Arthritis

What is Arthritis?

Arthritis means inflammation or damage in one or more joints, and it covers more than 100 different conditions. Osteoarthritis is the most common form worldwide, and rheumatoid arthritis is a well-known autoimmune form.^{[1, 2]}

Because the types differ in cause and treatment, the first step is knowing which type you have. This page covers arthritis in general and focuses on osteoarthritis and rheumatoid arthritis, where most research exists.

Common symptoms

Joint pain and loss of function are the core symptoms, though how much they bother people varies widely.^[1] In knee osteoarthritis, pain typically worsens with use and eases with rest, and morning stiffness is brief.^[3]

Rheumatoid arthritis usually starts in the small joints of the hands and feet, is usually symmetric, and can spread to larger joints if it is not treated. It can also involve parts of the body outside the joints.^[2] Warmth, redness, swelling, fatigue and a long period of morning stiffness are more typical of inflammatory types than of osteoarthritis.^{[2, 3]}

Causes and risk factors

Causes depend on the type. Osteoarthritis is becoming more common mainly because of aging and obesity, and overweight and obesity are the most important risk factor that can be changed.^{[3, 4]} Joint injury and mechanical loading also play a role.^[5]

Rheumatoid arthritis is a systemic autoimmune disease. In many people it arises from an interaction between genes and environmental factors, including tobacco.^[2] Other types, such as gout and psoriatic arthritis, have their own causes and are covered on separate pages.

How it is diagnosed and treated conventionally

Diagnosis rests on your history, a physical exam and, depending on the type, imaging and blood tests. No single laboratory test confirms rheumatoid arthritis, so diagnosis can be hard in the early stages.^[2]

For osteoarthritis of the hip or knee, higher-quality guidelines consistently recommend education, exercise and weight management, with anti-inflammatory drugs considered and corticosteroid injections for the knee.^[6] Treatments ease pain and improve function, but they do not reverse the joint changes, and surgery is reserved for when other measures fail to control symptoms.^[3]

For rheumatoid arthritis, the standard of care is early treatment with disease-modifying anti-rheumatic drugs, together with physical therapy, counseling and education.^[2]

Why Arthritis calls for a whole-person approach

Arthritis is not only a joint problem. Body weight, activity, inflammation, how the nervous system handles pain, and general health all shape symptoms, and they differ between people and between types.^[4]

Care that addresses these factors alongside the joint can be a reasonable addition to medical treatment, although it does not change the underlying disease.

Inflammation in the joint lining

Inflammation of the joint lining is present in osteoarthritis and has been linked to pain and to progression on imaging.^[5] In rheumatoid arthritis, inflammation is the central process, driven by the immune system attacking joint tissue.^[2]

Body weight and joint loading

Overweight and obesity are the most important modifiable risk factors for knee osteoarthritis.^[3] A 2025 review notes that newer evidence has questioned the benefit of some exercise and weight-loss programs, but that managing obesity and staying active remain important.^[4]

Pain processing

Osteoarthritis involves different pain mechanisms, not only damage to the joint itself.^[4] Pain can also trigger central sensitization, in which the nervous system amplifies pain signals.^[7]

Smoking and other exposures

Tobacco is among the environmental factors that interact with genes to trigger rheumatoid arthritis in many people.^[2]

Acupuncture for Arthritis

What the research shows

Most acupuncture research is in knee osteoarthritis, where results are mixed, with weaker evidence for rheumatoid arthritis. A 2024 review of 80 trials with 9,933 participants found that acupuncture may reduce knee pain more than sham acupuncture, NSAIDs or usual care. The authors rated the certainty of the evidence as very low, and electroacupuncture looked stronger than manual acupuncture.^[8]

In a multicenter trial of 480 people with knee osteoarthritis, electroacupuncture given three times a week for 8 weeks reduced pain and improved function more than sham acupuncture, and the effect lasted to week 26. Manual acupuncture did not beat sham at week 8.^[9] Not every review is as positive. A Cochrane review of 16 trials found that benefits over sham were small, did not reach the authors' threshold for clinical relevance, and were probably partly due to placebo effects. Larger benefits compared with waiting lists were likely due in part to expectation.^[10] Clinical guidelines are also inconsistent about acupuncture as an add-on treatment.^[6]

For rheumatoid arthritis, a 2022 meta-analysis of 12 trials (874 patients) found that acupuncture-related therapies added to drug treatment were linked to lower pain, joint counts and inflammation markers, and called for better trials.^[11] Earlier reviews were less encouraging. One found three sham-controlled trials with no significant pain difference, and concluded there was no good evidence of efficacy.^[12]

How acupuncture may work

Researchers propose that acupuncture strengthens the body's own pain-dampening pathways, including descending inhibition from the brain and spinal cord, and that it may lower local inflammatory chemicals and ease central sensitization.^[7] These are proposed mechanisms from laboratory and clinical research, not proven explanations.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points near the painful joints and elsewhere on the body, usually left in place for about 20 to 40 minutes. A course is several visits, with reassessment along the way. The knee osteoarthritis trial above used three sessions a week for 8 weeks.^[9]

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, pain or a flare at the needle site, and serious events occurred in about 1 in 10,000 patients.^[13] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). People taking immunosuppressing drugs should also tell us, so we can take care with skin and infection risk.

