Osteoarthritis (OA) is the most common form of arthritis and is regarded as a chronic degenerative joint disorder due to the wear and tear of joint cartilage and inflammation, causing pain, stiffness and impaired movement.
Some may not be comfortable taking pain-relievers like paracetamol or Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) that can potentially cause unwanted side effects. Alternatively, some supplements may be useful in relieving symptoms and slowing the progression of osteoarthritis.
Here are the 6 best joint supplements for osteoarthritis and the evidence behind them.
1. Indian Frankincense
Indian frankincense, also known as Boswellia, is a plant extract from the Boswellia Serrata tree commonly used for pain in osteoarthritis.¹ Studies have shown that patients taking Boswellia demonstrated significantly greater reduction in pain, swelling and improvement in joint function.¹
Compared to the usual Boswellia extract, the patented Boswellia formulation, Aflapin™, has been shown to have even better absorption and anti-inflammatory properties, with pain relief demonstrated as early as 7 days.² There were also no serious side effects reported in any studies.
Turmeric, a plant root, contains a compound called curcumin which is bright yellow in colour and has been reported to be a potent anti-inflammatory agent.³ Curcumin has beneficial effects on knee pain and quality of life in patients with knee OA. It may also reduce the need for rescue medication like NSAIDs.
Since one of the challenges for curcumin is poor absorption in the human gut, there are studies centred around increasing its absorption. One patented encapsulated curcumin technology named Cavacurmin® was produced with 40 times more bioavailability than pure turmeric, resulting in more effective pain-relieving and anti-inflammatory effects.⁴
It was also shown that a combination of curcumin and Boswellia extract increases the efficacy of OA treatment due to synergistic effects of both ingredients.³
Ginger is also a plant root similar to turmeric and is a very popular spice and the world production is estimated at 100000 tonnes every year.⁵ For more than 2500 years, ginger has also been used as traditional medicine and an anti-inflammatory agent for musculoskeletal diseases, including rheumatism, in Ayurvedic and Chinese medicine.⁵
Ginger contains a very complex mixture of compounds which was shown to reduce symptoms of joint pain, swelling and stiffness in OA.⁵
4. Winter Cherry
The root extracts of Winter cherry or Withania Somnifera are known to possess pain-relieving, anti-inflammatory and joint-preserving effects.⁶ A study has shown that treatment of OA patients with roots of Withania Somnifera produced a significant drop in severity of pain and increase in joint function.
Aside from that, the roots of the plant are reported to exhibit anti-tumour, anti-stress, antioxidant, immunomodulatory and rejuvenating properties.⁷
5. Glucosamine & Chondroitin
Glucosamine and chondroitin are natural compounds found in healthy cartilage. They are believed to promote cartilage formation and repair and have anti-inflammatory properties.
The first phase of the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) published in 2006 found that the combination of glucosamine and chondroitin sulfate didn’t offer significant relief to participants in general, but it did help a small subgroup of those with moderate-to-severe knee pain.⁸
However, a multinational study found that the combination of glucosamine and chondroitin is as effective at relieving knee OA pain and swelling as celecoxib (a type of NSAID), without the side effects.⁹ Another study also found the combination helped reduce joint space narrowing which is a sign of cartilage degeneration.¹⁰
As can be seen, the research on the combination yielded mixed results but the outcome difference may be attributed to the variety of supplement types and doses used.
6. Fish Oil
As indicated in the name, fish oil comes from many different types of fishes and is rich in omega-3 fatty acids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Fish that are especially rich in these oils are usually deep-sea fishes that include mackerel, herring, tuna, and salmon.¹¹ However, there are also plant-based omega-3 available from flaxseed and walnuts.¹¹
Research suggests omega-3 fatty acids can help reduce arthritic knee pain and improve knee function.¹²
Aside from medicines, there are many types of supplements that can potentially help manage symptoms of osteoarthritis.
It can be overwhelming to choose a joint supplement given the number of products available on the market.
You can consult with your doctor or pharmacist before choosing a supplement to avoid potential interactions with your medications.
De Silva V, El-Metwally A, Ernst E, Lewith G, Macfarlane GJ. Evidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis: a systematic review. Rheumatology. 2011 May; 50 (5): 911–920
Sengupta K, Krishnaraju AV, Vishal AA, et al. Comparative efficacy and tolerability of 5-Loxin and Aflapin against osteoarthritis of the knee: a double blind, randomized, placebo controlled clinical study. Int J Med Sci. 2010;7(6):366-377.
Haroyan A, Mukuchyan V, Mkrtchyan N, Minasyan N, Gasparyan S, Sargsyan A, Narimanyan M, Hovhannisyan A. Efficacy and safety of curcumin and its combination with boswellic acid in osteoarthritis: a comparative, randomized, double-blind, placebo-controlled study. BMC Complement Altern Med. 2018 Jan 9;18(1):7
Purpura M, Lowery RP, Wilson JM, Mannan H, Münch G, Razmovski-Naumovski V. Analysis of different innovative formulations of curcumin for improved relative oral bioavailability in human subjects. Eur J Nutr. 2018 Apr;57(3):929-938.
Altman RD, Marcussen KC. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum. 2001 Nov;44(11):2531-8
Ramakanth GS, Uday Kumar C, Kishan PV, Usharani P. A randomized, double blind placebo controlled study of efficacy and tolerability of Withaina somnifera extracts in knee joint pain. J Ayurveda Integr Med. 2016 Jul-Sep;7(3):151-157
Mishra LC, Singh BB, Dagenais S. Scientific basis for the therapeutic use of Withania somnifera (ashwagandha): a review. Altern Med Rev. 2000 Aug;5(4):334-46. PMID: 10956379.
Clegg DO, Reda DJ, Harris CL, Klein MA, O'Dell JR, Hooper MM, Bradley JD, Bingham CO 3rd, Weisman MH, Jackson CG, Lane NE, Cush JJ, Moreland LW, Schumacher HR Jr, Oddis CV, Wolfe F, Molitor JA, Yocum DE, Schnitzer TJ, Furst DE, Sawitzke AD, Shi H, Brandt KD, Moskowitz RW, Williams HJ. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006 Feb 23;354(8):795-808
Hochberg MC, Martel-Pelletier J, Monfort J, Möller I, Castillo JR, Arden N, Berenbaum F, Blanco FJ, Conaghan PG, Doménech G, Henrotin Y, Pap T, Richette P, Sawitzke A, du Souich P, Pelletier JP; MOVES Investigation Group. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib. Ann Rheum Dis. 2016 Jan;75(1):37-44
Fransen M, Agaliotis M, Nairn L, Votrubec M, Bridgett L, Su S, Jan S, March L, Edmonds J, Norton R, Woodward M, Day R; LEGS study collaborative group. Glucosamine and chondroitin for knee osteoarthritis: a double-blind randomised placebo-controlled clinical trial evaluating single and combination regimens. Ann Rheum Dis. 2015 May;74(5):851-8
Tur JA, Bibiloni MM, Sureda A, Pons A. Dietary sources of omega 3 fatty acids: public health risks and benefits. British Journal of Nutrition. 2012;107(2):23–52
Sibille KT, King C, Garrett TJ, Glover TL, Zhang H, Chen H, Reddy D, Goodin BR, Sotolongo A, Petrov ME, Cruz-Almeida Y, Herbert M, Bartley EJ, Edberg JC, Staud R, Redden DT, Bradley LA, Fillingim RB. Omega-6: Omega-3 PUFA Ratio, Pain, Functioning, and Distress in Adults With Knee Pain. Clin J Pain. 2018 Feb;34(2):182-189.
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