What’s the Bottom Line?

What do we know about the effectiveness of complementary health approaches for osteoarthritis?

Nutritional Approaches

• Even after many studies, it remains unclear whether glucosamine and chondroitin meaningfully improve osteoarthritis symptoms or protect joint structure.

• For most other dietary supplements, there is not enough reliable evidence to draw firm conclusions.

Psychological and Physical Approaches

• Acupuncture may provide relief from osteoarthritis pain for some individuals.

• Limited research suggests massage therapy might reduce symptoms.

• Tai chi has been shown to improve pain, stiffness, and physical function in people with knee osteoarthritis. Qi gong may offer similar benefits, although it has been studied less extensively.

What do we know about the safety of complementary health approaches for osteoarthritis?

• Some dietary supplements can cause side effects or interact with prescription or over-the-counter medications.

• Psychological and physical practices are generally considered safe when properly performed, but adjustments may be necessary for people with osteoarthritis.

• Magnetic therapies are not appropriate for individuals with certain implanted medical devices.

About Osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis. It most frequently affects the hands, knees, hips, and spine.

OA involves damage to cartilage, the smooth tissue that cushions the ends of bones within a joint. Healthy cartilage allows bones to glide smoothly and absorbs shock. In osteoarthritis, cartilage gradually deteriorates, causing bones to rub together. This friction can lead to pain, swelling, and reduced joint mobility.

Although OA is more common with aging, it can also occur in younger individuals, particularly after joint injuries.

More About Osteoarthritis

You may have osteoarthritis if you experience the following symptoms. Consult your health care provider for an accurate diagnosis.

• Joint stiffness after waking up or sitting for long periods.

• Swelling or tenderness in one or more joints.

• A grinding sensation or the sound of bones rubbing together.

If your joint feels hot, your skin becomes red, or you develop symptoms such as fever or rash, another condition may be responsible.

Osteoarthritis is typically managed through a combination of treatments. These may include regular exercise, weight management to reduce stress on joints, periods of rest, and medications to control pain and inflammation.

What the Science Says About Complementary Health Approaches for Osteoarthritis

Complementary approaches are often grouped by how they are delivered:

• Nutritional approaches (such as special diets, supplements, herbs, probiotics, and related products).

• Psychological approaches (including meditation, relaxation techniques, hypnosis, and music therapy).

• Physical approaches (such as acupuncture, massage, and spinal manipulation).

• Combined approaches that integrate psychological and physical elements (like yoga, tai chi, or dance therapy) or psychological and nutritional components (such as mindful eating).

A number of complementary therapies have been evaluated for osteoarthritis. The sections below summarize what research suggests about their effectiveness and safety.

Nutritional Approaches

Glucosamine and Chondroitin Sulfate

Glucosamine and chondroitin are natural components of cartilage and are also sold as dietary supplements. They have been widely studied for osteoarthritis.

Research findings are mixed. Some studies show little to no benefit for knee pain, while others report modest improvements. Overall, the largest and most rigorous studies have not shown consistent relief. Evidence for benefits in joints other than the knee is limited.

Research on whether these supplements slow structural joint damage has also produced inconsistent results. Any observed benefits appear small and may not be noticeable to patients.

These supplements may interact with the blood thinner warfarin. Aside from that interaction, serious side effects are uncommon.

DMSO and MSM

Dimethyl sulfoxide (DMSO) is applied to the skin, while methylsulfonylmethane (MSM) is taken orally. Both have been studied for osteoarthritis, but research is limited.

It is unclear whether either product significantly improves symptoms.

DMSO may cause digestive upset, skin irritation, and a garlic-like odor. MSM has been associated with allergic reactions, digestive issues, and rashes.

SAMe

S-Adenosyl-L-methionine (SAMe) is a naturally occurring compound in the body and is also available as a supplement.

Studies show mixed results. Some suggest SAMe may relieve osteoarthritis symptoms similarly to nonsteroidal anti-inflammatory drugs (NSAIDs), while others find no difference from placebo.

Side effects are generally mild, but long-term safety data are limited. SAMe may not be suitable for people with bipolar disorder or those who are HIV positive, and it can interact with certain medications, including antidepressants and levodopa.

