Osteoarthritis

There are a range of conventional and natural products available that might help arthritic pain. For safe use of over-the-counter medicines, herbal remedies and supplements, consult a qualified person (such as a pharmacist) before buying or taking any medicine, remedy or supplement:
– if you have a serious medical condition
– if you are breast-feeding, pregnant or planning to become pregnant
– if you suffer from allergies

Registered herbal medicines (bearing the THR logo) will have a package insert. Read this before taking the product.

Avoid taking the product if you think you may be allergic to any of the ingredients.

Do not combine over-the-counter medicines, remedies or supplements with prescribed medicines unless you have first checked with your prescriber or a pharmacist.

Seek advice from your doctor or pharmacist:
– If your symptoms do not get better
– if your symptoms get worse
– if you get new symptoms or have a side effect

The information here, including dosages, only applies to adults (over 16 years). Keep all medicines out of the reach of children.

Many modern drugs started as medicinal plants and people have been using herbs to treat illnesses for thousand of years. Some of these remedies have been tested against the toughest health conditions, and plants with the strongest reputations across many cultures deserve a close look.

From the way they have been described in old texts, and from what we now know of the action of many plant constituents, it is possible favourite plant remedies work particularly by nudging better function in digestion, circulation, and eliminatory processes: helping the body help itself rather than directly attack a disease. Women also favoured plants in managing their health and childrearing needs.

Researchers are now discovering that many herbal medicines have useful benefits for the body, including in healing and repair, in stabilising hormonal responses (including stress hormones, insulin and sex hormones), and in reducing long-term inflammation.

Summary
Rubbing anti-inflammatories into the joints, rather than swallowing them, has the advantage of getting the medication directly into the affected tissues. The drug is not absorbed through the skin as well as it is when you take it by mouth, and it is less likely to cause internal side-effects such as stomach ulcers and bleeding. However any NSAID can cause heart or circulation problems especially if you use it long term.

Evidence
Anti-inflammatory creams and gels definitely soak through the skin into muscles and joint fluid. They may help, but their effectiveness varies a great deal. One trial of anti-inflammatory creams and gels found that patients experiencing hand osteoarthritis get their pain decreased by 46% in 6 weeks after treatment started. And patients with knee osteoarthritis experienced relief of the pain by 51% in 12 weeks after the start of the treatment.

Safety
Do not apply anti-inflammatory creams and gels if you are taking other NSAIDs drugs or aspirin as this may increase the possibility of side effects.

Do not use anti-inflammatory creams and gels if aspirin or any non-steroidal anti-inflammatory drug (NSAID eg ibuprofen, diclofenac) have ever given you asthma or a severe allergic reaction.

Serious digestive side-effects can still occur but much less often with creams and gels than with tablets. Rarely, stomach bleeding or perforation can happen without warning while you are using anti-inflammatory creams and gels, especially in older adults. So if you have symptoms of stomach bleeding (black, bloody, or tarry stools, or vomit that looks like coffee grounds) go to A&E immediately.

In about 10 – 15% of people, anti-inflammatory creams and gels cause a skin irritation

Cost
Approximate costs should be no more than £10 per month.

Summary
Boswellia, or frankincense, is extracted from a tropical plant, Boswellia serrata, traditionally used in India for many diseases. Research has shown that it can stop the body producing some substances that trigger joint inflammation. 

Evidence
Trials suggest that boswellia may have some helpful effects in osteoarthritis of the knee.

Safety
A daily dose of 1g has been used in research trials for osteoarthritis. This seems to be safe in the short-term. Its safety is uncertain if you are using it for more than 12 weeks. Possible side effects include digestive upsets.

Cost
Capsules are available from pharmacies and healthfood shops, and may cost up to £15 per month.

Summary
Capsaicin is the hot constituent in chilli peppers, and it offsets joint pain by stimulating the relevant nerve fibres to send less pain signals, and inducing increased blod flow to the joint. So if you have osteoarthritis in your hands or knees and anti-inflammatory creams and gels haven’t eased your pain, your GP might suggest you try capsaicin. You can get it on prescription but if it works for you it will be an excellent form of self-care pain relief.

Evidence
There is some good evidence from research that, alongside the usual treatments, applying capsaicin can help with pain and tenderness in osteoarthritis, particularly in the knees or hands.

Safety
Capsaicin is an irritant, and some people find its irritating effect worse than the pain it is meant to offset. About one-third of patients get local adverse effects from capsaicin.

Always read the package instructions before use, and avoid using capsaicin if you think you may be allergic to it.

Use plastic gloves when you apply it. Keep it away from your eyes and wash your hands immediately after applying it. Keep it away from children. Wash it off any skin areas that do not need treating, using warm cooking oil, rather than soap or detergent. Natural acids like lemon juice or vinegar can be very effective.

Cost
Speak to your GP about prescription of this product. You may also buy it over the counter at around £6.

Further information
To find out more, see Ten things you should know about capsaicin

Summary
Chondroitin helps cartilage retain water. Chondroitin supplements are generally made from cow cartilage. Chondroitin sulfate is generally combined with glucosamine (see below). The usual dose is 1500 mg of glucosamine and 1200 of chondroitin daily for 1- 2 months. It may take weeks or months before improvements are noticed. If it helps, the dose can then be reduced to 1000 mg of glucosamine and 800 of chondroitin or less.

