Rheumatoid Arthritis: In Depth
What Is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a disease that causes pain, swelling, and stiffness in the joints. It occurs when the immune system attacks the membrane lining the joints. RA is more common in women than men and often begins in middle age, although it can also occur in younger people.
More About Rheumatoid Arthritis and How It’s Treated
RA is an autoimmune disease—a condition in which the immune system attacks the joints for unknown reasons. RA is different from other types of arthritis such as osteoarthritis, a wear-and-tear condition that most commonly occurs as people age.
Early treatment to avoid permanent joint damage is key for preventing disability and progression of RA. Treatment for RA combines a variety of approaches and is aimed at relieving pain, reducing inflammation, slowing or stopping joint damage, and improving the person’s sense of well-being and ability to function. Medicines used for RA include disease-modifying antirheumatic drugs (DMARDs) to slow the progress of the disease and nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids to reduce inflammation.
What the Science Says About Complementary Approaches for Rheumatoid Arthritis
Complementary approaches can be classified by their primary therapeutic input (how the therapy is taken in or delivered), which may be:
- Nutritional (e.g., special diets, dietary supplements, herbs, probiotics, and microbial-based therapies).
- Psychological (e.g., meditation, hypnosis, music therapies, relaxation therapies).
- Physical (e.g., acupuncture, massage, spinal manipulation).
- Combinations such as psychological and physical (e.g., yoga, tai chi, dance therapies, some forms of art therapy) or psychological and nutritional (e.g., mindful eating).
Nutritional approaches include what the National Center for Complementary and Integrative Health (NCCIH) previously categorized as natural products, whereas psychological and/or physical approaches include what was referred to as mind and body practices.
Psychological and Physical Approaches
- At least 11 studies of acupuncture for RA, with more than 1,300 total participants, have been completed. These studies have not shown clear evidence of a beneficial effect.
- Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Improperly performed acupuncture can cause potentially serious side effects.
- For more information, see the NCCIH webpage on acupuncture.
A single study with 42 participants, conducted in 2013, has indicated that moderate pressure massage therapy may reduce pain and increase grip strength in people who have RA that affects their arms and shoulders.
The risk of harmful effects from massage therapy appears to be low. However, there have been rare reports of serious injuries. Some of the reported cases have involved vigorous types of massage, such as deep tissue massage, or patients who might be at increased risk of injury, such as elderly people.
For more information, see the NCCIH webpage on massage therapy.
Four studies (401 total participants) have looked at the effects of mindfulness-based interventions in people with RA, and all found evidence of some improvement in subjective symptoms such as pain or in the ability to cope with the illness.
Mindfulness meditation may involve staying in one position for a prolonged period of time. This can be difficult or painful for a person with arthritis. If you’re interested in trying mindfulness meditation, tell the instructor about your physical limitations so that the instructor can modify the practice to make it comfortable for you.
For more information, see the NCCIH webpage on meditation.
Autogenic training, biofeedback, and other relaxation techniques have been studied in people with RA, but only a small amount of research has been done on each approach. Some results have been promising, but the amount of research is so small that no definite conclusions can be reached.
Relaxation techniques generally don’t have side effects. However, rare harmful effects have been reported in people with serious physical or mental health conditions.
For more information, visit the NCCIH webpage on relaxation techniques.
Several studies have looked at the effects of practicing tai chi on people with RA. Some studies showed improvements in participants’ physical functioning, but others did not. Most of these studies are more than 10 years old (some much older than that), so the study participants would not have been taking the types of drugs used in RA treatment today. Because of the inconsistent findings and the changes in RA treatment over the years, it’s uncertain whether tai chi has benefits in RA.
Studies of tai chi for RA indicate that it doesn’t make symptoms worse. However, traditional forms of tai chi may need to be adapted so that people with RA can participate safely and comfortably.
For more information, visit the NCCIH webpage on tai chi.
Yoga incorporates several elements of exercise that may be beneficial for arthritis, including activities that may help improve strength and flexibility. However, only a few studies have examined yoga for RA, and they have not been of high quality. They haven’t clearly shown whether it’s helpful.
Yoga exercises should be performed with caution by people with RA who have limited mobility or spinal problems. People with RA may need assistance in modifying some yoga postures to minimize joint stress and may need to use props to help with balance.
For more information, see the NCCIH webpage on yoga.
Omega-3 Fatty Acids
- Omega-3 fatty acids are a kind of fat found in foods and in the human body. They are also sold as dietary supplements. Different types of omega-3s are found in different foods. Much research has focused on the long-chain omega-3s found in seafood (fish and shellfish).
