Rheumatoid Arthritis (RA) : Supplements

Dietary sources of omega-3 fatty acids include fish oil and certain plant/nut oils. Fish oil contains both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), while some nuts (English walnuts) and vegetable oils (canola, soybean, flaxseed/linseed, olive) contain alpha-linolenic acid (ALA). There is evidence from multiple studies supporting intake of recommended amounts of DHA and EPA in the form of dietary fish or fish oil supplements lowers triglycerides, reduces the risk of death, heart attack, dangerous abnormal heart rhythms, and strokes in people with known cardiovascular disease, slows the buildup of atherosclerotic plaques ("hardening of the arteries"), and lowers blood pressure slightly. However, high doses may have harmful effects, such as an increased risk of bleeding. Although similar benefits are proposed for alpha-linolenic acid, scientific evidence is less compelling, and beneficial effects may be less pronounced. Some species of fish carry a higher risk of environmental contamination, such as with methylmercury.

Omega-6 fatty acids are one of two groups of essential fatty acids(EFAs) that are required in human nutrition.(The other is the omega-3 fatty acid group.)

Borage oil, extracted from the seeds by cold pressing, contains omega-6 essential fatty acids, with as much as a 25–30% concentration of gamma linolenic acid(GLA). GLA is a derivative of the omega-6 fatty acids.

Antilipemic agent; combination consisting predominantly of ethyl esters of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Omega-3 fatty acids are one of two groups of fatty acids—the omega-3s and the omega-6s—that are vital to human life. They are called essential fatty acids(EFAs), which the body cannot make but absolutely needs for normal growth and dev...

Omega-3 EFAs are found in deepwater fish, fish oil, and some vegetable oils, such as canola, flaxseed, and walnut oil. Nuts are also a good source of omega-3 fatty acids, particularly hazelnuts, almonds, pecans, cashews, walnuts, and macadamia nuts.

Borage ( Borago officinalis ) is an herb native to Syria that has spread throughout the Middle East and Mediterranean. Borage flowers and leaves may be eaten and borage seeds are often pressed to produce oil very high in gamma-linolenic acid (GLA). Borage is popularly used for premenstrual syndrome (PMS) and menopausal symptoms. Borage is also popular among elderly women. Borage is known for its anti-inflammatory properties and has been studied for the treatment of gum disease, rheumatoid arthritis, and asthma. There is currently controversy about the safety of borage. Consumers should use caution when taking borage as there have been cases of poisoning after confusion with foxglove.

Zinc is an important trace mineral. This element is second only to iron in its concentration in the body.

Zinc is a mineral that is essential for a healthy immune system, production of certain hormones, wound healing, bone formation, and clear skin. It is required in very small amounts, and is thus known as a trace mineral.

Zinc is a mineral that is essential for a healthy immune system, production of certain hormones, wound healing, bone formation, and clear skin. It is required in very small amounts, and is thus known as a trace mineral.

Glucosamine is a natural compound that is found in healthy cartilage. Glucosamine sulfate is a normal constituent of glycoaminoglycans in cartilage matrix and synovial fluid. Available evidence from randomized controlled trials supports the use of glucosamine sulfate in the treatment of osteoarthritis, particularly of the knee. It is believed that the sulfate moiety provides clinical benefit in the synovial fluid by strengthening cartilage and aiding glycosaminoglycan synthesis. If this hypothesis is confirmed, it would mean that only the glucosamine sulfate form is effective and non-sulfated glucosamine forms are not effective. Glucosamine is commonly taken in combination with chondroitin, a glycosaminoglycan derived from articular cartilage. Use of complementary therapies, including glucosamine, is common in patients with osteoarthritis, and may allow for reduced doses of non-steroidal anti-inflammatory agents.

Glucosamine is an amino sugar that occurs naturally in the body. This one-molecule substance consists of glucose and a hydrogen and nitrogen amine.