Evidence
It is not clear from research whether chondroitin used alone helps with osteoarthritis. But it may help with pain in the short term.

Safety
The long-term safety and effectiveness of chondroitin are unclear. Its reported side-effects include stomach upsets, headaches and rashes, but these are uncommon. Patients taking aspirin, heparin or warfarin should let their doctor know if they are taking chondroitin. Chondroitin might worsen breathing problems in people with asthma. 

Cost
Approximate costs will be from £15 per month.

Summary
This unusual plant from the desert regions of southern Africa has a thorny root, which the local people traditionally used as a remedy for arthritic problems. It is becoming rare nowadays in its natural state so it is important to buy from reliable manufacturers who supply only farm-grown devil’s claw. Devil’s claw is available in the UK as a registered herbal medicine (marked by the THR logo on the package). This a guarantee that the important constituents and general quality will be assured.

Evidence
There is moderate evidence showing that devil’s claw may be as effective as conventional medicines for osteoarthritis of the hip and knee.

Safety
Most of the side-effects seem to be mild and uncommon and include stomach upsets (though not for the same reasons as aspirin or derivatives like ibuprofen).

Cost
A THR devils’ claw product will cost between £15-20 per month.

Summary
Ginger preparations are made from the underground stem or rhizome (called ginger root). Laboratory studies have shown that ginger extracts can lessen the effect of several chemical substances that trigger joint inflammation. 

Evidence
Several trials have shown that ginger may ease pain and help with movement.

Safety
Being also a food, ginger is a safe herbal remedy. The most commonly reported side-effects are stomach upsets and a sore mouth, all minor. Taking ginger might also increase the risk of bleeding if you are taking blood-thinning medications like aspirin, heparin and warfarin.

Cost
Ginger capsules and ginger oil are available from pharmacies and health food shops. and may cost up to £10 per month. Good ginger teas are also effective. You can also use fresh grated ginger (for example in a tea) or even crystallised ginger.

Summary
Glucosamine and chondroitin sulfate are sold as dietary supplements in most pharmacies and healthfood shops. A lot of people now taking glucosamine and/or chondroitin for osteoarthritis say it helps reduce pain. It isn’t clear yet whether these supplements actually slow down the wear and tear in joint cartilage. The body produces glucosamine in cartilage and connective tissue. 

If you take glucosamine in capsule form, you will need at least 1500 mg per day. The usual dose is 1500 mg of glucosamine and 1200 of chondroitin daily for 1- 2 months. It may take weeks or months before improvements are noticed. If it helps, the dose can then be reduced to 1000 mg of glucosamine and 800 of chondroitin or less.

Evidence
A recent big study in the USA found that glucosamine sulphate combined with chondroitin sulfate did not help mild pain. But for people with moderate-to-severe pain, it did give significant relief. There have been many clinical trials of glucosamine for osteoarthritis, but results have been both for and against glucosamine’s usefulness. Consequently doctors are not sure whether to recommend it, and it has yet not been approved for NHS prescribing.

Safety
Side-effects are rare and mild such as upset stomach. Glucosamine supplements are made from shellfish shells. We have found no reports of allergic reactions to these supplements.

Cost
Glucosamine tablets are available online, and from health food shops and may cost up to £20 per month.

Summary
Green-lipped mussel extract is a nutritional supplement made from a type of New Zealand mussel (Perna canaliculus). 

Evidence
Some research studies have suggested that this supplement may help in mild to moderate osteoarthritis, when taken alongside paracetamol or anti-inflammatories.

Safety
Only minor side-effects, such as stomach upsets, have been noted. But problems may arise if this supplement is combined with blood-thinning medications such as aspirin or warfarin. Recommended safe doses are uncertain.

Cost
Available from pharmacists and healthfood shops as capsules and gel at up to £15 per month.

Summary
Anti-inflammatory tablets (such as ibuprofen) are slightly more effective than paracetamol for easing knee and hip pain in people with osteoarthritis. 

Evidence
There is good evidence to show that painkillers such as ibuprofen help with pain. Paracetamol also has some effect but not as much as ibuprofen.

Safety
If used in the correct dose, painkillers are generally safe, but taking painkillers (whether prescription or over-the-counter) every day can cause side effects.

Side effects can include headaches, indigestion and even stomach ulcers or bleeding. Stop taking them if you start getting indigestion or stomach pain, and tell your GP or pharmacist. Always follow the stated dose.

Cost
Painkillers can be bought from pharmacies for low cost.

Summary
Rosehip (Rosa canina) is a traditional herbal medication which contains substances that might reduce joint inflammation and help prevent joint damage. 

Evidence
Research suggests that rosehip may be helpful in relieving some of the symptoms of osteoarthritis. A dosage of 5g per day has been used in various clinical trials.

Safety
Side-effects are uncommon and mild, and include allergies and stomach upsets.

Cost
Approximate costs will be no more than £15 per month.

