There’s something appealing about being able to help manage a chronic illness with so-called “natural” remedies like vitamins and minerals. That explains why there’s no shortage of natural remedies marketed to people with rheumatoid arthritis and other forms of inflammatory arthritis.

There is a shortage, however, of solid scientific evidence to support whether or not you should take certain supplements. Will they actually help improve arthritis symptoms? Could they interact with other medications you take? Or might they potentially have negative side effects of their own?

“Herbal supplements in particular concern me because they’re marketed using testimonials and not on any clinical data,” says William Davis, MD, the chair of rheumatology at Oschner Health System in New Orleans and a fellow of the American College of Physicians and the American College of Rheumatology. “As a physician, it’s my role to recommend treatments where there’s a higher understanding of risks and benefits.”

There are, however, certain vitamins and minerals that research shows can be an essential part of treatment for many patients with inflammatory arthritis. We asked Dr. Davis which ones you may need as part of your recommended treatment plan, as well as which natural remedies may show the most promise in helping with pain relief.

Supplements Backed by Science

1) Folic acid

Not everyone with rheumatoid arthritis needs to take folic acid, which is the synthetic form of folate, a type of B vitamin that is involved in such critical functions as cell division and the production of new red blood cells. But if your rheumatologist prescribes the disease-modifying drug methotrexate to treat your arthritis, they’ll most likely recommend you take folic acid supplements to prevent a folate deficiency.

“One of methotrexate’s most important mechanisms of action also inhibits folic acid metabolism, and that can lead to a folate deficiency,” Dr. Davis explains. It’s such a serious concern that prescribing methotrexate and folic acid supplements together “is pretty much standard of care,” he adds.

Fortunately, taking folic acid supplements can help mitigate some of the folate deficiency-induced side effects of methotrexate, which range from hair loss and mouth ulcers to more serious issues such as decreases in blood cell counts and elevated liver enzymes.

This may be why a 2013 research review conducted by The Cochrane Collaboration found that people who take folic acid supplements with methotrexate are significantly less likely to discontinue methotrexate treatment than those who didn’t take folic acid.

2) Calcium

Doctors and nutritionists generally prefer that people get their calcium from food rather than supplements, but there are exceptions. “If you have RA and you’re diagnosed with osteopenia or osteoporosis — or you’re already being treated for osteoporosis — your doctor may recommend you take calcium supplements,” says Dr. Davis.

People with inflammatory arthritis who are treated with glucocorticoids — steroids that are often used to stop arthritis flares — may also need to take a calcium supplement. These drugs suppress bone formation and promote resorption, which can lead to glucocorticoid-induced osteoporosis.

Fortunately, a research review published in the Cochrane Database of Systematic Reviews showed that taking both calcium and vitamin D helped prevent bone loss in people taking corticosteroids. Ask your doctor if calcium supplements are a good idea for you based on your health history, diet, and medication regimen.

3) Vitamin D

While studies suggest that many Americans may be deficient in D, the problem appears to be even more prevalent among people with rheumatoid arthritis, according to a study published in the journal Therapeutic Advances in Endocrinology and Metabolism.

Dr. Davis says it’s not understood why this association exists (one theory is that the inflammation of RA may decrease levels of vitamin D), but it is worrisome. “It’s an area of ongoing research,” he says. “We are concerned that people with RA tend to be low in D because it could be associated with poor bone health.”

While there are no strong, well-done studies that show that vitamin D supplementation helps protect the bones of people with rheumatoid arthritis, rheumatologists do sometimes recommend taking vitamin D. That’s because anyone with inflammatory arthritis is already at greater risk of osteoporosis. The disease itself appears to trigger bone loss, as does inactivity. And glucocorticoids, as noted above, can cause bone loss.

If you aren’t already taking vitamin D, should you start doing so? Not without talking to your rheumatologist first, Dr. Davis says. “Determining whether someone with arthritis needs vitamin D supplements is usually done on a case-by-case basis,” he explains. Your doctor will want to test your D levels and then make a dosage recommendation based on the results as well as factors such as your age and sex.

4) Fish oil

These pills, which contain anti-inflammatory omega-3 fatty acids, may help ease symptoms of RA. “This is one area where we have seen controlled studies that show that taking them results in lower measures and symptoms of inflammation in people with RA,” Dr. Davis says.

For example, a research review in the journal Pain revealed that fish oil supplement use was associated with less joint pain, shorter duration of morning stiffness, and a reduction in the number of painful and/or swollen joints.

Supplements That Show Promise

5) Turmeric

This trendy spice has been touted for its antioxidant compounds and anti-inflammatory properties. And there’s a chance it may just live up to the hype when it comes to easing pain from RA.

“It’s quite possible that there is some chemical component in turmeric that works like ibuprofen or an even stronger drug we have yet to identify,” Dr. Davis says.

Studies that demonstrate turmeric’s effectiveness in people with inflammatory arthritis are very small. However, a review of existing studies showed that they “do provide a compelling justification for [turmeric’s] use as a dietary adjunct to conventional therapy.”

While turmeric supplements are widely available, it’s best to talk to your rheumatologist before you try them. They can interact with some medications such as blood thinners and diabetes drugs, and the supplements may not be safe if you have certain health conditions such as diabetes, gallbladder disease, and bleeding disorders.

6) CBD (cannabidiol) oil

CBD oil has been a hot topic lately; many proponents claim that this component of the cannabis plant can treat everything from anxiety to inflammation. However, Dr. Davis says there’s not much data supporting its use in people with RA yet; the studies that do exist are small. But CBD oil does have some potential: A 2016 research review in the journal Arthritis Care & Research suggested that cannabinoid treatments could provide some pain relief and improve sleep in those with RA.

The concern is that CBD oil isn’t legal nationwide. If you’re thinking about trying it, talk to your rheumatologist first to discuss whether you can access it and if it would be safe for you use.

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