Rheumatoid arthritis and herbs

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

There is a ton of information available on herbal remedies and arthritis. Some of it is valid… and some is not.

Rheumatoid arthritis is a chronic autoimmune inflammatory disease for which there is no cure just yet. While there are many effective agents available, some people would like to know more about herbal treatments.

What many people are not aware of is this…some of the medicines available today were originally made from plants. Examples include digitalis (a heart drug) from foxglove, aspirin from the willow tree, vincristine and taxol (cancer drugs) from the periwinkle plant and the bark of the yew tree, respectively.

The allure of herbs and natural supplements comes from the need to feel more in control. There is also frustration with modern medicine’s inability to cure illness. Couple that with the impersonal nature of technology and the rape of medicine by managed care, then it’s no surprise that people are attracted to natural remedies.

Natural does not equal safe nor does it equal effective. Since supplements are not regulated, there is very little standardization in the supplement industry. Couple that with the fact that herbs can interact with medicines to cause side effects, then one has to realize that natural does not necessarily mean “better.”

The Dietary Supplement Health and Education Act passed in 1994 states that dietary supplements don’t have to pass tests proving effectiveness or safety. They can only be removed from store shelves if they prove to be harmful.

It is tempting but wrong to think that all it takes is to pop an herb and that will not only cure the problem but not cause side-effects of any type.

The good news is that as we learn more about herbal supplements, the more we know about what works, what doesn’t, and what may be worthless or… even worse… harmful.

That has to be balanced against the fact that regulatory lack means there’s no guarantee that what the bottle says on the label is what the bottle contains... and that the bottle does not contain additives or potential toxins.

Words of advice: • Look for products with the USP notation indicating the manufacturer follows the United States Pharmacopoeia standards. • Ask your physician if they have recommendations • Always tell your doctor what you’re taking • Don’t take supplements if you are pregnant or breast-feeding without checking with your doctor first • Watch for potential drug interactions • Avoid the “if a little bit is good for me, more is better syndrome.” • Make sure your life style is a healthy one. Supplements won’t make up for a couch potato life style

Information from the Arthritis Foundation

Here is some information about some of the more common herbs and vitamins you might be curious about:

Avacado Soybean Unsaponifiables (ASU)

Natural extract made from soybean oils and avocado. May reduce the production of pro-inflammatory interleukins and prevent cartilage breakdown. Available in Europe for almost two decades.

Black currant oil

Derived from black currant seeds. Contains gamma-linolenic acid (GLA). Anti-inflammatory and also may boost immune response.

Borage oil

From borage plant. Contains GLA. Anti-inflammatory.


Derived from pineapples. May decrease inflammation in both OA and RA. Mechanism is to break down pro-inflammatory proteins and therefore has anti-inflammatory and analgesic effects. Sometime causes gastrointestinal upset. Can potentiate effects of anticoagulant drugs.

Cat’s claw

Derived from the bark of plant found in South American jungles. Effects include possible anti-TNF and antioxidant properties.

Cayenne pepper

Contains capsaicin that blocks substance P, a chemical responsible for pain transmission. Available in many topical agents.

CMO (Cetyl myristoleate)

Acts as a joint lubricant. May have anti inflammatory effects


From the roots of the turmeric plant native to southern Asia. Common ingredient in curry powder. Used in Chinese and Ayer Vedic medicine. Has anti inflammatory effects. May have immunomodulatory effects. Can interact with blood thinners. Also may cause gastrointestinal side-effects.

Devils claw

African herbal plant. Contains anti-inflammatory compound called harpagoside. Effective in OA. Take between meals. May cause gastrointestinal upset and may interfere with actions of blood thinners, anti-diabetic medicines, and cardiac drugs.


Produced in adrenal glands. Androgenic hormone. Possible immunoregulatory effects. May be beneficial in systemic lupus erythematosus. Also, potential beneficial effects on bone density. May cause androgenic side effects such as hair growth, acne, elevated blood pressure. May also induce insulin resistance. Avoid if you have liver disease.


Derivative of wood pulp. Topical anti inflammatory first used in race horses. Many potential side effects including gastrointestinal problems, liver and kidney toxicity, and rash.

Evening primrose oil

Made from seeds of an American wildflower. Contains GLA. Anti inflammatory.

