Osteoarthritis (OA) is the most common type of arthritis. It occurs most often in the hands, knees, hips, and spine.

OA affects cartilage—the slippery tissue that covers the ends of bones in a joint. Cartilage allows bones to glide over each other and absorbs the shock of movement. In OA, the top layer of cartilage breaks down and wears away, allowing the bones under it to rub against each other. This can cause pain, swelling, and difficulty in moving the joint.

OA is most common in older people, but younger people can have it too, especially in joints that have been injured.

You may have OA if you have these symptoms. Check with your health care provider.

• Stiffness in a joint after getting out of bed or sitting for a long time.
• Swelling or tenderness in one or more joints.
• A crunching feeling or the sound of bones rubbing together.

If you feel hot or your skin turns red, or if your joint pain is accompanied by other symptoms such as a rash or fever, you probably have a different problem.

OA is usually managed with a combination of treatments, which may include exercise, weight loss to reduce strain on the hips and knees, rest and relief from stress on joints, and medications to control pain.

What is osteoarthritis (OA)?

Osteoarthritis (OA) is the most common form of arthritis. Some people call it degenerative joint disease or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees.

With OA, the cartilage within a joint begins to break down and the underlying bone begins to change. These changes usually develop slowly and get worse over time. OA can cause pain, stiffness, and swelling. In some cases it also causes reduced function and disability; some people are no longer able to do daily tasks or work.

What are the signs and symptoms of OA?

• Pain or aching.
• Stiffness.
• Decreased range of motion (or flexibility).
• Swelling.

How many people have OA?

OA affects over 32.5 million US adults.

What causes OA?

OA is caused by damage or breakdown of joint cartilage between bones.

What are the risk factors for OA?

• Joint injury or overuse—Injury or overuse, such as knee bending and repetitive stress on a joint, can damage a joint and increase the risk of OA in that joint.
• Age—The risk of developing OA increases with age.
• Gender—Women are more likely to develop OA than men, especially after age 50.
• Obesity—Extra weight puts more stress on joints, particularly weight-bearing joints like the hips and knees. This stress increases the risk of OA in that joint. Obesity may also have metabolic effects that increase the risk of OA.
• Genetics—People who have family members with OA are more likely to develop OA. People who have hand OA are more likely to develop knee OA.
• Race— Some Asian populations have lower risk for OA.

How is OA diagnosed?

A doctor diagnoses OA through a review of symptoms, physical examination, X-rays, and lab tests.

A rheumatologist, a doctor who specializes in arthritis and other related conditions, can help if there are any questions about the diagnosis.

How is OA treated?

There is no cure for OA, so doctors usually treat OA symptoms with a combination of therapies, which may include the following:

• Increasing physical activity.
• Physical therapy with muscle strengthening exercises.
• Weight loss.
• Medications, including over-the-counter pain relievers and prescription drugs.
• Supportive devices such as crutches or canes.
• Surgery (if other treatment options have not been effective).

In addition to these treatments, people can gain confidence in managing their OA with self-management strategies. These strategies help reduce pain and disability so people with osteoarthritis can pursue the activities that are important to them. These five simple and effective arthritis management strategies can help.

Physical Activity for Arthritis

Some people are concerned that physical activity will make their arthritis worse, but joint-friendly physical activity can actually improve arthritis pain, function, and quality of life.

How can I manage OA and improve my quality of life?

CDC’s Arthritis Program recommends five self-management strategies for managing arthritis and its symptoms.

• Learn self-management skills. Join a self-management education class, which helps people with arthritis and other chronic conditions—including OA—understand how arthritis affects their lives and increase their confidence in controlling their symptoms and living well. Learn more about the CDC-recommended self-management education programs.
• Get physically active. Experts recommend that adults engage in 150 minutes per week of at least moderate physical activity. Every minute of activity counts, and any activity is better than none. Moderate, low impact activities recommended include walking, swimming, or biking. Regular physical activity can also reduce the risk of developing other chronic diseases such as heart disease, stroke, and diabetes. Learn more about physical activity for arthritis.
  • Go to effective physical activity programs. For people who worry that physical activity may make OA worse or are unsure how to exercise safely, participation in physical activity programs can help reduce pain and disability related to arthritis and improve mood and the ability to move. Classes take place at local Ys, parks, and community centers. These classes can help people with OA feel better. Learn more about CDC-recommended physical activity programs.