Selenium is a trace mineral found in soil, water, and some foods. It is an essential element in several metabolic pathways. Selenium deficiency can occur in areas where soil content of selenium is low, and may affect thyroid function and cause conditions such as Keshan disease. Selenium deficiency is also commonly seen in patients on total parenteral nutrition (TPN) as their sole source of nutrition. Gastrointestinal disorders may decrease the absorption of selenium resulting in depletion or deficiency. Selenium may be destroyed when foods are refined or processed. Specific dietary sources of selenium include brewer's yeast, wheat germ, butter, garlic, grains, sunflower seeds, Brazil nuts, walnuts, raisins, liver, kidney, shellfish (lobster, oyster, shrimp, scallops), fresh-water and salt-water fish (red snapper, salmon, swordfish, tuna, mackerel, halibut, flounder, herring, smelts). Selenium is also found in alfalfa, burdock root, catnip, fennel seed, ginseng, raspberry leaf, radish, horseradish, onion, chives, medicinal mushrooms (reishi, shiitake), and yarrow. The role of selenium in cancer prevention has been the subject of recent study and debate. Initial evidence from the Nutritional Prevention of Cancer (NPC) trial suggests that selenium supplementation reduces the risk of prostate cancer among men with normal baseline PSA (prostate specific antigen) levels, and low selenium blood levels. However, in this study selenium did not reduce the risk of lung, colorectal, or basal cell carcinoma of the skin, and actually increased the risk of squamous cell skin carcinoma. The ongoing Selenium and Vitamin E Cancer Prevention Trial (SELECT) aims to definitively address the role of selenium in prostate cancer prevention.

Selenium is an essential trace mineral. Small amounts of selenium are good for your health.Selenium has a variety of functions.

Selenium is a nonmetallic element with an atomic number of 34 and an atomic weight of 78.96. Its chemical symbol is Se.

The rhizomes (underground stem) and stems of ginger have assumed significant roles in Chinese, Japanese and Indian medicine since the 1500s. The oleoresin of ginger is often contained in digestive, antitussive, antiflatulent, laxative, and antacid compounds. There is supportive evidence from one randomized controlled trial and an open-label study that ginger reduces the severity and duration of chemotherapy-induced nausea/emesis. Effects appear to be additive to prochlorperazine (Compazine®). The optimal dose remains unclear. Ginger's effects on other types of nausea/emesis, such as postoperative nausea or motion sickness remain indeterminate. Ginger is used orally, topically, and intramuscularly for a wide array of other conditions, without scientific evidence of benefit. Ginger may inhibit platelet aggregation/decrease platelet thromboxane production, thus theoretically increasing bleeding risk.

The rhizome (root) of turmeric ( Curcuma longa Linn.) has long been used in traditional Asian medicine to treat gastrointestinal upset, arthritic pain, and "low energy." Laboratory and animal research has demonstrated anti-inflammatory, antioxidant, and anti-cancer properties of turmeric and its constituent curcumin. Preliminary human evidence, albeit poor quality, suggests possible efficacy in the management of dyspepsia (heartburn), hyperlipidemia (high cholesterol), and scabies (when used on the skin).

Turmeric is a member of the Curcuma botanical group, which is part of the ginger family of herbs, the Zingiberaceae. Its botanical name is Curcuma longa.

Black cohosh is popular as an alternative to hormonal therapy in the treatment of menopausal (climacteric) symptoms such as hot flashes, mood disturbances, diaphoresis, palpitations, and vaginal dryness. Several studies have reported black cohosh to improve menopausal symptoms for up to six months, although the current evidence is mixed. The mechanism of action of black cohosh remains unclear and the effects on estrogen receptors or hormonal levels (if any) are not definitively known. Recent publications suggest that there may be no direct effects on estrogen receptors, although this is an area of active controversy. Safety and efficacy beyond six months have not been proven, although recent reports suggest safety of short-term use, including in women experiencing menopausal symptoms for whom estrogen replacement therapy is contraindicated. Nonetheless, caution is advisable until better-quality safety data are available. Use of black cohosh in high-risk populations (such as in women with a history of breast cancer) should be under the supervision of a licensed healthcare professional.