Fever few

Contains parthenolide which may be anti inflammatory.

Fish oil

Made from cold water fish (tuna, mackerel, halibut, cod, salmon). Contains omega-3 fatty acids. Anti inflammatory. Effective in RA. Avoid high levels of fish intake if pregnant or nursing because of possible mercury contamination.

Flaxseed oil

Derived from flaxseeds. Contains omega-3 fatty oils and alpha-linolenic acid (ALA). Anti inflammatory. Can cause diarrhea. Interacts with blood thinners. Avoid if you have elevated cholesterol or are on cholesterol lowering medicines.


Bark of Boswellia tree. Found in India. Anti inflammatory and analgesic effects. May be effective in both OA and RA.


From ginger root. Anti inflammatory and analgesic properties. Effectivwe for OA and RA. May interact with blood thinners.


Derived from the ginkgo biloba tree in Asia. Stimulates blood flow. May be effective for Raynaud’s syndrome. Interacts with blood thinners. Some gastrointestinal side effects.

Gamma linolenic acid (GLA)

Found in borage oil, black currant oil, evening primrose oil. Omega-6 fatty acid. Anti inflammatory and immunoregulatory.


Usually sold as a combination ingredient. Major components of cartilage. Derived from shells of shellfish. Most popular form of glucosamine is glucosamine sulfate.

Claimed to slow progression of OA by preventing cartilage deterioration. Also suppose to help restore mobility and improve pain.

Both glucosamine and chondroitin are important components of normal cartilage and help maintain elasticity and compressive ability of joint cartilage.

Clinical studies, mostly done in Europe, have demonstrated improvement in joint function and pain reduction in patients with OA of the knee. Results indicate that patients taking the supplements had 20 to 25 % less pain and disability than patients taking placebo.

Some patients develop nausea, diarrhea, and heart burn. People allergic to shell fish should use caution. May elevate blood sugar in patients with brittle diabetes.


Methylsulfonylmethane… found normally in vegetables, fruits, grains, and animals. Sulphur is an important ingredient in connective tissue. Studies indicate an improvement in arthritis symptoms, chiefly pain. May cause diarrhea and a queasy stomach. Avoid if using blood thinners.


S-adenosyl-L-methionine is a naturally occurring substance. It has been used to treat arthritis-related pain and inflammation. Seems to work well in OA. A recent study showed it to be as effective as NSAIDS in OA of the knee. Patients may need to increase their dosage of B vitamins while on SAM-E. has been used for OA, bursitis, and tendinitis. Side effects include nausea, diarrhea, and headache. May aggravate Parkinson’s disease.

Shark cartilage

May have immunomodulatory and anti inflammatory effects.

Stinging nettle

Comes from the stinging nettle plant. Has analgesic and anti oxidant properties. May also have anti inflammatory effects through cytokine suppression. Helps with OA symptoms. Avoid if taking blood thinners, heart or diabetes medicines.

Thunder god vine

Derived from a plant grown in Asia. Used in Chinese medicine for centuries. Study published in 2002 demonstrated beneficial effects in patients with RA. May have immunomodulatory effects. Side effects include rash and gastrointestinal upset. Preparations must be made from the root only since the leaves and flowers of the plant are poisonous.

White willow bark

Active ingredient is salicin. Similar effects as aspirin. Amount of salicin in bark is small so intake may vary from preparation to preparation. Should not use if already taking anti inflammatory medicines. May interact with blood thinners.

Vitamin A

May stimulate immune system. Improves wound healing

Vitamin B complex

Powerful antioxidants. Important in many metabolic functions. Possible role in immune system function

Vitamin C

Required for collagen synthesis. Antioxidant so may slow rate of loss of cartilage.

Vitamin D

Possibly slows development of OA

Vitamin E

Antioxidant. May decrease level of pro inflammatory prostaglandins


Antioxidant and anti inflammatory


Trace mineral needed for muscles and joint health.


Supports bone strength and cell metabolism


Important role in cross-linking and strengthening of connective tissue

Coenzyme Q 10

Antioxidant with possible role in supporting joint health



Green tea



Important in maintenance of normal muscle function




Deficiency of this mineral may be associated with development of rheumatoid arthritis


Immunomodulatory effects

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