• Talk to your doctor. You can play an active role in controlling your arthritis by attending regular appointments with your health care provider and following your recommended treatment plan. This is especially important if you also have other chronic conditions, like diabetes or heart disease.
• Lose weight. For people who are overweight or obese, losing weight reduces pressure on joints, particularly weight bearing joints like the hips and knees. Reaching or maintaining a healthy weight can relieve pain, improve function, and slow the progression of OA.
• Protect your joints. Joint injuries can cause or worsen arthritis. Choose activities that are easy on the joints like walking, bicycling, and swimming. These low-impact activities have a low risk of injury and do not twist or put too much stress on the joints. Learn more about how to exercise safely with arthritis.

Complementary approaches can be classified by their primary therapeutic input (how the therapy is taken in or delivered), which may be:

• Nutritional (e.g., special diets, dietary supplements, herbs, probiotics, and microbial-based therapies).
• Psychological (e.g., meditation, hypnosis, music therapies, relaxation therapies).
• Physical (e.g., acupuncture, massage, spinal manipulation).
• Combinations such as psychological and physical (e.g., yoga, tai chi, dance therapies, some forms of art therapy) or psychological and nutritional (e.g., mindful eating).

Nutritional approaches include what the National Center for Complementary and Integrative Health (NCCIH) previously categorized as natural products, whereas psychological and/or physical approaches include what was referred to as mind and body practices.

A variety of complementary approaches have been studied for osteoarthritis. The following sections summarize the evidence on the effectiveness and safety of specific approaches.

Nutritional Approaches

Glucosamine and Chondroitin Sulfate

Glucosamine and chondroitin are substances found in cartilage. Both are produced naturally in the body. They are also available as dietary supplements. Researchers have studied their effects, individually or in combination, in people with OA.

Studies of glucosamine for pain in knee OA have had conflicting results. Some, including a major National Institutes of Health (NIH)-sponsored study, found little or no evidence that glucosamine can relieve pain, but several other studies indicated that it can. Studies of chondroitin for pain from OA of the knee have had inconsistent results, but in general, the largest, highest quality studies have not shown an effect. There isn’t enough evidence to show whether glucosamine or chondroitin lessens pain from OA in other joints.

A few studies have looked at whether glucosamine or chondroitin or the combination can have beneficial effects on joint structure in people with OA. Some but not all of these studies found evidence that chondroitin or a glucosamine/chondroitin combination might help, but the improvements seen in most studies may be too small to make a difference to patients. There’s little evidence that glucosamine alone has beneficial effects on joint structure.

Glucosamine and chondroitin supplements may interact with the anticoagulant (blood-thinning) drug warfarin (Coumadin). Overall, studies have not shown any other serious side effects.

DMSO and MSM

Dimethyl sulfoxide (DMSO) and methylsulfonylmethane (MSM) are two chemically related substances that have been studied for OA. DMSO is applied to the skin. MSM is used as a dietary supplement.

Very little research has been done on DMSO and MSM, so it’s uncertain whether they’re helpful for OA symptoms.

Both DMSO and MSM can have side effects. DMSO can cause digestive upset, skin irritation, and a garlic-like taste, breath, and body odor. MSM can cause allergic reactions, digestive upsets, and skin rashes.

SAMe

S-Adenosyl-L-methionine (SAMe) is a molecule that is naturally produced in the body. It’s also sold in the United States as a dietary supplement.

Studies of SAMe for OA have had inconsistent results. In some studies, SAMe appeared to be as effective as nonsteroidal anti-inflammatory drugs (NSAIDs) in relieving symptoms associated with OA, but in others it was no more helpful than a placebo (an inactive substance).