Ayurvedic medicine for Arthritis

The Ayurvedic view

In Ayurveda, joint pain and stiffness are described under names such as Sandhivata, usually linked to osteoarthritis, and Amavata, linked to rheumatoid-type disease. Sandhivata is traditionally seen as aggravated Vata drying and wearing the joints, and Amavata as ama, a sticky by-product of poor digestion, settling in the joints. These are traditional frameworks used to choose treatment, not biomedical diagnoses.

Therapies that may be used

Care is individualized and traditionally combines:

• Diet and daily routine meant to calm Vata or reduce ama, such as warm, freshly cooked meals and regular sleep hours
• Warm oil massage and local heat over the affected joints
• Herbs such as Boswellia (shallaki), turmeric, guduchi (Tinospora cordifolia), ginger and guggul-based formulas, some of which appear in osteoarthritis trials^[14]
• Panchakarma procedures where traditionally appropriate and medically sensible

Panchakarma is not appropriate during pregnancy, acute illness or frailty, or when a flare of inflammatory arthritis is active. People with advanced osteoarthritis or autoimmune arthritis should have it only with their physician's knowledge.

What the research shows

The research on Ayurveda for arthritis is limited and mostly in osteoarthritis. A systematic review of 33 trials with 2,952 patients found large effects beyond placebo for one compound preparation and some evidence for another, but no robust effect for most others, including massage, steam therapy and enema. Boswellia trials in this review did not show significant effects once bias was accounted for. The authors described the overall evidence as unsatisfactory, noted no severe adverse events and called for better trials.^[14]

For rheumatoid arthritis, a 2005 systematic review found only seven randomized trials of Ayurvedic medicine, and concluded they did not show convincingly that it is an effective option.^[15] Claims that Ayurvedic medicine can replace disease-modifying drugs are not supported.

Herbal medicine for Arthritis

Herbs and formulas that have been studied

The best-studied herbs for osteoarthritis are Boswellia serrata and turmeric (Curcuma longa) or its extract curcumin. In rheumatoid arthritis, curcumin has been studied, and Tripterygium wilfordii, a Chinese herb, has been used in China. Chinese medicine practitioners also use individualized formulas built from many herbs.

What the research shows

Boswellia has some support in osteoarthritis, though the trials are small. A Cochrane review of oral herbal products found high-quality evidence from two small studies that an enriched Boswellia extract improved symptoms compared with placebo, with no serious side effects.^[16] A meta-analysis of 15 trials with 1,621 people found that turmeric extract and curcumin reduced pain, stiffness and functional limitation compared with placebo. Adverse events were similar to placebo.^[17]

In rheumatoid arthritis, a meta-analysis of six studies (539 patients) found curcumin lowered an inflammation marker, disease activity score and swollen and tender joint counts. The authors called for larger trials.^[18] These results do not mean herbs can replace disease-modifying drugs.

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Reports describe enhanced anticoagulation and bleeding when danshen or ginkgo is combined with warfarin, and St John's wort lowering levels of the immunosuppressants ciclosporin and tacrolimus.^[19] This matters for people with rheumatoid arthritis who take immunosuppressing drugs.

Some arthritis drugs affect the liver, and so can some herbs. About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, or are taking blood thinners, antidiabetic drugs or immunosuppressants.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes painful joints as obstruction of qi and blood by wind, cold or dampness. Researchers studying acupuncture look at things that loosely parallel this picture: local inflammatory chemicals, pain pathways and central sensitization.^[7]

Ayurveda's aggravated Vata and ama also describe stiffness, pain and inflammation in traditional terms. No study shows that a dosha or ama corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for arthritis is complementary. Keep your physician or rheumatologist, and do not stop or change prescribed medicines without your prescriber, especially disease-modifying drugs, biologics or steroids. We do not diagnose arthritis or manage the disease itself, and new or worsening joint symptoms should be medically evaluated.

For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Please bring your diagnosis, recent imaging and blood test results, and a full list of medicines and supplements.

When to seek urgent medical care

Some joint symptoms need prompt medical assessment rather than complementary care.

• A single hot, red, swollen joint with fever, which can mean a joint infection
• Sudden severe joint pain with inability to move or bear weight on the joint
• Joint pain with red, painful eyes or vision changes
• New numbness, weakness or loss of bladder or bowel control
• Joint symptoms with chest pain, shortness of breath or a high fever on immunosuppressing medicine

If any of these occur, call 911 or go to the nearest emergency department.