in RA, B vitamins (when combined together are sometimes called B complex vitamins), including B6, B9 (folic acid), and B12, taken together can lower homocysteine, an amino acid which is linked to increased risk for heart attack and stroke. Because individuals with RA face increased risk for cardiovascular disease, getting adequate amounts of B complex vitamins is important.⁹

Selenium

Sources of the mineral selenium, which has antioxidant properties potentially useful in RA, include legumes, seafood, whole grains, lean meats, and dairy products. Selenium is present in antioxidant enzymes (thioredoxin reductase and glutathione peroxidase) which are active in reducing certain oxidized molecules in the body. Recommended dosages for supplements of selenium typically range from 100 to 200 micrograms (mcg) per day.¹⁰

Calcium

Adequate intake of calcium, which is the most abundant mineral in the body, is important to maintain the health of bones, teeth, and the regulation of vital body processes. Dietary sources of calcium include dairy products, leafy vegetables, and eggs. People with RA are at increased risk for bone loss, so adequate calcium intake is crucial (RDA for adults: 1,000 to 1,200 mg). However, calcium can be taken in excess and may result in toxic effects. To avoid this risk, calcium intake should not exceed 2,000 mg per day for those over 50 years of age and 2,500 mg for those 19 to 50 years of age.¹¹

Zinc

Zinc is used in many different processes in the body and is essential for good health (RDA for men: 11 mg; women: 8 mg). Dietary sources of zinc include seafood, eggs, meat, wheat germ, and yogurt. The typical dose for a zinc supplement is 50 mg. Although no study has implicated low levels of zinc as a cause of RA, results from studies have shown that some people with RA have low levels of zinc and that the metabolism of zinc may be impaired in individuals with RA. Studies evaluating the use of zinc supplements in people with RA have produced conflicting results, with one study showing improvements in symptoms and others showing no effects at all.¹²

Boron

The mineral boron contributes to bone health by regulating the rate of calcium resorption (release of calcium as bones are broken down) and may be useful in patients with RA who are deficient in vitamin D. Dietary sources of boron include fruits, such as apples and peaches, peas, beans, lentils, almonds, peanuts, grapes, and hazelnuts. As a supplement, boron is typically taken at a dose of 3 to 9 mg. Studies of boron supplementation in patients with RA indicate that the mineral may help relieve inflammation.¹³

Chemical supplements and preparations

There are a variety of chemical supplements and preparations that have potential benefits as adjuncts (this means a treatment that is secondary or supportive) to conventional RA treatments.

Melatonin. Melatonin is a hormone secreted by the pineal gland (a small gland located near the center of the brain) that plays an important role in regulating our sleep-wake cycle, among other body functions. Based on a limited body of research, melatonin may be effective in fighting inflammation, and, therefore, useful in RA. However, there is currently limited evidence to support its use as an anti-inflammatory treatment.¹⁴

Chondroitin sulfate. The natural chemical compound chondroitin sulfate is a key part of cartilage and other connective tissue. A synthesized form of chondroitin given as an oral supplement (often combined with glucosamine, another component of cartilage) is used in patients with osteoarthritis where it has resulted in moderate to major improvements in joint symptoms, including decreased pain and improved function. There is currently limited evidence for the effectiveness of chondroitin in RA.¹⁵

Glucosamine. The natural chemical compound glucosamine is a key component of human cartilage. A synthesized form of glucosamine given as an oral supplement (often combined with chondroitin, its partner compound) is used in patients with osteoarthritis where it has resulted in moderate to major improvements in joint symptoms, including decreased pain and improved function. There is currently only limited evidence for the effectiveness of chondroitin in RA.¹⁶

Sam-e (S-Adenosyl methionine).  Sam-e is a chemical that occurs naturally throughout the entire body. It is made of the essential sulfur-containing amino acid methionine, a component of most proteins in the body, and the energy-producing compound adenosine triphosphate (ATP), found in all cells in the body.

Sam-e has been shown to have anti-inflammatory and analgesic (pain relief) properties and is commonly used as a supplement to treat musculoskeletal disorders, such as osteoarthritis, and other health conditions, including heart disease and depression. Studies have demonstrated that Sam-e is effective in relieving pain associated with osteoarthritis. However, there is only limited evidence of benefit in RA.¹⁷

Dehydroepiandrosterone (DHEA). DHEA is an endogenous (this means produced in the body) steroid produced by the adrenal gland which plays a role in a broad range of biological functions in the body. DHEA is used within the body to produce male and female sex hormones (androgens and estrogens, respectively). DHEA has been found to be effective as an adjunctive (this means secondary or supportive) treatment for adrenal insufficiency, depression, and systemic lupus erythematosus (SLE), as well as for inducing labor in pregnant women. Additionally, there is some evidence that DHEA may be beneficial in improving bone density. A limited number of studies have evaluated DHEA as a treatment for RA. Results from these studies have been inconclusive.¹⁸

Dimethyl sulfoxide (DMSO). DMSO is an organic compound that occurs naturally in fruits, vegetables, grains, and selected animal products. It is also a byproduct of paper manufacturing and is a powerful solvent with the ability to penetrate plant and animal tissues. DMSO is used as a topical analgesic to block pain signals. In a randomized, controlled trial conducted in patients with RA, DMSO applied as a topical gel resulted in significant reduction in pain.¹⁹

Methylsulfonylmethane (MSM). MSM is a natural, sulfur-containing compound found in fruits, vegetables, grains, and animal products. It is an oxidative product of DMSO (this means MSM is produced when DMSO is exposed to oxygen). MSM is recognized as a potent antioxidant and has been shown to be effective for the relief of inflammation and pain associated with osteoarthritis.²⁰

Learn more about DHEA, DMSO, and MSM

Herbal supplements and preparations

There are a variety of herbal supplements and preparations with potential benefits for individuals with RA. These supplements and preparations are available in different formulations, including as raw herbs freshly harvested, extracts in liquid or powder form, infusions made by steeping an herb or plant in boiling water (like a tea), tinctures made by steeping an herb in alcohol, and topical preparations. Herbal supplements and preparations can be categorized by their main effects (although many have multiple potential benefits in RA), including anti-inflammatory, anti-rheumatic, sedative, and analgesic effects.