Osteoarthritis and Complementary 

Health Approaches

© Ingram Publishing/Thinkstock

Osteoarthritis (OA) is a disease that causes pain and difficulty 

moving joints, particularly in the knees, hips, hands, and spine. This 

fact sheet provides basic information on OA, summarizes scientific 

research on selected dietary supplements, mind and body practices, 

and other complementary health approaches that have been studied 

for OA, and suggests sources for additional information.

Key Points 

• It is important not to replace conventional medical treatments 

for OA with an unproven complementary health approach. 

• Some research has shown that acupuncture may help to reduce 

pain and improve joint mobility, and a small number of studies 

on massage and tai chi for OA symptoms suggest that both

practices may help to reduce pain and improve physical 

function (the ability to walk and move).

• There is little conclusive evidence that dietary supplements help 

with OA symptoms or the underlying course of the disease. 

• Tell all your health care providers about any complementary 

health approaches you use. Give them a full picture of what you do 

to manage your health. This will help ensure coordinated and 

safe care.

About Osteoarthritis 

Osteoarthritis is the most common type of arthritis—affecting 

nearly 27 million Americans—and is an increasing problem among 

older adults. OA occurs when the cartilage (protective tissue) 

between the bones of a joint is worn down. As a result, the bones 

rub together, causing pain and loss of function—such as stiffness or 

reduced range of motion—in the joints. 

OA is different from rheumatoid arthritis, which is an autoimmune 

disease that also affects other tissues in the body in addition to joints, 

including the eyes, heart, and lungs. Risk factors include aging, joint 

injuries, or genetic problems that specifically affect the joint cartilage. 

Both men and women are affected by OA; although after the age of 45 

women tend to be more at risk of developing the disease.
2 

Treatments for OA address the symptoms, such as pain, swelling, and reduced function in the 

joints. Nonmedicinal approaches involve lifestyle changes such as exercise, weight control, and rest. 

Conventional medicinal treatments for OA include nonsteroidal anti-inflammatory drugs 

(NSAIDS), acetaminophen (a class of pain reliever), and injections of corticosteroids (antiinflammatory hormones). While important and very helpful for many, these treatments are not 

always effective and they sometimes result in serious side effects. For example, NSAIDS may cause 

liver damage, ulcers, and gastrointestinal bleeding and can increase risk of heart attack and stroke.

To find out more about OA, visit the National Institute of Arthritis and Musculoskeletal and 

Skin Diseases Web site (see “For More Information”).

Use of Complementary Health Approaches for Osteoarthritis in the 

United States

According to the 2007 National Health Interview Survey, which included a comprehensive survey 

on the use of complementary health approaches by Americans, 5.2 percent of U.S. adults used 

complementary health approaches for joint pain or stiffness, and 3.5 percent used them for arthritis.

What the Science Says 

Dietary Supplements

Researchers have found little conclusive evidence that dietary supplements work for OA symptoms 

or the underlying course of the disease.

Glucosamine and Chondroitin Sulfate

Glucosamine and chondroitin sulfate—taken separately or 

together—are marketed for supporting joint health and 

have also been widely used for treating OA. Both 

supplements are forms of chemicals found naturally within 

the body’s cartilage.

• NCCAM funded a study that examined the use of 

glucosamine and chondroitin sulfate for knee pain from 

OA. The Glucosamine/chondroitin Arthritis Intervention 

Trial (GAIT) enrolled close to 1,600 participants. Results 

indicated that overall, a 6-month treatment with the 

dietary supplements was no better than placebo. While 

there was some evidence suggesting that participants 

with moderate-to-severe pain had modest reductions in 

pain with the combined supplements, this has not been 

confirmed. In a followup study of GAIT participants, 

researchers examined whether glucosamine and 

chondroitin could prevent the progression of OA—an 

evaluation based on measuring joint space width. 

Results showed no significant change in joint space 

width or improvement in pain and function.

About Scientific Evidence 

on Complementary 

 Health Approaches

Scientific evidence on 

complementary health 

approaches includes results from 

laboratory research as well as 

clinical trials (studies in people). 