Black cohosh( Cimicufuga racemosa) is a member of the Ranunculaceae family. Its nicknames of squawroot and snakeroot denote its Algonquian heritage and differentiate it from the common snake root plant( Aristolochia serpentaria).

Feverfew is an herb that has been used traditionally for fevers, as its name denotes, although this effect has not been well studied. Feverfew is most commonly taken by mouth for the prevention of migraine headache. Several human trials have been conducted with mixed results. Overall, these studies suggest that feverfew taken daily as dried leaf capsules may reduce the incidence of headache attacks in patients who experience chronic migraines. However, this research has been poorly designed and reported. There is currently inconclusive evidence regarding the use of feverfew for symptoms associated with rheumatoid arthritis. Feverfew appears to be well tolerated in clinical trials, with a mild and reversible side effects profile. The most common adverse effect appears to be mouth ulceration and inflammation with direct exposure to leaves. In theory, there may be an increased risk of bleeding.

Feverfew( Chrysanthemum parthenium or Tanacetum parthenium) is named for one of the herb''s traditional medicinal uses as a febrifuge, from the Latin febrifugia, indicating its fever-reducing action. This European native of the Compositae(Asteracea...

DHEA (dehydroepiandrosterone) is an endogenous hormone (made in the human body), and secreted by the adrenal gland. DHEA serves as precursor to male and female sex hormones (androgens and estrogens). DHEA levels in the body begin to decrease after age 30, and are reported to be low in some people with anorexia, end-stage kidney disease, type 2 diabetes (non-insulin dependent diabetes), AIDS, adrenal insufficiency, and in the critically ill. DHEA levels may also be depleted by a number of drugs, including insulin, corticosteroids, opiates, and danazol. There is sufficient evidence supporting the use of DHEA in the treatment of adrenal insufficiency, depression, induction of labor, and systemic lupus erythematosus. No studies on the long-term effects of DHEA have been conducted. DHEA can cause higher than normal levels of androgens and estrogens in the body, and theoretically may increase the risk of prostate, breast, ovarian, and other hormone-sensitive cancers. Therefore, it is not recommended for regular use without supervision by a licensed health professional.

DHEA is the acronym for dehydroepiandrosterone, a hormone produced naturally from cholesterol in the adrenal glands of males and females. It is a precursor to the male sex hormone testosterone.

Dimethyl sulfoxide (C 2 H 6 OS), or DMSO, is a sulfur-containing organic compound. DMSO occurs naturally in vegetables, fruits, grains, and animal products. DMSO was first synthesized in 1866 as a byproduct of paper manufacturing. Therapeutic interest began in 1963. DMSO was reported to penetrate through the skin and produce analgesia, decrease pain, and promote tissue healing. DMSO is available for both non-medicinal and medicinal uses. The major clinical use of DMSO is to relieve symptoms of interstitial cystitis. Potential toxic effects to the lens of the eye have been reported in animals but no effects have been noted in humans. Topical application has been associated with redness and inflammation of skin, and a garlic-like taste and odor on the breath have been reported. DMSO has been used to treat amyloidosis ( 1 ; 2 ; 3 ; 4 ; 5 ; 6 ), diabetic ulcers ( 7 ), extravasation ( 8 ), erosive gastritis ( 9 ), and ischemia prevention in surgical flaps ( 10 ), but well designed clinical trials are lacking. Because of the limited scientific evidence, whether DMSO provides effective treatment of patients with closed head trauma ( 11 ), herpes zoster ( 12 ; 13 ), tendopathies ( 14 ), and complex regional pain syndrome ( 15 ) will require more research.

Guggul (gum guggul) is a resin produced by the mukul mirth tree. Guggulipid is extracted from guggul, and contains plant sterols (guggulsterones E and Z), which are believed to be its bioactive compounds. Prior to 2003, the majority of scientific evidence suggested that guggulipid elicits significant reductions in serum total cholesterol, low-density lipoprotein (LDL), and triglycerides, as well as elevations in high-density lipoprotein (HDL). Although recent evidence provides preliminary evidence against the efficacy of guggul for hypercholesterolemia, and thus, further study is necessary before a definitive conclusion can be reached. Initial research reports that guggulsterones are antagonists of the farsenoid X receptor (FXR) and the bile acid receptor (BAR), nuclear hormones that are involved with cholesterol metabolism and bile acid regulation.

