Do joint supplements really help with the pain of arthritis?

We assess the effectiveness of omega-3 fatty acids, ­glucosamine and ­chondroitin, and rosehip extracts

Joint health supplements are big business in the UK. Millions of pounds are spent over the counter every year, and most buyers are seeking relief from the symptoms of arthritis — a group of painful long-term conditions thought to affect around 10 million Britons.

Osteoarthritis is the most common form, affecting around eight million people. It usually comes on as you age, with joint pain and stiffness developing as the cartilage between the bones gradually wears away. Rheumatoid arthritis tends to affect a younger section of the population and is caused by the body’s immune system attacking the joints.

NHS guidelines recommend that sufferers maintain a healthy weight and stay physically active, strengthening their muscles while protecting any damaged joints during daily life. First-choice prescription drugs for osteoarthritis are topical non-steroidal anti–inflammatories (NSAIDs) and paracetamol; for Rheumatoid arthritis, drugs that suppress the immune system are usually recommended.

So why do people with arthritis turn to joint supplements when they can be treated on prescription? And do any of the supplements really work? In my experience, patients try these products as an alternative to their prescription drugs, or to supplement them. The most popular include omega-3 fatty acids, glucosamine and chondroitin, and rosehip extracts. So let’s look at the evidence for their use and effectiveness…

Omega-3 fatty acids

These are found in fish oils and are usually sold as capsules or liquids. They have anti-inflammatory properties and some evidence suggests that, when taken regularly at a high enough dose, they reduce cholesterol and may benefit heart health. UK diet guidelines recommend eating at least one portion a week of oily fish such as sardines or mackerel. This works out at about 0.45 grams per day of omega-3 fatty acids.

However, a daily dose of at least 2.7 grams is thought necessary to get the anti-inflammatory effect, and this means taking a lot of standard fish-oil capsules every day. There is reasonably good evidence — although the studies are quite old — that fish oil provides effective pain relief for some people with rheumatoid arthritis, reducing their symptoms and their need to take NSAIDs. However, these benefits may not appear for up to three months, so perseverance is vital. Very little evidence exists to suggest that fish-oil supplements benefit people with osteoarthritis.

Glucosamine and chondroitin

Many people with osteoarthritis try glucosamine, sometimes in combination with chondroitin. Both occur naturally in the body and help to keep our joints healthy. Some early studies reported positive findings with glucosamine, but more recent and better–designed research found no consistent benefits. Of the two types available (glucosamine sulphate and glucosamine hydrochloride), the sulphate appears to be more effective, and a daily dose of 1500mg is generally recommended. Treatment should stop if there is no improvement after a three-month trial.

Rosehip extracts

Roses and rosehip extracts have a long history of medicinal use but their potential for treating both types of arthritis has come to light only recently. The most consistent and robust research used extracts from a specific species of rosehip called w, which was found to contain a potent anti-inflammatory ingredient called galactolipid (or Gopo for short). Several well-designed studies in Scandinavia and Germany found that Gopo can rapidly reduce joint pain, stiffness and swelling, improve joint mobility and reduce the need for standard painkillers. In one combined analysis of all Gopo studies, the researchers said it may be more effective than either paracetamol or glucosamine in treating osteoarthritis. As with all the supplements reviewed here, a three-month trial at the manufacturer’s recommended dose may be considered.

Though a variety of rosehip supplements are on sale, it’s not clear whether they contain the same amount of Gopo as the product used in all the studies (called Gopo Joint Health). No research has been carried out with other preparations so it’s unwise to presume that all rosehip products offer the same benefits.

So where do the supplements fit in?

Many people with painful joint conditions feel they benefit from taking supplements alongside or instead of their prescribed medication. All those reviewed here are generally well tolerated and I would not dissuade anyone from starting a three-month trial if they wish.

Fish oils have many potential benefits, but you need a least nine standard capsules a day to achieve a clinically effective dose. This may be too expensive for many people. Glucosamine and chondroitin may work for some, but it seems likely that there’s an equal number of patients who feel no improvement. Gopo has been well studied and appears to have multiple benefits for a range of painful joint conditions — but do beware of the copycat products that may not contain the active ingredient.

  • Robert Jones

    Hm. Well at least the article differentiates between the two major types of arthritis, which newspaper reports hardly ever do: the conditions have little connection. However, forgive me for sneering at the point that Gopo is more effective than paracetamol or glucosamine in treating osteoarthritis, since neither is even remotely effective. A tube of Smarties might work better – at least you’d derive some pleasure from them.

    • kim

      How did you get the doctors to listen to you? I’m 47 and the doctors have the evidence in hand that I have 5 herniated discs in my neck and lower back combined. I have spinal stenosis and arthritis and they STILL don’t believe I have back pain! I’m in the US. I look very young for my age but I was physically abused for most of my adult life (poor choice in men). I do not ‘act’ like I’m in pain because I believe that the people who get the pain killers are doing just that, acting. They groan and moan and present themselves in such a way that they get the attention they are seeking. And they aren’t even good at the acting! I have the proof and they won’t listen. They diagnose the fake people with Fibro and throw drugs at them even though they know they are faking. I just don’t get it. Thanks in advance. The doctors treat me like I am their friend. They tell me about their lives and ask me for advice. I am lost. I’ve tried everything to get them to listen.