It provides information on 

whether an approach is helpful 

and safe. Scientific journals 

publish study results, as well as 

review articles that evaluate the 

evidence as it accumulates; fact 

sheets from the National Center 

for Complementary and 

Alternative Medicine (NCCAM)—

like this one—base information 

about research findings primarily 

on the most rigorous review 

articles, known as systematic 

reviews and meta-analyses.
3 

• A 2010 meta-analysis that analyzed 10 glucosamine and chondroitin trials involving 3,803 

patients with knee or hip OA published similar results. Compared with placebo, glucosamine, 

chondroitin, or a combination of both did not significantly reduce pain or change joint space.

• Glucosamine and chondroitin appear to be relatively safe and well tolerated when used in 

suggested doses over a 2-year period. In a few specific situations, however, there are 

concerns that side effects or drug interactions might occur:

o Glucosamine may interact with the anticoagulant (blood-thinning) drug warfarin.

o There is conflicting evidence about whether glucosamine might have negative effects 

on glucose metabolism, especially in people with insulin resistance or impaired glucose 

tolerance; more research on this topic is needed.

o It is possible that glucosamine might make asthma worse, although this has not 

been proven.

o There have been concerns that glucosamine—which is often derived from the shells of 

shrimp, lobsters, or crabs—might trigger allergic reactions in people with allergies to 

these shellfish. However, no such allergic reactions have been reported.

o Finally, although recent studies conducted by the U.S. Food and Drug Administration 

show that high doses of glucosamine hydrochloride taken by mouth in rats may 

promote cartilage regeneration and repair, this dose was also found to cause severe 

kidney problems in the rats—a serious side effect of the treatment. 

Dimethyl Sulfoxide (DMSO) and Methylsulfonylmethane (MSM)

DMSO and MSM are two chemically related dietary supplements that have been used for 

arthritic conditions. A 2009 meta-analysis of a small number of studies looked at topical (applied 

to skin) DMSO and oral (taken by mouth) MSM as potential products for OA of the knee. There 

was no evidence of significant reductions in pain compared to placebo. Although there is limited 

safety data available, some side effects from topical DMSO have been reported, including upset 

stomach, skin irritation, and garlic taste, breath, and body odor. Only minor side effects are 

associated with MSM in humans including allergy, upset stomach, and skin rashes.

S-Adenosyl-L-methionine (SAMe)

SAMe is a molecule that is naturally produced in the body and is often taken as a dietary 

supplement. A 2009 systematic review concluded that there was not enough evidence to use 

SAMe for OA of the knee or hip. The reviewers did indicate that small improvements in pain 

and function were seen in some but not all studies. SAMe is generally considered safe. 

Common side effects include gastrointestinal problems, dry mouth, headache, sweating, 

dizziness, and nervousness.

Herbal Remedies

Although some results suggest that a few herbs may be beneficial for OA symptoms, the 

overall evidence is weak. In addition, not all herbs have been studied or prepared in a 

consistent way, and conclusions among reviews of the literature provide conflicting 

interpretations. There is also a general lack of safety data available for many herbal medicines.

Be aware that an herbal supplement may contain dozens of compounds and that its 

composition may not be well characterized or fully understood. Researchers are studying 
4 

many of these products in an effort to identify active ingredients and understand their effects 

in the body. It is also important to keep in mind that although many dietary supplements (and 

some prescription drugs) come from natural sources, “natural does not always mean safe.”

Mind and Body Practices

Mind and body practices—such as acupuncture, massage, tai chi, qi gong, and yoga—have been 

studied for OA. Results from clinical trials suggest that acupuncture may be beneficial for some 

OA symptoms. There are a limited number of quality studies for tai chi, qi gong, and yoga.

In 2012, the American College of Rheumatology issued recommendations for using pharmacologic 

and nonpharmacologic approaches for OA of the hand, hip, and knee. The guidelines conditionally 

(cautiously) recommend tai chi, along with other nonpharmacologic approaches such as selfmanagement programs and walking aids, for managing knee OA. Acupuncture is also conditionally 

recommended for those who have chronic moderate-to-severe knee pain and are candidates for 

total knee arthroplasty but can’t or won’t undergo the procedure. It is important to talk with your 

health care provider before beginning any new conventional or complementary approach.

Acupuncture has been studied in clinical trials for pain in a number of conditions including 

OA. Studies focused primarily on OA of the knee. There is also evidence that acupuncture may 

help to lessen pain and improve function in other joints such as the hip.