It grows naturally throughout India and Arabia. Guggul is the gum resin that comes from this tree, which belongs to the same genus as myrrh and has some similar components and actions.

Gamma linolenic acid (GLA) is a dietary omega-6 fatty acid found in many plant oil extracts. Commercial products are typically made from seed extracts from evening primrose (average oil content 7-14%), blackcurrant (15-20%), borage oil (20-27%) and fungal oil (25%). GLA is not found in high levels in the diet. It has been suggested that some individuals may not convert the omega-6 fatty acid linoleic acid to longer chain derivatives, such as GLA, efficiently. Thus, supplementation with GLA-containing oils, such as borage oil and evening primrose oil, is occasionally recommended to increase GLA levels in the body. GLA is available commonly as a dietary supplement and is sold over the counter in capsules or oil to treat a variety of conditions such as eczema, oral mucoceles (mucus polyps), hyperlipidemia (high cholesterol), depression, postpartum depression, chronic fatigue syndrome (CFS), psoriasis (chronic skin disease), muscle aches, and menopausal flushing. There is currently good evidence for GLA treatment in rheumatoid arthritis, acute respiratory distress syndrome, and diabetic neuropathy (nerve damage). Little or no effect has been found in treatment of atopic dermatitis, attention deficit hyperactivity disorder (ADHD), cancer prevention, menopausal flushing, systemic sclerosis, and hypertension (high blood pressure). GLA has also been used to help with the body's response to tamoxifen in breast cancer patients. Today, production and extraction of oil from evening primrose and borage is done by companies primarily in China, New Zealand, and England. Pharmaceutical licensing for GLA oil products has had only limited success worldwide.

Pantothenic acid (vitamin B5) is essential to all life, and is a component of coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol. The name pantothenic acid comes from the Greek word pantos, meaning "everywhere," referring to its wide distribution in most plants and animals. Rich food sources include meats, liver, kidney, fish/shellfish, chicken, vegetables, legumes, yeast, eggs, and milk. However, freezing and canning may lead to a loss of much of the pantothenic acid content. Whole grains are also a good source, although refining may degrade much of the pantothenic acid content. In commercial supplement products, vitamin B5 is available as D-pantothenic acid and as the synthetic products dexpanthenol (converted in the body to pantothenic acid) or calcium pantothenate. Pantothenic acid is frequently used in combination with other B vitamins in vitamin B complex formulations. Only the dextrorotatory (D) isomer of pantothenic acid possesses biologic activity. Pantothenic acid deficiency is exceedingly rare, and likely only occurs only in cases of the most severe life-threatening malnutrition. Most individuals likely obtain sufficient amounts from dietary sources. Pantothenic acid has been used or studied for numerous health conditions, but has not been clearly demonstrated as beneficial for any. Oral, topical (on the skin), or injected forms have been used.

Pantothenic acid and biotin are types of B vitamins. They are water-soluble, which means that the body can''t store them.

Pantothenic acid, also known as vitamin B 5, is a member of the water-soluble B vitamin family. It is an essential ingredient of two substances, coenzyme A and acyl carrier protein, which are needed to metabolize carbohydrates and fats.

The black currant shrub is native to Europe and parts of Asia and is particularly popular in Eastern Europe and Russia. Traditional herbalists uphold that black currant has diuretic (increases urine flow), diaphoretic (promotes sweating), and antipyretic (fever reducer) properties. In Europe, it has been used topically (applied to the skin) to treat skin disorders, such as atopic dermatitis, and as part of gargles to treat sore throats. Black currant juice has been boiled down into a sugary extract, called Rob, to treat sore throat inflammation, colds, the flu, and febrile (fever) illness. A mixture made from black currant bark has been used to treat calculus (hardened plaque), edema (swelling), and hemorrhoids. With a vitamin C content estimated to be five times that of oranges (2,000 milligrams/kilogram), black currant has potential dietary benefits. Black currant is also rich in rutin and other flavonoids, which are known antioxidants. Because of black currant's high essential fatty acid content, researchers believe that it may be effective in the treatment of inflammatory conditions and pain management, as well as in regulating the circulatory system and increasing immunity. As a medicinal treatment, black currant seed oil is the most commonly used part of the plant and is available in capsule form. The effectiveness of black currant seed oil is mixed and safety concerns seem to be minor in non-allergic people.

