Arthritis is a condition which imposes great restriction on the individual.
As many as 6 million people suffering from arthritis find it difficult to walk 0.25 miles.
Around 43.2% of the individuals suffering from arthritis report limitations in daily activity. Arthritis is the leading cause of disability in US.
Inflammation, pain and reduced joint mobility are the major symptoms of arthritis. This can either be restricted to the joint or spread to other organs.
Arthritis can also pave way for other complications such as obesity, autoimmune conditions, depression etc.
Medications targeted to reduce symptoms are of prime importance.
Simultaneously researchers and clinicians are investigating the role of vitamins and minerals in arthritis and whether supplementation with these would bring relief.
What is the role of vitamins and minerals in arthritis?
Conditions like rheumatoid arthritis are characterized by overproduction of reactive oxygen species and free radicals.
These molecules are normally produced in the body as a result of various reactions but in excess they imbalance prooxidant and antioxidant levels of the body.
These reactive oxygen species then induce inflammation, damaged bone tissue and lead to cell death, thus contributing to the progression of the disease.
Various studies have correlated deficient antioxidant status to rheumatoid arthritis. Generation of free radical species is observed in osteoarthritis.
Antioxidants in form of vitamins and minerals can help counteract these reactive oxygen species and help prevent the disease from progressing.
Certain types of arthritis are autoimmune conditions where the body attacks its own tissues just as it would attack a foreign body, as in the case of arthritis.
Certain vitamins are found to regulate such immune responses thus proving to be helpful in arthritis and associated complications.
Individuals suffering from arthritis are also found to have diets deficient in vital vitamins and minerals.
Supplementation with certain vitamins is found to be helpful in counteracting side effects of conventional medications in arthritis.
Mineral supplementation helps rectify deficiencies and reduces bone loss in arthritis.
6 Essential Vitamins In Arthritis: Do they really work?
Here is a list of vitamins whose supplementation has been evaluated in arthritis to assess whether they really reduce pain and inflammation in arthritis.
1. Vitamin D
Vitamin D is highly recommended in treatment of arthritis. Vitamin D receptor, the protein that Vitamin D binds to, is present on immune cells and vitamin D is produced by activated immune cells.
Therefore it is suggested that vitamin D could play a role in regulating immune responses in autoimmune conditions like arthritis.
Vitamin D is also essential for calcium metabolism, bone mineralization and formation.
Increased intake of vitamin D has been associated with reduced risk of developing rheumatoid arthritis.
Vitamin D deficiency has been linked with risk of heart disease and metabolic syndrome in rheumatoid arthritis.
Vitamin D deficiency is commonly observed in patients suffering from rheumatoid arthritis, spondyloarthritis and hence its supplementation is thought to be effective in the treatment of the disease.
Many clinical trials demonstrate that supplementation with Vitamin D raises the serum levels of vitamin D in patients but has little or no significant improvement in disease activity.
Calcium and vitamin D supplementation was found to prevent bone mineral loss in individuals who were treated with low dose of steroids but did not improve bone mineral density in those who didn’t receive steroids.
Interestingly a couple of studies conducted in India have demonstrated that supplementation with Vitamin D leads to a reduction in pain, reduced disease activity and statistically significant improvement in arthritis.
A recent publication ‘Serum Vitamin D Level and Rheumatoid Arthritis Disease Activity: Review and Meta-Analysis’ , Plos One, Jan 2016 reveals that there is a negative correlation between vitamin D levels and rheumatoid arthritis and this is more pronounced in low latitude countries and developing countries.
So what we understand here is that vitamin D deficiency is prevalent in arthritis but its supplementation may not lead to a pronounced reduction in symptoms.
Also, the time period required to see any effect of vitamin D supplementation is around 1-3 years.
Vitamin D is synthesized by our skin cells when exposed to the sunlight. A study published in the International Journal Of Rheumatic Diseases, April 2016 examined this point.
45 patients were enrolled in the study and vitamin D insufficiency was 36% and deficiency was 29% in the study population.