• A 2009 NCCAM-funded literature review examined acupuncture for chronic back pain, OA, 

and headache. The authors concluded that acupuncture typically appears better than 

usual, or conventional, care or wait list controls for people with OA but may not provide 

additional benefit for people with OA who are receiving advice and exercise.

• In a 2008 NCCAM-funded systematic review of randomized controlled trials of acupuncture for 

OA of the knee, researchers examined 10 trials involving 1,456 participants. The authors 

concluded that these studies provide evidence that acupuncture is an effective treatment for 

pain and improving mobility in people with OA.

• Authors of a 2007 meta-analysis suggested that although some large, high-quality trials have 

shown that acupuncture may be effective for osteoarthritis of the knee, differences in the design, 

size, and protocol of the studies make it hard to draw any definite conclusions from the body of 

research. These authors concluded that it is too soon to recommend acupuncture as a routine 

part of care for patients with osteoarthritis.

• Authors of a 2010 systematic review looked at the effects of acupuncture in people with OA 

in peripheral joints of the body—knee, hip, or hand. The reviewers examined 16 trials 

involving 3,498 people and found that although acupuncture, when compared to a sham 

treatment, showed statistically significant, short-term improvements in osteoarthritis 

pain, the benefits were small and were not found to be clinically relevant (useful in a 

clinical setting). In contrast, the reviewers also found that acupuncture, when compared to 

a waiting list control, showed statistically significant and clinically relevant benefits in 

people with peripheral joint osteoarthritis. The researchers suggest the beneficial effects in 

the latter studies were due in part to expectation or placebo effects.
5 

There are few complications associated with acupuncture, but adverse effects such as minor 

bruising or bleeding can occur; infections can result from the use of nonsterile needles or poor 

technique from an inexperienced practitioner.

Massage therapy has been studied for pain; however, there 

are very few studies that look at massage therapy and OA 

specifically. The results of one clinical trial, which did 

examine massage on adults with OA of the knee, indicated 

that massage may reduce pain and improve function.

Tai chi is an ancient meditative practice that originated 

in China as a martial art.

• In 2009, Arthritis and Rheumatism published a small 

NCCAM-funded randomized controlled trial on the 

effects of tai chi on knee OA. The results indicated 

that participants who practiced tai chi had 

improvement in pain and physical function as well as 

in depression and health-related quality of life when 

compared to participants enrolled in an education 

and stretching program. Although previous tai chi 

studies have shown an improvement in balance, this 

study did not find a statistically significant 

improvement in participants’ balance tests.

• Tai chi is considered to be a relatively safe practice.

Qi gong is a group of traditional Chinese exercises, 

breathing techniques, and meditation practices. There 

are studies on qi gong and pain, but there is very little 

research specifically on qi gong and OA.

• A randomized controlled trial funded by NCCAM 

studied the effects of practitioner-led qi gong on OA 

of the knee. The results from this study were 

inconclusive.

• Qi gong is generally considered to be a safe practice.

Yoga—while numerous studies have been published on 

yoga for anxiety and stress, little research has been done 

to study yoga and OA. Yoga is generally low-impact and 

safe for healthy people when practiced appropriately 

under the guidance of a well-trained instructor, however 

overstretching can occur particularly in diseased joints 

and ligaments. If you have a medical condition, consult 

your health care provider before starting yoga.

Mind and Body Practices 

and Placebo

Researching mind and body 

interventions for pain 

management presents many 

challenges. One such challenge 

is the role of placebo effects—a 

term which describes 

improvements that are not 

related specifically to the 

treatment being studied. It is 

well known that placebo effects 

can be quite large in pain 

studies. A “placebo control” pill 

(which is identical in 

appearance but contains no 

active ingredient) can be useful 

in separating product-related 

effects from placebo effects 

when researching a dietary 

supplement. However, it is 

much more difficult—and often 

impossible—to conceal the 

nature of mind and body 

practices from study 

participants because they 

involve activities in which the 

person must engage. They also 

often involve interactions with 

providers that are known to 

activate placebo effects 

(e.g., touch). In the case of 

studies of mind and body 

practices for pain, investigators 

must give very careful attention 

to study design and steps to 

ensure that measurements of 

improvement are as objective 

as possible.
6 

Other Complementary Health Approaches for Osteoarthritis

• Homeopathy—a 2006 literature review concluded that there is little evidence to support 

homeopathy as an effective therapy for OA symptoms, particularly pain. There has been no 

recent research studying the effects of homeopathy on OA.