Oral Herbal Remedies

Various herbal products have been studied for osteoarthritis. Some evidence suggests that avocado-soybean unsaponifiables (ASUs) and Boswellia serrata may provide slight improvements in pain and function, though the benefits appear modest.

For most other oral herbal remedies, research is insufficient to determine effectiveness.

Safety data for many herbal products are limited. Herbs can cause side effects or interact with medications and other supplements.

Topical Herbal Remedies

Herbal products applied to the skin have also been evaluated. Arnica gel and comfrey extract gel may offer some benefit, while capsicum extract gel is unlikely to help.

Information on safety is limited, but some topical products may cause skin irritation.

Tainted Arthritis Supplements

Some products marketed for arthritis or pain relief have been found to contain undisclosed prescription drugs. These hidden ingredients can cause harmful side effects or dangerous drug interactions.

Discuss any supplement you are taking or considering with your health care provider.

Psychological and Physical Approaches

Acupuncture

Analyses of clinical trials suggest acupuncture may reduce osteoarthritis pain, particularly in the knee. However, it is often only slightly more effective than simulated acupuncture, indicating that expectations and other nonspecific factors may play a role.

When performed by a qualified practitioner using sterile needles, acupuncture is generally safe. Poor technique can lead to serious complications.

Cupping and Moxibustion

Cupping involves suction on the skin, and moxibustion uses heat from burning herbs near acupuncture points. Research on these therapies for osteoarthritis is limited and preliminary.

Both practices can leave temporary skin marks. Cupping may carry a risk of infection if equipment is not properly sterilized. Moxibustion has been associated with burns and allergic reactions.

Massage Therapy

Only a small number of studies have examined massage for osteoarthritis. Available evidence suggests it may reduce knee pain and improve function.

Massage is generally safe when performed by a trained therapist familiar with arthritis-related joint sensitivity.

Tai Chi and Qi Gong

Tai chi and qi gong combine gentle movements, controlled breathing, and focused attention.

Research indicates that tai chi can improve pain, stiffness, balance, and physical function in people with knee osteoarthritis. Some studies suggest benefits comparable to physical therapy. Evidence for qi gong is more limited but points to possible symptom improvement.

These practices are generally safe, though some individuals report temporary increases in knee discomfort.

Yoga

Yoga includes stretching, strengthening, and relaxation techniques that may be helpful for arthritis. However, only limited research has evaluated yoga specifically for osteoarthritis.

People with OA should consult their health care provider and inform instructors about their condition so poses can be modified as needed.

Other Complementary Health Approaches for Osteoarthritis

Balneotherapy

Balneotherapy involves bathing in mineral-rich water and may include mud treatments. Some studies suggest pain relief, but the overall evidence base is small.

This approach generally has a good safety record.

Homeopathy

There is little scientific support for homeopathy in managing osteoarthritis symptoms.

Although most homeopathic remedies are highly diluted, some may contain active ingredients or contaminants that could cause harm.

Magnets

Research does not support the use of static magnets for osteoarthritis pain. Electromagnetic field therapy may provide limited pain relief, but its impact on function and quality of life remains unclear.

Magnetic devices may pose risks for people with implanted medical devices such as pacemakers.

Guidelines for Treating Osteoarthritis

Professional medical organizations have developed treatment guidelines for osteoarthritis, some of which address complementary therapies.

The American College of Rheumatology:

• Conditionally recommends tai chi for knee osteoarthritis.

• Conditionally recommends acupuncture for certain knee OA patients who are unable or unwilling to undergo knee replacement surgery.

• Recommends against glucosamine and chondroitin for knee or hip OA.

• Recommends topical capsaicin for hand OA but not for knee OA.

The American Academy of Orthopaedic Surgeons:

• Recommends against acupuncture for knee OA.

• Recommends against glucosamine and chondroitin.

More To Consider

• Do not delay seeking medical evaluation for joint symptoms while trying complementary approaches.

• Remember that supplements can interact with medications and may contain unlisted ingredients.

• Inform all your health care providers about any complementary practices you use to ensure coordinated and safe care.

Acknowledgments

This publication was prepared with contributions from experts in complementary and integrative health.

The material is provided for informational purposes only and is not a substitute for professional medical advice. Always consult your health care provider regarding treatment decisions. Mention of specific products or therapies does not constitute endorsement.