Note: The U.S. Food and Drug Administration (FDA) does not approve supplements for safety or effectiveness. Talk to a healthcare professional about whether a supplement is the right fit for your individual health, and about any potential drug interactions or safety concerns.
For people living with rheumatoid arthritis (RA), an autoimmune condition that causes inflammation and damage in the joints, medications like DMARDs and biologics are essential to slowing disease progression and managing symptoms. But even with these treatments, symptoms like joint pain and stiffness can get in the way of daily activities.
Dietary supplements are an attractive add-on for many people with RA who view them as a way to ease symptoms without adding another prescription medicine. While these supplements aren’t a cure or a replacement for prescribed medication, there is evidence that some herbs or nutrients may help with symptoms or even disease activity.
If you do decide to take supplements for RA, remember to check in with your provider first, and keep in mind that supplements aren’t a replacement for your prescribed treatment.
With more than 100,000 different types of supplements on the market, it can be hard to know what’s helpful or even where to start looking. Keep reading to learn about the most promising RA supplements and expert advice on the best way to take them.
1. Omega-3 Fatty Acids
How to take it: The best way to increase your omega-3 intake is to eat cold-water fish like wild salmon (not farmed), mackerel, cod, or sardines a couple of times per week, says Neha Shah, MD, a rheumatologist at Stanford Medicine in California.
“I don’t recommend eating it more than that, because there is a risk of accumulating ocean-borne toxins like mercury. You can also get omega-3s from foods like walnuts, chia seeds, or flaxseed,” says Dr. Shah.
If you can’t get enough omega-3s from foods, supplements could help, she says.
Choose high-quality products that have been tested for mercury and other contaminants.
“I typically recommend a dose of 500 to 1,000 milligrams (mg) once or twice a day, depending on how much a person is already consuming in their diet and what they can tolerate,” says Shah.
And always talk to your doctor before you start taking omega 3-supplements, especially if you’re on blood thinners, as they can affect clotting.
2. Turmeric (Curcumin)
Turmeric is a golden-yellow spice that comes from Curcuma longa, a perennial plant native to South Asia. For centuries, it’s been used as a spice in Indian foods and in ayurvedic medicine. Its active ingredient, curcumin, has been studied for its anti-inflammatory and antioxidant properties.
How to take it: You can use turmeric in your cooking, but most experts agree it would be hard to get a meaningful amount of curcumin that way; supplements provide a much higher concentration of curcumin. Look for formulas that include black pepper extract (piperine), which boosts absorption.
Bear in mind, however, that curcumin and black pepper can cause interactions with certain medications, so it’s always best to review your plans with your healthcare provider before starting a supplement.
3. Vitamin D
Vitamin D is essential for bone health and immune function, two areas that are especially relevant for people with RA. And low levels of vitamin D are common in people with autoimmune conditions, including RA, says Shah.
“I frequently check vitamin D levels, and I do recommend supplements to my patients who are deficient to get them in the adequate range,” Shah says. “The data suggesting that vitamin D helps with disease activity is mixed, but it’s important for bone health and osteoporosis prevention.”
How to take it: Sun exposure helps the body produce vitamin D naturally, but many people, especially those with darker skin or limited sun exposure, may need more.
The first step is to ask your doctor to test your vitamin D level to find out if you’re deficient.
If you show a deficit, you may be able to get enough through your diet by eating more foods that are fortified with vitamin D — things like milk, yogurt, cereal, and orange juice.
Many clinical trials use a dose of 2,000 IU of vitamin D a day. But because high doses of vitamin D can be toxic, talk with your provider before you add the supplement to your RA treatment plan.
4. Probiotics
Probiotics are beneficial bacteria that support gut health, and emerging research suggests they may also play a role in regulating the immune system. This connection has generated a lot of interest and ongoing research in autoimmune diseases, including RA.
A few issues keep Shah from making general recommendations on probiotics to her RA patients.
“One concern stems from the fact that some patients are immunocompromised because of the biologics they are taking to control RA. Although it is extremely rare, there have been a few case reports where the bacteria strain of a probiotic a person was taking moved out of the gut and into the bloodstream, which causes sepsis and is potentially fatal,” she says.
“This very rare event could happen if the person has issues with their gut lining and they were taking very high concentrated probiotics of a very specific strain,” says Shah.
The other issue is the lack of solid evidence: Very few studies have looked at probiotics in people with RA.
“In 5 or 10 years, we may have more advanced studies so that we can make general statements about a particular probiotic that will be helpful for all or most people, but right now we don’t have that evidence,” she says.
How to take it: Again, Shah recommends diet changes rather than supplements. Fermented foods like yogurt, kefir, sauerkraut, and kimchi naturally contain probiotics. She also recommends a diet rich in legumes, fruits, vegetables, and whole grains to meet the daily recommended amount of fiber, which is between 25 and 30 grams (g) a day.
Supplement Smarts
Although dietary supplements may offer benefits, they also come with risks — especially if you take multiple products, combine them with prescription drugs, or choose brands that haven’t been tested for purity. Look for brands that have been tested and validated by an independent third party, such as ConsumerLab.com.
Always talk with your healthcare provider before taking any supplements.
The Takeaway
- Supplements show promise in helping manage symptoms of rheumatoid arthritis (RA), but they should be used as an add-on, not a replacement for your prescribed medications.
- Most experts recommend a “food first” approach to getting the right amounts of vitamins and nutrients.
- Research into probiotics for RA is still in the early stages, with only a few strains showing potential benefits. For now, a diet rich in fiber and fermented foods is the safest way to support gut health.
- Always speak with your healthcare provider before starting any supplement. Certain products may interact with medications or pose risks, especially for people who are immunocompromised.
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