Podophyllum gets its name from the Greek words podos and phyllon , meaning foot shaped leaves. Podophyllum rhizomes have a long medicinal history among native North American tribes who used a rhizome powder as a laxative or an agent that expels worms (anthelmintic). A poultice of the powder was also used to treat warts and tumorous growths on the skin. Podophyllotoxin is a plant-derived compound used to produce two cytostatic drugs, etoposide and teniposide. The substance has been primarily obtained from the American mayapple ( Podophyllum peltatum ). The Himalayan mayapple ( Podophyllum hexandrum or Podophyllum emodi ) contains this constituent in a much greater quantity, but is endangered in the wild. Currently, extracts of the podophyllum plant are used in topical medications for genital warts, HIV-related oral hairy leukoplakia, and some skin cancers. Preliminary research also shows that CPH 82, an oral form of Podophyllum emodi composed of two purified semisynthetic lignan glycosides, may be useful in treating rheumatoid arthritis. However, when used orally, podophyllum can be lethal and should be avoided. The drug etoposide (VePesid®) is the semisynthetic derivative of podophyllotoxin, and is approved by the U.S. Food and Drug Administration (FDA) for various types of cancer.

Chlorophyll is a chemoprotein commonly known for its contribution to the green pigmentation in plants, and is related to protoheme, the red pigment of blood. It can be obtained from green leafy vegetables (broccoli, Brussel sprouts, cabbage, lettuce, and spinach), algae ( Chlorella and Spirulina ), wheat grass, and numerous herbs (alfalfa, damiana, nettle, and parsley). Chlorophyll has been used traditionally to improve bad breath and other forms of body odor including odors of the urine, feces, and infected wounds. More recently chlorophyll has been used to aid in the removal of various toxins via the liver and remains a key compound for improving the function of essential detoxification pathways. Supportive evidence suggests it may be used as an anti-inflammatory agent for conditions, such as pancreatitis as well as exhibiting potent antioxidant and chemoprotective activities. Scientific research has demonstrated it may be an effective therapeutic agent in the treatment of herpes simplex, benign breast disease, chemoprevention, tuberculosis, and rheumatoid arthritis. Type 2 diabetes and obesity are also being explored as areas where chlorophyll can also be used.

Classified as an herb, bromelain is a sulfur-containing proteolytic digestive enzyme that is extracted from the stem and the fruit of the pineapple plant ( Ananas comosus , family Bromeliaceae) . When taken with meals, bromelain is believed to assist in the digestion of proteins. When taken on an empty stomach, it is believed to act medicinally as an anti-inflammatory agent. The expert panel, the German Commission E approved bromelain for the treatment of swelling/inflammation of the nose and sinuses caused by injuries and surgery in 1993.

Bromelain, also known as bromelin, is a protein-digesting enzyme extracted from the flesh and stem of the pineapple plant, Ananas comosus. Although the people of Guadeloupe introduced Christopher Columbus to the fruit in 1493, Europeans did not re...