Side effects of SAMe are uncommon and usually mild. However, little is known about the long-term safety of SAMe because most studies have been brief. SAMe may have special risks for people with bipolar disorder and those who are HIV positive. It also may interact with drugs, including some antidepressants and levodopa, a drug used for Parkinson’s disease.

Oral Herbal Remedies

A variety of herbal products that are taken orally (by mouth) have been studied for OA. A 2014 evaluation of oral herbal remedies for OA found enough evidence to conclude that avocado-soybean unsaponifiables (ASUs) and Boswellia serrata, an herb used in Ayurvedic medicine, may produce slight improvements in pain and function; however, the improvements were so small that patients might not consider them meaningful. For all other herbal products, the amount of research is too small to allow any conclusions to be reached.

Little information is available on the safety of most herbal products used for OA, including ASUs and Boswellia serrata. Herbs and other dietary supplements may cause health problems if not used correctly, and some may interact with prescription or nonprescription medications or other dietary supplements.

Topical Herbal Remedies

Tainted Arthritis Supplements

U.S. Food and Drug Administration (FDA) has warned the public about several dietary supplements promoted for arthritis or pain that were tainted with prescription drugs. The hidden ingredients in these products could cause side effects or interact in harmful ways with medicines.

You can find a list of tainted arthritis/pain products and general information about dietary supplements on the FDA website. It’s also a good idea to talk with your health care provider about any dietary supplement you’re taking or considering.

Psychological and Physical Approaches

Acupuncture

A 2012 combined analysis of data from several studies indicated that acupuncture can be helpful and a reasonable option to consider for OA pain. A 2013 analysis using different statistical methods also concluded that acupuncture may help relieve knee OA pain. After these analyses were completed, a 2014 Australian study showed that both needle and laser acupuncture were modestly better at relieving knee pain from OA than no treatment but not better than simulated (sham) laser acupuncture. These results are generally consistent with previous studies, which showed that acupuncture is consistently better than no treatment but not necessarily better than simulated acupuncture at relieving OA pain. A 2016 review of U.S. studies found evidence that acupuncture, as practiced in the United States, may help some patients with knee OA manage their pain.

How acupuncture works to relieve pain is unclear. Current evidence suggests that many factors—like expectation and belief—that are unrelated to acupuncture needling may play important roles in the beneficial effects of acupuncture on pain.

Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Improperly performed acupuncture can cause potentially serious side effects.

Cupping and Moxibustion

In addition to acupuncture, other traditional Asian practices that have been used for OA include cupping (applying a cup to the skin and creating suction either mechanically or by using heat) and moxibustion (burning an herb above the skin to apply heat to acupuncture points). Only a small amount of research has been done on the use of these practices for OA. A single study evaluated cupping for OA; its results were promising, but it’s a very preliminary study. Several studies evaluated moxibustion for OA symptoms and found that it might be helpful; however, because the amount of research was small and the studies may have been biased, definite conclusions cannot be reached.

Both cupping and moxibustion can leave marks on the skin, which are usually temporary. Because cupping may draw blood, it could expose people to disease-causing microorganisms if the same device is used on more than one person without being sterilized after each use. Moxibustion has been linked to allergic reactions, burns, and infections.

Massage Therapy

Very few studies have evaluated massage therapy for OA. The small amount of available evidence suggests that massage may help to reduce symptoms in people with knee OA.

Massage therapy appears to have few risks when performed by a trained practitioner. However, arthritis-stressed joints are sensitive, so massage therapists who treat people with OA need to be familiar with the special needs of people with this condition.

Tai Chi and Qi Gong

Tai chi and qi gong combine certain postures and gentle, dance-like body movements with mental focus, breathing, and relaxation.

Several studies have evaluated the effects of tai chi on knee OA. In general, they showed short-term improvements in pain, stiffness, and physical function. Some studies also showed other desirable changes, such as improved balance or reduced depression. In a 2016 study in which tai chi was compared with physical therapy for knee osteoarthritis and patients were encouraged to continue their exercises after the 12-week study period ended, patients in both the tai chi and physical therapy groups showed improvement in pain for a full year. Much less research has been done on qi gong, but the few studies that have been completed showed improvements in some OA symptoms.