Summary
TENS is a way of delivering a small, pulsating current to your muscles and nerve endings. It is relatively easy and safe to use. Small electrical currents are sent through pads on the skin near the site of the pain. Several small studies have suggested that using TENS machines helps some people with long-term pain in general. 

Evidence
There have been a few small studies of TENS for osteoarthritis of the knee, but they haven’t firmly established whether or not TENS gives effective pain relief.

Safety
See the information sheet on TENS machines from Versus Arthritis for information on how to use TENS machines safely.

Cost
TENS machines are available from many pharmacies and some online retailers. They usually cost between £25 and £60 but this is a one-off cost.

Summary
Turmeric has an extremely long history as a food and medicine in India and across Asia. Its applications include arthritic pain and other inflammatory conditions.

Evidence
Turmeric has been shown to be useful in knee osteoarthritis, reducing the pain and preserving functionality with an efficiency equivalent to ibuprofen, but with fewer gastrointestinal side effects.

Safety
Being a food, turmeric is a safe herbal remedy and no side effects are expected.

Cost
Turmeric capsules are available online, from supermarkets, pharmacies and health food shops. and may cost up to £25 per month.

Summary
Arthritis has been recognised as a problem throughout history – it is seen even in prehistoric bones – and there are many traditional approaches to treating it.

The first principle across many cultures is to apply heat. Not only is there often temporary relief but if vigorous enough there could be something more lasting. Simple hot water bottles or hot packs are commonly applied but extra heating agents were also popular. These could include mustard, cayenne (chilli), ginger and horseradish. In Europe there is even a persistent tradition of beating arthritic joints with stinging nettles! There are scientific studies that back all of these approaches: we now understand that these agents can ‘counter-irritate’ and reduce pain signals. Perhaps more significantly any heating increases circulation: this can in effect substitute for the cause of the arthritis. The inflammatory response includes a major increase in blood flow so as to bring defensive agents to the site. The strength of the heating remedy may be in the degree to which it does the same without the pain.

Most of the heating agents above can be used as homemade plasters, applied to a gauze strip and applied under a hot pack. Mustard has often been used as a hot bath for small peripheral joints in hands and feet (make the bath concentrated enough by using a small bowl kept hot inside a larger bowl of hot water). 

Another common model to explain arthritis was that it results from accumulation of toxins or waste products on the joints. In traditional European medicine these were classified as ‘acids’. There is some plausibility in this image: the tissues are constantly producing metabolites that are mainly acidic and the body spends much energy eliminating these from the body. The kidneys are specialists at this, the bowels are the major outlet, and the lungs excrete carbon dioxide, an acidic product. The idea was that arthritis and other illnesses happen when these eliminatory pathways are inadequate for the job. The overwhelming advice was to reduce intake of ‘acidic’ foods, which meant eating more plants. Confusingly it is not the taste that counts but what is left behind after digestion. A good example of the difference is seen by comparing lemons with the ash they leave after being burnt: the fruit is acidic, the ask is alkaline. Digestion leads to essentially the same endpoints as combustion. Lemon and most citrus are classified as alkaline foods. The take home message? Most plant foods are alkaline; most animal foods are acidic.

An associated folk explanation was that the kidneys were where acid wastes were best eliminated and that these were particularly involved in arthritic pain. Common arthritic remedies were often also classified as diuretic – ie. they were associated with increased urine production. Two classic examples of these remedies in Europe were

Celery seed (Apium graveolens) – commonly used for arthritis, particularly in reducing acid accumulation of gout. Often combined with –

Dandelion root (Taraxacum officinale) – both a diuretic and a traditional liver remedy.

Other diuretic remedies often used for arthritis in the European tradition were –

Birch (Betula spp) – all parts of the tree

Burdock root (Artium lappa)

Cleavers (Galium aparine)

Nettle leaf (Urtica spp)

Safety
The diuretic remedies above are all likely to be safe to take as home remedies, usually as teas.

There are risks in applying heating agents although these are almost always only short-term. Some types of arthritis can be exacerbated by heat – this will be obvious and will not last. If heat does suit then the stronger remedies may be carefully tried. Avoid open cuts or mucosal surfaces and keep a constant check to make sure the skin is not getting red too quickly. In extreme cases blistering can be caused (this used to be sought after as a sign of the most powerful activity but is inappropriate in modern times).

It is also advisable not to buy herbs online unless from suppliers with prominent reputation (they will be concerned to protect this by ensuring quality for their products). Unfortunately there are few controls on herbal sales and many cases of adulterated or wrong products.

A good approach in choosing traditional herbal approaches for arthritis is to see a qualified herbal practitioner. They can choose from a wide list of herbs, from a number of traditions that have good reputations for helping arthritic pain but are not so accessible to the wider public. You will find well trained practitioners from a number of traditions from the website of the main umbrella body the European Herbal and Traditional Practitioners Association. This will entail extra costs but will allow you to have herbs you might not find elsewhere, and tailored to your needs.

Cost
Dietary changes are almost free and may even save money. Most herbs should be inexpensive and can be bought from specialist suppliers. Seeing a practitioner may cost around £50 for a first visit.