Zinc formulations have been used since Ancient Egyptian times to enhance wound healing, although the usefulness of this approach is only partially confirmed by clinical data of today. Zinc is necessary for the functioning of over 300 different enzymes and plays a vital role in an enormous number of biological processes. Zinc is a cofactor for the antioxidant enzyme superoxide dismutase (SOD) and is in a number of enzymatic reactions involved in carbohydrate and protein metabolism. Its immunologic activities include regulation of T lymphocytes, CD4, natural killer cells, and interleukin II. In addition, zinc has been claimed to possess antiviral activity. It has been shown to play a role in wound healing, especially following burns or surgical incisions. Zinc is necessary for the maturation of sperm and normal fetal development. It is involved in sensory perception (taste, smell, and vision) and controls the release of stored vitamin A from the liver. Within the endocrine system, zinc has been shown to regulate insulin activity and promote the conversion thyroid hormones thyroxine to triiodothyronine. Based on available scientific evidence, zinc may be efficacious in the treatment of (childhood) malnutrition, acne vulgaris, peptic ulcers, leg ulcers, infertility, Wilson's disease, herpes, and taste or smell disorders. Zinc has also gained popularity for its use in prevention of the common cold. The role for zinc is controversial in some cases, as the results of published studies provide either contradictory information, and/or the methodological quality of the studies do not allow for a confident conclusion regarding the role of zinc in those diseases.

Resin extracts from the Boswellia serrata tree have been found to have anti-inflammatory effects. Animal and laboratory studies suggest possible efficacy for inflammatory conditions such as inflammatory bowel disease, rheumatoid arthritis, and osteoarthritis, although high-quality human data are lacking. Initial human evidence suggests the efficacy of boswellia as a chronic therapy for asthma (but not for the relief of acute asthma exacerbations). Further studies are warranted in this area. As opposed to non-steroidal anti-inflammatory drugs (NSAIDs), long-term use of boswellia has not been shown to cause gastrointestinal irritation or ulceration, although adverse effects have not been well studied in humans.

Astaxanthin is classified as a xanthophyll, which is a carotenoid pigment, and can be found in microalgae, yeast, salmon, trout, krill, shrimp, crayfish, crustaceans, and the feathers of some birds. Haematococcus pluvialis , a green microalga and one of the richest sources of natural astaxanthin, was reviewed and cleared for marketing by the United States Food and Drug Administration (FDA) in August 1999 as a new dietary ingredient by means of the Dietary Supplement Health and Education Act (DSHEA) (21 CRF part 190.6). Astaxanthin is most commonly used as an antioxidant and may be beneficial in decreasing the risks of certain chronic diseases, such as cancer and cardiovascular diseases. Astaxanthin may also be effective in carpal tunnel syndrome, rheumatoid arthritis, muscle strength and endurance, high cholesterol (LDL oxidation), musculoskeletal injuries, and male infertility. Astaxanthin has been used as a feed supplement and food coloring additive for salmon, crabs, shrimp, chickens, and egg production. According to the Code of Federal Regulations, astaxanthin is generally recognized as safe (GRAS) when used as a color additive in salmon foods to obtain the desired pink to orange-red color.

In the United States, willow bark is used by herbalists as an antipyretic (fever reducer), a mild analgesic (pain reliever), and an anti-inflammatory. There is currently strong scientific evidence that willow bark is effective for osteoarthritis and lower back pain. Early study suggests that willow bark extracts may not be helpful for rheumatoid arthritis, but further study is warranted to confirm these recommendations. Taking willow bark may increase the risk of bleeding; however, this risk may be less than taking aspirin. Several countries in Europe have approved willow bark for pain and inflammatory disorders. The German Commission E has approved willow bark for fever, rheumatic ailments, and headaches. The British Herbal Compendium indicates that willow bark can be used for rheumatic and arthritic conditions, and fever associated with cold and influenza. In France, willow bark has been approved as an analgesic to treat headache and toothache pain, as well as painful articular (joint) conditions, tendonitis, and sprains. The European Scientific Cooperative on Phytotherapy (ESCOP) has approved willow bark extract for the treatment of fever, pain, and mild rheumatic complaints.

Evening primrose oil (EPO) contains an omega-6 essential fatty acid, gamma-linolenic acid (GLA), which is believed to be the active ingredient. EPO has been studied in a wide variety of disorders, particularly those affected by metabolic products of essential fatty acids. However, high-quality evidence for its use in most conditions is still lacking.

Evening primrose oil is a dietary supplement derived from the seeds of the evening primrose plant, Oenothera biennis. Its Latin name is derived from the Greek word for wine, reflecting the folk belief that the plant could.relieve the symptoms of a...