Tai chi and qi gong are generally considered to be safe practices. However, side effects, such as temporarily increased knee pain, have been reported in some people with OA.

Yoga

Yoga incorporates several elements of exercise that may be beneficial for arthritis, including activities that may help improve strength and flexibility. However, very little research has been done on yoga for OA, so it’s uncertain whether it’s helpful.

Before starting to do yoga, people with OA should discuss their special needs with their health care provider and the yoga instructor. Props and modifications may be necessary to make yoga safe and comfortable for people with OA.

Other Complementary Health Approaches for Osteoarthritis

Balneotherapy

Balneotherapy is the technique of bathing in mineral water for health purposes; it also includes related practices such as mud packs. Although some studies have reported that balneotherapy can reduce pain in OA, the amount of high-quality research is too small for definite conclusions to be reached.

Balneotherapy has a good safety record.

Homeopathy

There’s little evidence to support homeopathy as an effective approach for OA symptoms, particularly pain. There’s been no recent research on the effects of homeopathy on OA.

Although most homeopathic products are highly dilute and therefore considered to be safe, some contain ingredients in amounts large enough that they could cause harmful effects. There have also been instances when potentially harmful contaminants have been found in homeopathic products.

Magnets

The available scientific evidence does not support using static magnets for pain relief. Static magnets are magnets often sold in shoe insoles, wrist wraps, headbands, and similar products. A small amount of evidence suggests that electromagnetic field therapy, which involves the use of small machines or mats to deliver an electromagnetic field to a joint or to the whole body, may provide some pain relief in OA, but it’s unclear whether it has a meaningful effect on physical function or quality of life for OA patients.

Static magnets are generally considered safe. Information about the safety of electromagnetic field therapy is limited, but few adverse effects have been reported in studies of this technique. Magnetic devices of any kind may be hazardous for people with certain types of implanted medical devices, such as pacemakers.

What’s the Bottom Line?

How much do we know about glucosamine and chondroitin supplements?

• We have some information about the safety and usefulness of glucosamine and chondroitin from large, high-quality studies in people.

What do we know about the effectiveness of glucosamine and chondroitin supplements?

• Research results suggest that chondroitin isn’t helpful for pain from osteoarthritis of the knee or hip.
• It’s unclear whether glucosamine helps with osteoarthritis knee pain or whether either supplement lessens osteoarthritis pain in other joints.

What do we know about the safety of glucosamine and chondroitin supplements?

• Studies have found that glucosamine and chondroitin supplements may interact with the anticoagulant (blood-thinning) drug warfarin (Coumadin). Overall, studies have not shown any other serious side effects.
• If you take glucosamine or chondroitin supplements, tell your health care providers. They can do a better job caring for you if they know what dietary supplements you use.

What Are Glucosamine and Chondroitin?

Glucosamine and chondroitin are structural components of cartilage, the tissue that cushions the joints. Both are produced naturally in the body. They are also available as dietary supplements. Researchers have studied the effects of these supplements, individually or in combination, on osteoarthritis, a common type of arthritis that destroys cartilage in the joints.

Cartilage is the connective tissue that cushions the ends of bones within the joints. In osteoarthritis, the surface layer of cartilage between the bones of a joint wears down. This allows the bones to rub together, which can cause pain and swelling and make it difficult to move the joint. The knees, hips, spine, and hands are the parts of the body most likely to be affected by osteoarthritis.

What the Science Says About Glucosamine and Chondroitin for Osteoarthritis

For the Knee or Hip

Glucosamine

Major studies of glucosamine for osteoarthritis of the knee have had conflicting results.

