Osteoarthritis is considered a “wear-and-tear” condition of the joints that most commonly presents as joint pain that is worse with activity and better with rest. Its prevalence increases with age and is most commonly experienced in the knees, hands, hips and spine.

In the case of arthritis, a joint’s normal function is limited due to a loss of cartilage. Cartilage is a flexible tissue that covers the joint surface of bones and allows for smooth movement of the joint. Its loss can lead to bone-on-bone contact which often results in pain, stiffness, joint deformity or growth, and audible cracking or popping sounds know as crepitus.

Where arthritis cannot be cured, our role as Naturopathic Doctors is to work with patients to sustainably relieve joint pain, preserve joint function, and prevent further injury through dietary and lifestyle modifications, as well as using botanical or nutritional supplementation.

Below you’ll find a list that scratches the surface of Naturopathic arthritis management. As always, be sure to consult your ND to confirm which of the following would be appropriate for you, and at what dose!

---

1. Diet

Ensuring adequate nutrition is a fundamental way to support optimal body function. Following a Mediterranean diet minimizes inflammation in the body that may exacerbate pain associated with arthritis. Likely due to its anti-inflammatory and cardioprotective effects, this particular diet has been shown to¹:

• Reduce:
  • Joint pain & difficulty of movement
  • Markers of cartilage damage
  • Prevalence of knee arthritis
• Improve
  • Hip and knee range of motion
  • Increase quality of life

Click here for more information on the Mediterranean diet.

Additionally, some common foods such as tomatoes, eggplant, white potatoes, bell peppers, and cayenne pepper may aggravate symptoms. The aforementioned foods belong to a group of plants known as Night shades, which contain the compound solanine. Solanine has the potential to produce a pro-inflammatory response in susceptible individuals. Therefore, some individuals may have no reaction to Night shades and others may notice increased joint pain after consumption. If you are curious about how you respond to Night shades, a 3-week elimination followed by mindful reintroduction of individual foods can bring insight to how your body handles exposure to solanine. Be sure to contact your Naturopathic doctor for more guidance on this process!

2. Natural Eggshell Membrane

Eggshell membrane (NEM) is a natural source of calcium, collagen, hyaluronic acid, chondroitin and glucosamine, all of which work synergistically to support healthy joints.

A recent double blind, placebo-controlled intervention study investigated the use of eggshell membrane in those with arthritis of the knee and an average age of fifty-three. The results showed significant improvements in joint stiffness, mobility and physical performance of the knee compared to placebo after five days of use. These benefits were further maintained over the 12-week duration of the study. Additionally, the safety profile for NEM was confirmed, as none of the participants experienced any side effects with its use.²

3. Boswellia

Also known as Frankincense, Boswellia is a cultivated gum resin that is rich in the anti-inflammatory and pain-relieving compound Boswellic acid. It has a long history of use as an anti-arthritic and recent research has supported this use.^3,4 In addition to musculoskeletal support, Boswellia is also a potent anti-inflammatory for the gastrointestinal tract.

A meta-analysis from 2018 concluded that Boswellia extracts are more effective than placebo in relieving pain and improving function in those with arthritis of the knee.³ This past year, a double-blind, placebo controlled human trial found that use of Boswellia for 120 days resulted in improved function, reduced pain & stiffness, and improvements in blood markers of inflammation.⁴

4. Curcumin

Turmeric is a root that, like ginger, is often added to meals when cooking. The most active compound in Turmeric is Curcumin. Curcumin is a potent anti-inflammatory and is used to address musculoskeletal, digestive, and other health conditions. In addition to its anti-inflammatory effects, Curcumin acts as a circulatory tonic and can be useful in cases of high cholesterol or dyslipidemia.

With regards to arthritis, Curcumin is well established in the literature to provide improvements in joint pain and function.^3,5 This past year, a study looked to compare Curcumin with Diclofenac for pain management in participants with confirmed arthritis of the knee. Diclofenac is a commonly used nonsteroidal anti-inflammatory drug (NSAID). The study showed improvements in pain scores in both intervention groups and there was no statistically significant difference observed between the use of Curcumin and Diclofenac after two and four weeks of treatment. This means that both Curcumin and Diclofenac worked equally well in addressing the participants’ pain. Additionally, the Curcumin group showed improvements in other avenues of health such as improvements in gastric ulcers, and was better tolerated overall than the Diclofenac.⁵

5. Proteolytic Enzymes

Proteolytic enzymes help the body digest foods and also have been shown to have anti-inflammatory effects. Wobenzm is the name of a product that contains bromelain from pineapple, trypsin from bovine sources, and rutin from the Japanese pagoda tree.