• Magnets—the available scientific evidence does not support the use of magnets for pain relief.

If You Have OA and Are Thinking Complementary Health Approaches

for Osteoarthritis

• Do not replace proven conventional medical treatments for OA with unproven 

complementary health approaches.

• Be aware that some complementary health approaches—particularly dietary supplements—may 

interact with conventional medical treatments. It is important to keep in mind that although 

many supplements (and some prescription drugs) come from natural sources, “natural” does 

not always mean “safe.” To learn more about using dietary supplements, see the NCCAM fact 

sheet Using Dietary Supplements Wisely at nccam.nih.gov/health/supplements/wiseuse.htm.

• Women who are pregnant or nursing should consult their health care provider before using 

any complementary health approach. 

• Tell all your health care providers about any complementary health approaches you use. Give 

them a full picture of what you do to manage your health. This will help ensure 

coordinated and safe care. For tips about talking with your health care providers about 

complementary health approaches, see NCCAM’s Time to Talk campaign at 

nccam.nih.gov/timetotalk. 

Selected References 

About Osteoarthritis and Complementary Health Approaches

Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United 

States, 2007. CDC National Health Statistics Report # 12. 2008.

Ernst E. Complementary or alternative therapies for osteoarthritis. Nature Clinical Practice. Rheumatology. 2006;2(2):74-80.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Handout on Health: Osteoarthritis. National 

Institute of Arthritis and Musculoskeletal and Skin Diseases Web site. Accessed at 

http://www.niams.nih.gov/health_info/osteoarthritis/default.asp on May 30, 2012.

Complementary Health Approaches for Osteoarthritis: Dietary Supplements

Glucosamine and Chondroitin Sulfate

Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee 

osteoarthritis. New England Journal of Medicine. 2006;354(8):795-808.
7 

Sawitzke AD, Shi H, Finco MF, et al. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their 

combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT. Annals of the 

Rheumatic Diseases. 2010;69(8):1459-1464.

Sawitzke AD, Shi H, Finco MF, et al. The effect of glucosamine and/or chondroitin sulfate on the progression of knee 

osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial. Arthritis and Rheumatism.

2008;58(10):3183-3191.

Towheed T, Maxwell L, Anastassiades TP, et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database of 

Systematic Reviews. 2005 [edited 2009];(2):CD002946. Accessed at http://www.thecochranelibrary.com on May 30, 2012.

Wandel S, Jüni P, Tendal B, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip 

or knee: network meta-analysis. BMJ. 2010;341:c4675.

DMSO and MSM

Brien S, Prescott P, Lewith G. Meta-analysis of the related nutritional supplements dimethyl sulfoxide and 

methylsulfonylmethane in the treatment of osteoarthritis of the knee. Evidence-Based Complementary and 

Alternative Medicine. 2011;2011:528403 [Epub 2011 Feb 17].

SAMe

Rutjes AWS, Nüesch E, Reichenbach S, et al. S-adenosylmethionine for osteoarthritis of the knee or hip. Cochrane Database 

of Systematic Reviews. 2009;(4):CD007321. Accessed at http://www.thecochranelibrary.com on May 30, 2012.

Herbal Remedies

Cameron M, Gagnier JJ, Little CV, et al. Evidence of effectiveness of herbal medicinal products in the treatment of 

arthritis. Part 1: osteoarthritis. Phytotherapy Research. 2009;23(11):1497-1515.

Ernst E. Complementary or alternative therapies for osteoarthritis. Nature Clinical Practice. Rheumatology. 2006;2(2):74-80.

Little CV, Parsons T, Logan S. Herbal therapy for treating osteoarthritis. Cochrane Database of Systematic Reviews. 2000 

[edited 2009];(4):CD002947. Accessed at http://www.thecochranelibrary.com on May 30, 2012.