• A large National Institutes of Health (NIH) study, called the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), compared glucosamine hydrochloride, chondroitin, both supplements together, celecoxib (a prescription drug used to manage osteoarthritis pain), or a placebo (an inactive substance) in patients with knee osteoarthritis. Most participants in the study had mild knee pain.
  • Those who received the prescription drug had better short-term pain relief (at 6 months) than those who received a placebo.
  • Overall, those who received the supplements had no significant improvement in knee pain or function, although the investigators saw evidence of improvement in a small subgroup of patients with moderate-to-severe pain who took glucosamine and chondroitin together.
• In several European studies, participants reported that their knees felt and functioned better after taking glucosamine. The study participants took a large, once-a-day dose of a preparation of glucosamine sulfate sold as a prescription drug in Europe.
• Researchers don’t know why the results of these large, well-done studies differ. It may be because of differences in the types of glucosamine used (glucosamine hydrochloride in the NIH study vs. glucosamine sulfate in the European studies), differences in the way they were administered (one large daily dose in the European studies vs. three smaller ones in the NIH study), other differences in the way the studies were done, or chance.

Chondroitin

In general, research on chondroitin has not shown it to be helpful for pain from knee or hip osteoarthritis.

• More than 20 studies have looked at the effect of chondroitin on pain from knee or hip osteoarthritis. The quality of the studies varied and so did the results. However, the largest and best studies (including the NIH study discussed under the heading “Glucosamine” above) showed that chondroitin doesn’t lessen osteoarthritis pain.

Joint Structure

A few studies have looked at whether glucosamine or chondroitin can have beneficial effects on joint structure. Some but not all studies found evidence that chondroitin might help, but the improvements may be too small to make a difference to patients. There is little evidence that glucosamine has beneficial effects on joint structure.

Experts’ Recommendations

Experts disagree on whether glucosamine and chondroitin may help knee and hip osteoarthritis. The American College of Rheumatology (ACR) has recommended that people with knee or hip osteoarthritis not use glucosamine or chondroitin. But the recommendation was not a strong one, and the ACR acknowledged that it was controversial.

For Other Parts of the Body

Only a small amount of research has been done on glucosamine and chondroitin for osteoarthritis of joints other than the knee and hip. Because there have been only a few relatively small studies, no definite conclusions can be reached.

• Chondroitin for osteoarthritis of the hand
  A 6-month trial of chondroitin in 162 patients with severe osteoarthritis of the hand showed that it may improve pain and function.
• Glucosamine for osteoarthritis of the jaw
  One study of 45 patients with osteoarthritis of the jaw showed that those given glucosamine had less pain than those given ibuprofen. But another study, which included 59 patients with osteoarthritis of the jaw, found that those taking glucosamine did no better than those taking a placebo (pills that don’t contain the active ingredient).
• Glucosamine for chronic low-back pain and osteoarthritis of the spine
  A Norwegian trial involving 250 people with chronic low-back pain and osteoarthritis of the lower spine found that participants who received glucosamine fared the same at 6 months as those who received placebo.

What the Science Says About Safety and Side Effects

• No serious side effects have been reported in large, well-conducted studies of people taking glucosamine, chondroitin, or both for up to 3 years.
• However, glucosamine or chondroitin may interact with the anticoagulant (blood-thinning) drug warfarin (Coumadin).
• A study in rats showed that long-term use of moderately large doses of glucosamine might damage the kidneys. Although results from animal studies don’t always apply to people, this study does raise concern.
• Glucosamine might affect the way your body handles sugar, especially if you have diabetes or other blood sugar problems, such as insulin resistance or impaired glucose tolerance.

If you use dietary supplements, such as glucosamine and chondroitin, read and follow the label instructions, and recognize that “natural” does not always mean “safe.”

The U.S. Food and Drug Administration regulates dietary supplements, but the regulations for dietary supplements are different and less strict than those for prescription or over-the-counter drugs.

Some dietary supplements may interact with medications or pose risks if you have medical problems or are going to have surgery. Most dietary supplements have not been tested in pregnant women, nursing mothers, or children.

More To Consider

• If your joints hurt, see your health care provider. It’s important to find out what’s causing your joint pain. Some diseases that cause joint pain—such as rheumatoid arthritis—may need immediate treatment.
• If you take warfarin or have blood sugar problems, make sure you talk to your doctor about potential side effects if you are considering or taking glucosamine or chondroitin supplements.
• If you’re pregnant or nursing a child, it’s especially important to see your health care provider before taking any medication or supplement, including glucosamine or chondroitin.
• Help your health care providers give you better coordinated and safe care by telling them about all the health approaches you use. Give them a full picture of what you do to manage your health.