- A 2017 review of 22 studies (956 total participants) that tested supplements of long-chain omega-3s found a favorable effect on pain in patients with RA.
- Omega-3 supplements usually produce only mild side effects, if any. There’s conflicting evidence on whether omega-3 supplements might influence the risk of prostate cancer. If you’re taking medicine that affects blood clotting or if you’re allergic to fish or shellfish, consult your health care provider before taking omega-3 supplements.
- For more information, visit the NCCIH webpage on omega-3s.
Gamma-Linolenic Acid (GLA)
GLA is an omega-6 fatty acid found in the oils from some plants, including evening primrose (Oenothera biennis), borage (Borago officinalis), and black currant (Ribes nigrum). Oils containing GLA may have some benefit in relieving RA symptoms; however, only a few studies have been conducted on each of the oils.
In short-term studies, oils containing GLA produced only mild side effects, such as upset stomach or headache. The long-term safety of GLA supplements is uncertain. Some borage products may contain substances called pyrrolizidine alkaloids that can harm the liver.
A few preliminary studies have tested various probiotics in patients with RA, but the types of probiotics used differed from study to study, and the results differed as well. No conclusions about the effects of probiotics can be reached on the basis of the current evidence.
In people who are generally healthy, probiotics have a good safety record. Side effects, if they occur at all, usually consist only of mild digestive symptoms such as gas. However, information on the long-term safety of probiotics is limited, and safety may differ from one type of probiotic to another. Probiotics have been linked to severe side effects, such as dangerous infections, in people with serious underlying medical problems.
For more information, visit the NCCIH webpage on probiotics.
Thunder God Vine
Thunder god vine (Tripterygium wilfordii) is an herb used in traditional Chinese medicine. There have been only a few high-quality studies of oral thunder god vine for RA. These studies indicate that thunder god vine may improve some RA symptoms. In two studies, thunder god vine was at least as helpful as a conventional drug. Promising results have also been seen in studies in China where thunder god vine was used in combination with a conventional drug.
Thunder god vine can have serious side effects, including loss of bone density and male infertility. Thunder god vine can be extremely poisonous if the extract is not prepared properly. The risks of using this herb may exceed its benefits.
For more information, see the NCCIH webpage on thunder god vine.
Other Dietary Supplements
Other dietary supplements that have been studied for RA include cat’s claw, deer or elk antler velvet, feverfew, flaxseed oil, green-lipped mussel, rose hip, and willow bark extract. For all of these supplements, only a very small amount of research has been done in people, and it isn’t possible to reach any conclusions about their effects.
Other Complementary Health Approaches
Ayurvedic medicine is a system of health care that originated in India. Two preliminary studies (161 total participants) have compared Ayurvedic herbal preparations with conventional drugs used to treat RA. Both indicated that some Ayurvedic preparations may be comparable in effectiveness to the drugs. However, the two studies used different Ayurvedic preparations and compared them with different drugs.
Ayurvedic medicine uses a variety of products and practices. Some products may be harmful, particularly if used improperly or without the direction of a trained practitioner.
For more information, see the NCCIH webpage on Ayurvedic medicine.
Balneotherapy is the technique of bathing in tap or mineral water for health purposes; it also includes related practices such as mud packs. A 2016 review of 8 studies of balneotherapy for RA (496 total participants) was unable to reach definite conclusions because of the variability in the types of balneotherapy used in different studies as well as variability in study designs.
Balneotherapy has a good safety record.
The effects of special diets—such as vegetarian, Mediterranean, or elimination diets—on RA are uncertain because very little research has been done.
In studies that tested special diets for RA, some people lost weight even though they didn’t intend to, an effect that is undesirable in people who are already at or below normal weight. Some special diets, especially those that eliminate one or more major food groups, are so restrictive that they may put people at risk of developing nutritional deficiencies.
More To Consider
If you’re considering dietary supplements, keep in mind that they can cause health problems if not used correctly, and some may interact with prescription or nonprescription medications or other dietary supplements. Your health care provider can advise you. If you’re pregnant or nursing a child, or if you’re considering giving a child a dietary supplement, it’s especially important to consult your (or the child’s) health care provider. To learn more, visit the NCCIH webpage on dietary supplements.
Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.
For More Information
The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
Toll-free in the U.S.: 1-888-644-6226
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Email: firstname.lastname@example.org (link sends email)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
The mission of NIAMS is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases.