Complementary Health Approaches for Osteoarthritis: Mind and Body Practices

Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of 

nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. "SUISJUJT$BSF

Research. 2012;64(4):455-474.

Acupuncture

Berman BM, Lao L, Langenberg P, et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee;

a randomized, controlled trial. Annals of Internal Medicine. 2004;141(12):901-910.

Manheimer E, Cheng K, Linde K, et al. Acupuncture for peripheral joint osteoarthritis. Cochrane Database of Systematic 

Reviews. 2010;(1):CD001977. Accessed at http://www.thecochranelibrary.com on May 30, 2012.

Selfe TK, Taylor AG. Acupuncture and osteoarthritis of the knee: a review of randomized, controlled trials. Family and 

Community Health. 2008;31(3):247-254.

Sherman KJ, Coeytaux RR. Acupuncture for improving chronic back pain, osteoarthritis and headache. Journal of Clinical 

Outcomes Management. 2009;16(5):224-230.
8 

Massage Therapy

Perlman AI, Sabina A, Williams AL, et al. Massage therapy for osteoarthritis of the knee: a randomized controlled trial.

Archives of Internal Medicine. 2006;166(22):2533-2538.

Tai Chi

Wang C, Schmid CH, Hibberd PL, et al. Tai chi is effective in treating knee osteoarthritis: a randomized controlled trial. 

Arthritis and Rheumatism. 2009;61(11):1545-1553.

Qi Gong

Chen KW, Perlman A, Liao JG, et al. Effects of external qigong therapy on osteoarthritis of the knee: a randomized 

controlled trial. Clinical Rheumatology. 2008;27(12):1497-1505.

Lee MS, Pittler MH, Ernst E. External qigong for pain conditions: a systematic review of randomized clinical trials. 

Journal of Pain. 2007;8(11):827-831.

Morone NE, Greco CM. Mind-body interventions for chronic pain in older adults: a structured review. Pain Medicine.

2007;8(4):359-375.

Yoga

Kolasinski SL, Garfinkel M, Tsai AG, et al. Iyengar yoga for treating symptoms of osteoarthritis of the knees: a pilot 

study. Journal of Alternative and Complementary Medicine. 2005;11(4):689-693.

Other Types of Complementary Health Approaches

Homeopathy

Ernst E. Complementary or alternative therapies for osteoarthritis. Nature Clinical Practice. Rheumatology. 2006;2(2):74-80.

Magnets

Pittler MH, Brown EM, Ernst E. Static magnets for reducing pain: systematic and meta-analysis of randomized trials. 

Canadian Medical Association Journal. 2007; 177(7):736-742.

For More Information

NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on NCCAM and complementary health 

approaches, including publications and searches of Federal databases of scientific and medical 

literature. The Clearinghouse does not provide medical advice, treatment recommendations, 

or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226

TTY (for deaf and hard-of-hearing callers): 1-866-464-3615

Web site: nccam.nih.gov

E-mail: info@nccam.nih.gov
9 

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

NIAMS supports research into the causes, treatment, and prevention of arthritis and 

musculoskeletal and skin diseases; the training of scientists; and the sharing of research-based 

information.

Web site: www.niams.nih.gov

Toll-free in the U.S.: 1-877-22-NIAMS

PubMed®

A service of the National Library of Medicine, PubMed contains publication information and (in 

most cases) brief summaries of articles from scientific and medical journals.

Web site: www.ncbi.nlm.nih.gov/sites/entrez

Acknowledgments 

NCCAM thanks the following people for their technical expertise and review of this 

publication: Daniel O. Clegg, M.D., University of Utah; Jonelle Drugan, Ph.D., and Gayle Lester, 

Ph.D., NIAMS; Marcy O’Koon Moss, Arthritis Foundation; and John Glowa, Ph.D., and John (Jack) 

Killen, Jr., M.D., NCCAM.

This publication is not copyrighted and is in the public domain.

Duplication is encouraged.

NCCAM has provided this material for your information. It is not intended to substitute for the 

medical expertise and advice of your primary health care provider. We encourage you to 

discuss any decisions about treatment or care with your health care provider. The mention of 

any product, service, or therapy is not an endorsement by NCCAM.

National Institutes of Health

♦♦♦

U.S. Department of Health and Human Services
D477

Created July 2012