In 2015, a randomized, placebo-controlled clinical study out of Germany aimed to compare the effects of Wobenzym and Diclofenac in participants with confirmed arthritis of the knee. After 12 weeks of use, both treatment groups showed improvements in joint pain, stiffness, and functionality scores when compared to placebo. Additionally, the Wobenzym group required fewer doses of acetaminophen to rescue the pain symptoms, and had fewer side effects than the Diclofenac group.⁶

6. Castor Oil

Ricinus communis is the bean from which Castor oil is derived. Internally, castor oil can act as a stimulating laxative but when used topically, it can reduce local inflammation and relieve arthritic joint pain.⁷ If you’re interested in trying this topical treatment, be sure to contact your Naturopathic doctor for instructions on the application process.

7. Exercise

Exercise is important in maintaining joint function and reducing pain. As stated by the Arthritis Foundation, daily exercise⁸:

• Promotes joint flexibility and eases stiffness
• Strengthens stabilizing muscles that surround joints
• Slows cartilage deterioration
• Strengthens the bones
• Maintains joint function to allow one to continue carrying out daily activities

• 

• 

• 

Range of motion exercises challenge the joint’s range of motion and maintain flexibility:

• Gentle stretching
• Yoga^9,11
• Swimming or Aquatic based exercises¹⁰

Aerobic exercise improves stamina and promotes healthy weight maintenance that could otherwise negatively impact arthritis:

• Walking
• Biking
• Elliptical
• Swimming

Weight bearing exercises promote stability of the joint and provide pain relief by strengthening the surrounding muscles.¹¹ A study published this year showed that completing 24 resistance training sessions over 8-12 weeks of any form, number of repetitions, strength, or frequency can improve pain and physical function in those with arthritis of the knee.¹²

---

References:

1. Morales-Ivorra I, Romera-Baures M, Roman-Viñas B, Serra-Majem L. Osteoarthritis and the Mediterranean Diet: A Systematic Review. Nutrients. 2018;10(8):1030.

2. Hewlings S, Kalman D, Schneider LV. A Randomized, Double-Blind, Placebo-Controlled, Prospective Clinical Trial Evaluating Water-Soluble Chicken Eggshell Membrane for Improvement in Joint Health in Adults with Knee Osteoarthritis. J Med Food. 2019;22(9):875–884. doi:10.1089/jmf.2019.0068

3. Bannuru RR, Osani MC, Al-Eid F, Wang C. Efficacy of curcumin and Boswellia for knee osteoarthritis: Systematic review and meta-analysis. Semin Arthritis Rheum. 2018;48(3):416–429. doi:10.1016/j.semarthrit.2018.03.001

4. Majeed M, Majeed S, Narayanan NK, Nagabhushanam K. A pilot, randomized, double-blind, placebo-controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee. Phytother Res. 2019;33(5):1457–1468. doi:10.1002/ptr.6338.

5. Shep D, Khanwelkar C, Gade P, Karad S. Safety and efficacy of curcumin versus diclofenac in knee osteoarthritis: a randomized open-label parallel-arm study. Trials. 2019;20(1):214. doi:10.1186/s13063-019-3327-2

6. Bolten WW, Glade MJ, Raum S, Ritz BW. The safety and efficacy of an enzyme combination in managing knee osteoarthritis pain in adults: a randomized, double-blind, placebo-controlled trial. Arthritis. 2015;2015:251521. doi:10.1155/2015/251521

7. Castor Bean Professional Monograph. Natural Medicines Database. Updated: October 15, 2019. Accessed: April 6, 2020.

8. Exercise and Arthritis Fact Sheet. Arthritis Foundation. Updated 2018. Accessed from: https://www.arthritis.org/getmedia/600dd559-1b48-4b40-9258-e542805fe22a/Exercise-FactSheet2.pdf. Accessed April 7, 2020.

9. Wang Y, Lu S, Wang R, et al. Integrative effect of yoga practice in patients with knee arthritis: A PRISMA-compliant meta-analysis. Medicine (Baltimore). 2018;97(31):e11742.

10. Bartels EM, Juhl CB, Christensen R, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev. 2016;3. CD005523.

11. Zhang Q, Young L, Li F. Network Meta-Analysis of Various Nonpharmacological Interventions on Pain Relief in Older Adults With Osteoarthritis. Am J Phys Med Rehabil. 2019;98(6):469-478.

12. Turner MN, Hernandez DO, Cade W, Emerson CP, Reynolds JM, Best TM. The Role of Resistance Training Dosing on Pain and Physical Function in Individuals with Knee Osteoarthritis: A Systematic Review. Sports Health. 2020;12(2):200-206.

*“Arthritis” in this article specifically refers to Osteoarthritis

Editor’s Note: The information in this article is intended for your educational use only. Always seek the advice of your physician or other qualified health practitioners with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.