Toll-free in the U.S.: 1-877-22-NIAMS
A service of the National Library of Medicine, PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. For guidance from NCCIH on using PubMed, see How To Find Information About Complementary Health Approaches on PubMed.
To provide resources that help answer health questions, MedlinePlus (a service of the National Library of Medicine) brings together authoritative information from the National Institutes of Health as well as other Government agencies and health-related organizations.
- Agarwal SK. Core management principles in rheumatoid arthritis to help guide managed care professionals. Journal of Managed Care Pharmacy. 2011;17(9 Suppl B):S03-S08.
- Cameron M, Gagnier JJ, Chrubasik S. Herbal therapy for treating rheumatoid arthritis. Cochrane Database of Systematic Reviews. 2011;(2):CD002948. Accessed at https://www.cochranelibrary.com on January 12, 2018.
- Dissanayake RK, Bertouch JV. Psychosocial interventions as adjunct therapy for patients with rheumatoid arthritis: a systematic review. International Journal of Rheumatic Diseases. 2010;13(4):324-334.
- Field T, Diego M, Delgado J, et al. Rheumatoid arthritis in upper limbs benefits from moderate pressure massage therapy. Complementary Therapies in Clinical Practice. 2013;19(2):101-103.
- Hagen KB, Byfuglien MG, Falzon L, et al. Dietary interventions for rheumatoid arthritis. Cochrane Database of Systematic Reviews. 2009;(1):CD006400. Accessed at https://www.cochranelibrary.com on January 12, 2018.
- Han A, Judd M, Welch V, et al. Tai chi for rheumatoid arthritis. Cochrane Database of Systematic Reviews. 2004;(3):CD004849 [edited 2010]. Accessed at https://www.cochranelibrary.com on January 12, 2018.
- National Institute of Musculoskeletal and Skin Diseases. Rheumatoid arthritis. In-depth. Accessed at https://www.niams.nih.gov/health-topics/rheumatoid-arthritis/advanced on December 22, 2017.
- Senftleber NK, Nielsen SM, Andersen JR, et al. Marine oil supplements for arthritis pain: a systematic review and meta-analysis of randomized trials. Nutrients. 2017;9(1):E42.
- Uhlig T. Tai chi and yoga as complementary therapies in rheumatologic conditions. Best Practice & Research. Clinical Rheumatology. 2012;26(3):387-398.
- Anain JM Jr, Bojrab AR, Rhinehart FC. Conservative treatments for rheumatoid arthritis in the foot and ankle. Clinics in Podiatric Medicine and Surgery. 2010;27(2):193-207.
- Badsha H, Chhabra V, Leibman C, et al. The benefits of yoga for rheumatoid arthritis: results of a preliminary, structured 8-week program. Rheumatology International. 2009;29(12):1417-1421.
- Bamford JT, Ray S, Musekiwa A, et al. Oral evening primrose oil and borage oil for eczema. Cochrane Database of Systematic Reviews. 2013;(4):CD004416. Accessed at http://www.cochranelibrary.com on January 16, 2018.
- Bosch PR, Traustadóttir T, Howard P, et al. Functional and physiological effects of yoga in women with rheumatoid arthritis: a pilot study. Alternative Therapies in Health and Medicine. 2009;15(4):24-31.
- Brasky TM, Darke AK, Song X, et al. Plasma phospholipid fatty acids and prostate cancer risk in the SELECT trial. Journal of the National Cancer Institute. 2013;105(15):1132-1141.
- Bykerk VP, Akhavan P, Hazlewood GS, et al. Canadian Rheumatology Association recommendations for pharmacological management of rheumatoid arthritis with traditional and biologic disease-modifying antirheumatic drugs. Journal of Rheumatology. 2012;39(8):1559-1582.
- Canter PH, Lee HS, Ernst E. A systematic review of randomised clinical trials of Trypterygium wilfordii for rheumatoid arthritis. Phytomedicine. 2006;13(5):371-377.
- Chang CY, Wu YT, Chen LC, et al. Massage-induced brachial plexus injury. Physical Therapy. 2015;95(1):109-116.
- Chopra A, Saluja M, Tillu G, et al. Comparable efficacy of standardized Ayurveda formulation and hydroxychloroquine sulfate (HCQS) in the treatment of rheumatoid arthritis (RA): a randomized investigator-blind controlled study. Clinical Rheumatology. 2012;31(2):259-269.