National health professional organizations have issued guidelines for treating OA. Some mention the use of complementary approaches.

The American College of Rheumatology’s guidelines

• Conditionally recommend tai chi for knee OA
• Conditionally recommend acupuncture for knee OA patients who are candidates for knee replacement but who cannot or will not have the surgery
• Conditionally recommend against the use of glucosamine and chondroitin for knee or hip OA
• Conditionally recommend topical capsaicin for hand OA but conditionally recommend against its use for knee OA

The American Academy of Orthopaedic Surgeons’ guidelines for treating OA of the knee

• Strongly recommend against acupuncture
• Strongly recommend against glucosamine and chondroitin

More To Consider

• Don’t use complementary health approaches to postpone seeing your health care provider about joint symptoms or any other health problem.
• Keep in mind that dietary supplements may interact with medications or other supplements and may contain ingredients not listed on the label. Your health care provider can advise you.
• Tell all your health care providers about any complementary or integrative 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.

What do we know about the effectiveness of complementary health approaches for osteoarthritis?

Nutritional Approaches

• Despite extensive research, it’s still uncertain whether glucosamine and chondroitin have a meaningful impact on symptoms or joint structure in osteoarthritis.
• The evidence on other dietary supplements is too limited for any conclusions to be reached.

Psychological and Physical Approaches

• Acupuncture may help relieve osteoarthritis pain.
• A small amount of evidence suggests that massage therapy may be helpful.
• Participating in tai chi may improve pain, stiffness, and joint function in people with knee osteoarthritis. Qi gong may have similar benefits, but less research has been done on it.

What do we know about the safety of complementary health approaches for osteoarthritis?

• Some dietary supplements can have side effects or interact with drugs.
• Psychological and/or physical approaches generally have good safety records when used correctly. However, some may need to be adapted to make them safe and comfortable for people with osteoarthritis.
• Magnetic therapies are not safe for people with some types of implantable medical devices.

Osteoarthritis is the most common type of arthritis—affecting 27 million Americans—and is an increasing problem among older adults. Treatments for osteoarthritis 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 (anti-inflammatory hormones).

Many people with OA report trying various dietary supplements, including glucosamine and chondroitin, alone or in combination, in an effort to relieve pain and improve function. However, there is no convincing evidence that any dietary supplement helps with OA symptoms or the course of the underlying disease. Here are 6 things you should know about dietary supplements for osteoarthritis:

1. The majority of research has found little effect of glucosamine or chondroitin on symptoms or joint damage associated with osteoarthritis of the knee or hip. Studies have found that glucosamine and chondroitin supplements may interact with the anticoagulant (blood-thinning) drug warfarin (Coumadin). But overall, studies have not shown any other serious side effects.

2. Dimethyl Sulfoxide (DMSO) and Methylsulfonylmethane (MSM) are two chemically related dietary supplements that have been used for arthritic conditions; however, evidence does not suggest that DMSO and MSM are helpful for osteoarthritis symptoms. Although there are 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.

3. S-Adenosyl-L-methionine (SAMe) is a molecule that is naturally produced in the body and is often taken as a dietary supplement; however, there is not enough evidence to support the use of SAMe for osteoarthritis of the knee or hip. SAMe is generally considered safe, but common side effects include gastrointestinal problems, dry mouth, headache, sweating, dizziness, and nervousness.

4. There is preliminary evidence that avocado/soybean unsaponifiables (ASU), supplements made from avocado oil and soybean oil extracts, may have modest beneficial effects on symptoms of osteoarthritis. Safety information has not been sufficiently available.

5. Although some results suggest that a few herbs may be beneficial for OA symptoms, the overall evidence is weak, and conclusions among reviews of the literature provide conflicting interpretations. In general, herbs have not been studied or prepared in a consistent way. There is also a general lack of safety data available.

6. If you take, or are considering taking, dietary supplements for osteoarthritis, tell your health care providers. They can do a better job caring for you if they know what dietary supplements you use.