It was found that patients whose hand and feet were exposed to the sun had higher vitamin D levels than those who had only hands exposed.
Interestingly they found no correlation between vitamin D levels and disease activity.
The Women Health’s Initiative Calcium plus Vitamin D trial reported that multiple high Vitamin D exposures(oral and sun exposure) may increase the risk of rheumatoid arthritis.
What does this mean? Vitamin D deficiency is prevalent in patients suffering from arthritis. Vitamin D supplementation may help rectify the deficiency but brings about no improvement in disease activity. Exposure to sunlight can help in increasing serum levels of vitamin D. Natural sources: Salmon, sardines, eggs, milk
2. Vitamin B6
Vitamin B6 deficiency is held responsible for inappropriate immune responses. Abnormal Vitamin B6 status has been linked with severe inflammation in arthritis.
A paper published in Arthritis Research & Therapy, 2005 demonstrated 50mg of vitamin B6 supplementation for 30 days rectified vitamin B6 deficiency in rheumatoid arthritis but did not improve inflammation.
Huang et. al conducted a clinical trial in which individuals suffering from RA were treated with folic acid (control group) or folic acid and Vitamin B6.
The dose of folic acid was 5mg/day and vitamin B6 100mg/day.
At the end of 12 weeks, the vitamin B6 group experienced a reduction in inflammatory parameters and it was concluded that a high dose of vitamin B6 helps lower inflammation.
An older study reported that the combination of NSAIDs and B-Vitamins brings about better pain relief and reduces the dose of NSAIDs.
What does this mean? Vitamin B6 deficiency is observed in rheumatoid arthritis and it may be linked to high levels of inflammation in arthritis. Research till date that only high dose supplementation of vitamin B6 may be beneficial in reducing inflammation but whether this brings about reduction in disease activity is doubtful.
Natural sources: Seafood and meat especially tuna, grass fed beef and chicken. Sweet potato, potato, sunflower seeds, banana, spinach
3. Vitamin B12
Many individuals suffering from rheumatoid arthritis also suffer from anemia. One of the common causative factors is Vitamin B12 deficiency.
Reduced vitamin B12 levels have been associated with increased levels of Tumor necrosis factor, which plays an important role in inflammation.
Anemia and vitamin B12 deficiency is common in rheumatoid arthritis, lupus, sjogren’s syndrome, and psoriatic arthritis.
Methylcobalamin a preferred form of vitamin B12 is also said to have pain killer activity.
There is no clinical trial in recent research that investigates sole supplementation of vitamin B12 in arthritis.
Combination of folate and vitamin B12 is found to be as effective as NSAIDs in reducing pain in osteoarthritis.
Similarly a combination of B vitamins is proven to be beneficial in reducing pain and inflammation in osteoarthritis and improving mobility.
Elevated levels of amino acid, homocysteine has been linked with increased heart disease.
Supplementation of B vitamins including B12 helps to reduce elevated levels of homocysteine in individuals taking methotrexate therapy in rheumatoid arthritis.
What does this mean? Vitamin B12 supplementation may be necessary in arthritis in case of anemia or elevated homocysteine levels. Not single supplementation of B12 but a combination of B vitamins has been found to reduce pain in arthritis.
Natural sources: Seafood like sardines, salmon; beef,lamb ,milk, cottage cheese, yogurt
4. Folic acid
Methotrexate is an anti-arthritic medication that is considered as the gold standard in the treatment of rheumatoid arthritis.
80% of the patients use this medication but withdrawals can be as high as 30-50% due to its toxicity.
Methotrexate has a structure similar to folic acid and folic acid supplementation is found to beneficial in reducing methotrexate toxicity.
The Cochrane Review 2013 reported that supplementation with folic acid or folinic acid for patients taking methotrexate has a protective effect.
A significant reduction in gastric side effects and liver dysfunction was observed. With folic acid supplementation, fewer individuals discontinued methotrexate therapy.
Folate supplementation is also said to be beneficial in reducing the risk of heart disease in patients suffering from rheumatoid arthritis.