- Christie A, Jamtvedt G, Dahm KT, et al. Effectiveness of nonpharmacological and nonsurgical interventions for patients with rheumatoid arthritis: an overview of systematic reviews. Physical Therapy. 2007;87(12):1697-1715.
- Chua ME, Sio MCD, Sorongon MC, et al. Relationship of dietary intake of omega-3 and omega-6 fatty acids with risk of prostate cancer development: a meta-analysis of prospective studies and review of literature. Prostate Cancer. 2012;2012:826254.
- Cramer H, Lauche R, Langhorst J, et al. Yoga for rheumatic diseases: a systematic review. Rheumatology. 2013;52(11):2025-2030.
- Crump C, Paluska SA. Venous thromboembolism following vigorous deep tissue massage. The Physician and Sportsmedicine. 2010;38(4):136-139.
- Davis MC, Zautra AJ, Wolf LD, et al. Mindfulness and cognitive-behavioral interventions for chronic pain: differential effects on daily pain reactivity and stress reactivity. Journal of Consulting and Clinical Psychology. 2015;83(1):24-35.
- de los Angeles Pineda M, Thompson SF, Summers K, et al. A randomized, double-blinded, placebo-controlled pilot study of probiotics in active rheumatoid arthritis. Medical Science Monitor. 2011;17(6):CR347-CR354.
- Duffy LC, Sporn S, Hibberd P, et al. Lactobacilli and bifidobacteria. In: Coates PM, Betz JM, Blackman MR, et al., eds. Encyclopedia of Dietary Supplements. 2nd ed. New York, NY: Informa Healthcare; 2010:469-478.
- Fogarty FA, Booth RJ, Gamble GD, et al. The effect of mindfulness-based stress reduction on disease activity in people with rheumatoid arthritis: a randomised controlled trial. Annals of Rheumatic Diseases. 2015;74(2):472-474.
- Furst DE, Venkatraman MM, McGann M, et al. Double-blind, randomized, controlled, pilot study comparing classic Ayurvedic medicine, methotrexate, and their combination in rheumatoid arthritis. Journal of Clinical Rheumatology. 2011;17(4):185-192.
- Gilbey A, Perezgonzalez JD. Health benefits of deer and elk velvet antler supplements: a systematic review of randomised controlled studies. New Zealand Medical Journal. 2012;125(1367):80-86.
- Gogtay NJ, Bhatt HA, Dalvi SS, et al. The use and safety of non-allopathic Indian medicines. Drug Safety. 2002;25(14):1005-1019.
- Goldbach-Mansky R, Wilson M, Fleischmann R, et al. Comparison of Tripterygium wilfordii Hook F versus sulfasalazine in the treatment of rheumatoid arthritis: a randomized trial. Annals of Internal Medicine. 2009;151(4):229-240.
- Guo Z, Chen W, Su Y, et al. Isolated unilateral vertebral pedicle fracture caused by a back massage in an elderly patient: a case report and literature review. European Journal of Orthopaedic Surgery and Traumatology. 2013;23 Suppl 2:S149-S153.
- Haaz S, Bartlett SJ. Yoga for arthritis: a scoping review. Rheumatic Diseases Clinics of North America. 2011;37(1):33-46.
- Hatakka K, Martio J, Korpela M, et al. Effects of probiotic therapy on the activity and activation of mild rheumatoid arthritis—a pilot study. Scandinavian Journal of Rheumatology. 2003;32(4):211-215.
- Hempel S, Newberry S, Ruelaz A, et al. Safety of Probiotics to Reduce Risk and Prevent or Treat Disease. Evidence Report/Technology Assessment no. 200. Rockville, MD: Agency for Healthcare Research and Quality; 2011. AHRQ publication no. 11-E007.
- Kligler B, Cohrssen A. Probiotics. American Family Physician. 2008;78(9):1073-1078.
- Lao L. Safety issues in acupuncture. Journal of Alternative and Complementary Medicine. 1996;2(1):27-31.
- Lee MS, Shin B-C, Ernst E. Acupuncture for rheumatoid arthritis: a systematic review. Rheumatology. 2008;47(12):1747-1753.
- Lustyk MK, Chawla N, Nolan RS, et al. Mindfulness meditation research: issues of participant screening, safety procedures, and researcher training. Advances in Mind-Body Medicine. 2009;24(1):20-30.
- Lv Q-W, Zhang W, Shi Q, et al. Comparison of Tripterygium wilfordii Hook F with methotrexate in the treatment of active rheumatoid arthritis (TRIFRA): a randomised, controlled clinical trial. Annals of the Rheumatic Diseases. 2015;74(6):1078-1086.