      • David Brown

        I know what works best for me – cbd cream for arthritis
        It’s a relatively new trend, which is still being tested. Yet some proof of the positive effect of hemp lotion for pain or the CBD cream for arthritis is already available. CBD ointments are rather medical than recreational goodies, since they have no TCH and correspondingly are free from any psychedelic offshoots.

  • Helen Ellis

    Glucosamine works for me, my knees are in better shape now, at 56, than when I was first diagnosed with Osteoarthritis aged 37. It took a year of 1,500mg daily dose of glucosamine sulphate, along with flax seed oil and celery seed ( as was recommended) for the pain and creaking in my knees to disappear, but it did and my strength and confidence returned. I could return to jazz and tap dance classes, and to horse riding, all of which I’d had to stop. It clearly doesn’t work for everyone, but for me it was a life saver.

    • Robert Jones

      Interesting, and glad that you’ve improved: but osteo-arthritis is at least said to be a condition that limits itself to specific joints (in fact, I believe that if you have a propensity to it it can pop up anywhere, but let us stick to the evidence). By what process could these substances enter the knee joints – presumably you took them orally – still less counter the gradual thinning of cartilage and erosion of bone? Is there X-ray evidence to support your belief that your initial diagnosis was correct, or to suggest that there has been an improvement over the last 20 years? Without that, it’s impossible to form any conclusion from the anecdote.

      Strengthening and improving musculature can in itself do a certain amount at least to lessen the pain of osteo-arthritis – hence the usefulness of swimming (together with the supportive element of the water) as an exercise.

      I am by the way neither a doctor nor a scientist – just arthritic, of long sufferance.

      • Helen Ellis

        The only diagnosis was from my GP, from feeling the kneecaps as I flexed my knees. They both crunched like crazy and I also had pain and bruising just below the sides of each knee, the top side of my shin bones I suppose. She prescribed ibuprofen, which I took. It helped but gradually I had to stop, or practice more gently, my dance, riding, etc as my knees were too painful and sometimes gave way under me. So I was fit and exercising while it was worsening. Then I met a couple of dancers who recommended the glucosamine, plus flax seed oil and celery seed. Worth a try I thought so started taking them and came off the ibuprofen. For a week I was in agony, felt like my knees were great big red swollen things, (nothing visible though) but gradually the pain decreased and after a couple of months I could feel the strength returning.
        It took a year for the pain and the crunching to go but the difference then was amazing. If I say I could not only return to dance class, I could do the same class as the students (16-18 yr olds) did and one routine included knee spins! I understand that glucosamine doesn’t work for everyone, and I can’t explain this as it so evidently worked for me. As a side effect my nails have become much stronger than they ever were before and I can now grow a nice set of nails which I couldn’t do before, they always broke.
        I used Healthspan glucosamine 1,500 mg which I get by mail order as I know it works for me.

        So yes it’s anecdotal evidence with no x rays to back it up. Maybe I caught it in time, before the cartilege was gone, or It just filled a nutritional need in me.

        I do have a friend who has tried glucosamine and it didn’t work, she ended up having two knee replacements.

        Hope you find something that works for you.

  • bert

    I was/am taking Animal Flex; which is an over the counter supplement that body builders take as they tend to be hard on their joints. It runs about $45 USD for a two month supply and there are about 8 pills per individual packet that you have to take.

    I guess it works, but my Osteo flare ups have come back while taking the supplement and they were unbearable. Typically I get the flare ups in both my feet and my morning walk from my car to the office is excruciating. As the day progresses they get milder. Anyhow, I went to the doctor yesterday and got four cortisone shots in my feet and they feel better for now. He sent me home with a trial packet (three days worth) of a drug called Duexis. I think this is a potent NSAID with a antacid component in it for GI relief. My only problem is the Duexis looks to cost roughly $2,300 UDS for a 90 day supply.

    Oh the joys of getting arthritis in my 30s….

  • John Doe

    In 2006 the largest and best-designed clinical trial was the
    Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), which was funded by the National Institutes of Health. The study found that glucosamine and chondroitin, alone or together, did not reduce osteoarthritis knee pain any more effectively than a placebo.
    There has been study after study from 2006 to 2014 and in the end there were no statistically significant differences among the
    So my question is. Having no clinical proof that glucosamine sulfate works any better than a placebo or glucosamine hydrochloride for that matter – how do you make the fraudulent claim that sulfate is any better than hydrochloride?
    And just who is suggesting that 1500mg appears to be a more effective dose. Really!
    That’s as irresponsible as me suggesting that a half gallon of cream is
    more effective than 1500 mg of glucosamine hydrochloride because it has