Dhir et. al conducted a clinical trial to assess the effect of folic acid supplementation on toxicity of methotrexate and they found that high dose (30mg/week) had no significant benefit over low dose (10mg/week) in terms of reducing the side effect of methotrexate.
A more recent study compared the effect of low dose with high dose supplementation of folic acid, 5mg/week and 30mg/week respectively.
There were no significant differences between the side effects and discontinuation of methotrexate in both groups.
In fact, the low dose group had reduced disease activity compared to the high dose group.
Researchers concluded that both low and high dose of folic acid supplementation brings about similar tolerability of methotrexate in rheumatoid arthritis.
What does this mean? Folic acid supplementation is beneficial and protective if you are taking methotrexate therapy for arthritis.
Natural sources: Many beans and lentils such pinto beans, garbanzo beans, navy beans, black beans; spinach, asparagus, broccoli
5. Vitamin E
Vitamin E is an antioxidant so its supplementation is considered beneficial in arthritis since it is characterized by oxidative damage or imbalance between prooxidants and antioxidants.
Animal studies demonstrate that vitamin E helps reduce inflammation in arthritis. Vitamin E also regulates immune responses which is why its use is suggested in arthritis.
Review and observational studies suggest that Vitamin E alone or in combination with Vitamin A and C do not have any significant therapeutic effect in arthritis.
A clinical trial demonstrated oral palm vitamin E is just as effective as glucosamine sulphate in reducing symptoms of osteoarthritis and improving mobility. (Read Chondroitin and Glucosamine In Arthritis)
Another study reported that the combination of Vitamin E and conjugated linoleic acid can help reduce inflammation in arthritis.
What does this mean? Although vitamin E is an antioxidant and thereby may benefit arthritis but research shows that its supplementation has no beneficial effect on disease activity. Natural sources: Sunflower seeds, almonds, spinach, avocados, peanuts, asparagus
6. Vitamin C
Vitamin C supplementation is considered beneficial in arthritis as it is an antioxidant. Production of free radical species and imbalance in antioxidant enzymes is evidenced in osteoarthritis.
Reduced vitamin C intake has been associated with back pain. Optimal vitamin C intake can be beneficial in preventing the reduction in bone size and bone lesions.
Vitamin C supplementation may not be helpful in the progression of osteoarthritis but can aid in preventing it.
Oral vitamin C supplementation can help in reducing serum uric acid and benefit in gout.
Clinical trials present mixed reports; based on current research there isn’t any concrete evidence that suggests that Vitamin C supplementation brings about any improvement in disease activity in arthritis.
What does this mean? Review studies suggest that vitamin C supplementation can benefit in gout. As per current research the benefits of vitamin C supplementation in other forms of arthritis is doubtful. Natural sources: Citrus fruits like orange, lime, grapefruit; papaya, kiwi, pineapple, strawberries, broccoli, brussel sprouts, cauliflower
Dosage
Various government and health-related bodies have outlined the recommended daily intake value of minerals and vitamins which you can freely access.
If opting for supplements, evaluate yourself prior for deficiency and consult a doctor regarding the dosage.
Precautions
Vitamins and minerals when in balance or at normal levels have no side effects.
Excess or deficiency of these micronutrients can lead to gastric side effects, fatigue, hair loss, etc.
Consult a doctor before taking supplements. They may interact with anti-arthritic medications or even increase the risk of bleeding disorder.
Conclusion
In general, despite deficiency observed in individuals suffering from arthritis, supplementation with vitamins is not found to reduce symptoms or lower disease activity in arthritis.
Folic acid supplementation may be beneficial in attenuating side effects of methotrexate.
Vitamin D and calcium supplementation may help reducing bone loss moderately. Vitamin C intake may benefit from gout.
Supplementation with vitamins may also benefit from complications of arthritis such as depression and autoimmune conditions.
It is best to consult a doctor about vitamin supplements and keep mind that a time period of 4months to 1 year may be necessary to observe any positive change in health.
Supplements are advised only in case of deficiency.
Incorporating foods rich in these vitamins can help in arthritis and improvement of overall health.