- Macfarlane GJ, El-Metwally A, De Silva V, et al. Evidence for the efficacy of complementary and alternative medicines in the management of rheumatoid arthritis: a systematic review. Rheumatology. 2011;50(9):1672-1683.
- Macfarlane GJ, Paudyal P, Doherty M, et al. A systematic review of evidence for the effectiveness of practitioner-based complementary and alternative therapies in the management of rheumatic diseases: rheumatoid arthritis. Rheumatology. 2012;51(9):1707-1713.
- Mandel DR, Eichas K, Holmes J. Bacillus coagulans: a viable adjunct therapy for relieving symptoms of rheumatoid arthritis according to a randomized, controlled trial. BMC Complementary and Alternative Medicine. 2010;10:1.
- Maste P, Paik SH, Oh JK, et al. Acute spinal subdural hematoma after vigorous back massage: a case report and review of literature. Spine. 2014;39(25):E1545-E1548.
- Sanders ME, Akkermans LM, Haller D, et al. Safety assessment of probiotics for human use. Gut Microbes. 2010;1(3):164-185.
- Santos I, Cantista P, Vasconcelos C. Balneotherapy in rheumatoid arthritis—a systematic review. International Journal of Biometeorology. 2016;60(8):1287-1301.
- Saper RB, Phillips RS, Sehgal A, et al. Lead, mercury, and arsenic in U.S.- and Indian-manufactured Ayurvedic medicines sold via the Internet. JAMA. 2008;300(8):915-923.
- Setty AR, Sigal LH. Herbal medications commonly used in the practice of rheumatology: mechanisms of action, efficacy, and side effects. Seminars in Arthritis and Rheumatism. 2005;34(6):773-784.
- Shanahan F. A commentary on the safety of probiotics. Gastroenterology Clinics of North America. 2012;41(4):869-876.
- Stack RJ, Shaw K, Mallen C, et al. Delays in help seeking at the onset of the symptoms of rheumatoid arthritis: a systematic synthesis of qualitative literature. Annals of the Rheumatic Diseases. 2012;71(4):493-497.
- Sun F, Yuan QL, Zhang YG. Large buttocks hematoma caused by deep tissue massage therapy. Pain Medicine. 2015;16(7):1445-1447.
- Szymanski KM, Wheeler DC, Mucci LA. Fish consumption and prostate cancer risk: a review and meta-analysis. American Journal of Clinical Nutrition. 2010;92(5):1223-1233.
- Taibi DM, Bourguignon C. The role of complementary and alternative therapies in managing rheumatoid arthritis. Family & Community Health. 2003;26(1):41-52.
- Verhagen AP, Bierma-Zeinstra SM, Boers M, et al. Balneotherapy (or spa therapy) for rheumatoid arthritis. Cochrane Database of Systematic Reviews. 2015;(4):CD000518. Accessed at http://www.cochranelibrary.com on January 16, 2018.
- Vickers A, Zollman C, Payne DK. Hypnosis and relaxation therapies. Western Journal of Medicine. 2001;175(4):269-272.
- Wang C, de Pablo P, Chen X, et al. Acupuncture for pain relief in patients with rheumatoid arthritis: a systematic review. Arthritis and Rheumatism. 2008;59(9):1249-1256.
- Wang X, Zu Y, Huang L, et al. Treatment of rheumatoid arthritis with combination of methotrexate and Tripterygium wilfordii: a meta-analysis. Life Sciences. 2017;171:45-50.
- Ward L, Treharne GJ, Stebbings S. The suitability of yoga as a potential therapeutic intervention for rheumatoid arthritis: a focus group approach. Musculoskeletal Care. 2011;9(4):211-221.
- Yin P, Gao N, Wu J, et al. Adverse events of massage therapy in pain-related conditions: a systematic review. Evidence-Based Complementary and Alternative Medicine. 2014;2014:480956.
- Xu S, Wang L, Cooper E, et al. Adverse events of acupuncture: a systematic review of case reports. Evidence-Based Complementary and Alternative Medicine. 2013;2013:581203.
- Zamani B, Golkar HR, Farshbaf S, et al. Clinical and metabolic response to probiotic supplementation in patients with rheumatoid arthritis: a randomized, double-blind, placebo-controlled trial. International Journal of Rheumatic Diseases. 2016;19(9):869-879.
NCCIH thanks D. Craig Hopp, Ph.D., and David Shurtleff, Ph.D., NCCIH, for their review of the 2019 update of this publication.
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