What supplements can help alleviate creaking joints, specifically for osteoarthritis?

Supplements for Creaking Joints in Osteoarthritis

Do not use glucosamine or chondroitin supplements for osteoarthritis—major medical societies strongly recommend against them based on high-quality evidence showing no benefit over placebo. 1, 2, 3

Why Supplements Don't Work

Glucosamine

• The American College of Rheumatology strongly recommends against glucosamine for knee, hip, and hand osteoarthritis 1, 2, 3
• Multiple high-quality trials demonstrate no benefit over placebo when industry-sponsored bias is removed from the analysis 3
• NICE guidelines explicitly state glucosamine products are not recommended 4
• May cause elevations in serum glucose levels in some patients 3

Chondroitin Sulfate

• The American College of Rheumatology strongly recommends against chondroitin for knee and hip osteoarthritis 1, 2, 3
• The highest quality data with lowest risk of bias fail to show any important benefits over placebo 3
• Combination products (glucosamine + chondroitin) are also strongly recommended against 3

Other Ineffective Supplements

• Vitamin D: Conditionally recommended against—pooled data across multiple trials yielded null results with small effect sizes at best 1, 2, 3
• Fish oil: Conditionally recommended against—only one trial exists, which failed to show efficacy 1, 2, 3
• Turmeric and ginger extract: Evidence shows either minimal improvement or no change, with significant variability between manufacturers and lack of FDA oversight 1, 2
• Bisphosphonates: Strongly recommended against—preponderance of data shows no improvement in pain or functional outcomes 1, 3

What Actually Works Instead

First-Line Pharmacologic Options

• Acetaminophen (paracetamol): First-line oral analgesic for mild-to-moderate pain, though it carries an FDA black box warning 4, 1, 2
• Topical NSAIDs: Particularly recommended for patients 75 years or older, with clinical efficacy and minimal systemic exposure 4, 1, 2
• Oral NSAIDs or COX-2 inhibitors: Use at the lowest effective dose for the shortest duration when acetaminophen is insufficient, always with gastroprotection (proton pump inhibitor) 4, 1, 2

Non-Pharmacologic Interventions (Core Treatments)

• Exercise programs: Low-impact aerobic activity and quadriceps strengthening show significant effects (effect size 0.52 for pain, 0.46 for disability) 1, 2
• Weight loss: At least 5% body weight reduction significantly improves function in patients with BMI ≥25 kg/m² 1, 2
• Combining diet and exercise provides optimal results 2

Additional Options

• Intra-articular corticosteroid injections: Recommended for moderate to severe pain or acute flares, especially with effusion, supported by 19 high-quality and 6 moderate-quality studies 4, 1, 2
• Topical capsaicin: Conditionally recommended for hand osteoarthritis 4

Critical Clinical Pitfalls

Do not recommend supplements based on patient expectations or perceived safety alone—they lack efficacy and create unnecessary financial burden to patients 2

Patients often believe different formulations of glucosamine have varying effectiveness, but the highest quality evidence consistently shows no benefit over placebo for pain relief or disease modification 3. The 2019 American College of Rheumatology guidelines supersede older recommendations that may have suggested benefit 3.

While some older research from 2008-2012 suggested possible benefits 5, 6, 7, these findings have not been reproducible in higher-quality studies with lower risk of bias 1, 2, 3. The variability between manufacturers and lack of FDA oversight further undermines any potential benefit 1, 2.