What Supplements Should Be Avoided with Rheumatoid Arthritis? A Guide to Nutrition and Safety

October 7, 2025 •

4 min read

Roughly half of all adults with rheumatoid arthritis (RA) use dietary supplements, seeking relief from pain and inflammation. However, many of these products carry significant risks, from liver damage to harmful drug interactions. Knowing exactly what supplements should be avoided with rheumatoid arthritis is crucial to protect your health and support your prescribed medical treatment safely.

Quick Summary

Understand which supplements pose serious risks for rheumatoid arthritis patients, including those causing liver toxicity, interfering with medication, or triggering immune system overactivity. Prioritizing safety is key for managing your condition.

Key Points

High-Risk Supplements: Avoid chaparral, oral arnica, red yeast rice, kava, and homemade kombucha due to significant liver and other health risks.
Avoid Immune Stimulants: Do not take immune-boosting supplements like cat's claw, blue-green algae (spirulina), echinacea, or elderberry, as they can worsen autoimmune activity and cause RA flare-ups.
Check for Drug Interactions: Discuss all supplements with your doctor, especially concerning methotrexate and blood thinners, as harmful interactions can reduce medication effectiveness or increase bleeding risk.
Oral vs. Topical Arnica: Never consume arnica orally, as it is poisonous. It may be used topically, but risks and limited research exist.
Consult a Professional: Always talk to your rheumatologist or other healthcare provider before starting any new supplement to ensure it's safe for your specific condition and medications.
Focus on Safer Alternatives: Complementary treatments like a healthy diet, exercise, and stress management are often safer and more effective than supplements for managing RA symptoms.

Why Caution is Needed with Supplements

Rheumatoid arthritis is a chronic autoimmune disease in which the body's immune system mistakenly attacks its own joints, causing painful inflammation. While some supplements are touted as natural remedies for inflammation, many can interfere with prescribed medications or worsen autoimmune activity, creating significant health risks. Unlike prescription drugs, supplements are not regulated by the FDA for safety or effectiveness, making it even more important to consult a healthcare provider before adding anything new to your routine.

Supplements with High Risk of Liver Toxicity

Patients with rheumatoid arthritis often take medications like methotrexate (MTX) that can affect liver function. Adding supplements known to be hepatotoxic (harmful to the liver) can increase this risk dramatically. Avoiding the following is strongly recommended:

Chaparral: Derived from the creosote bush, this supplement has been linked to numerous cases of severe liver damage, including cirrhosis and liver failure. It is particularly dangerous for anyone taking methotrexate and should be avoided entirely.
Kava: Traditionally used for relaxation, kava has been shown to cause liver damage. Given the stress on the liver from some RA medications, this supplement should be avoided.
Homemade Kombucha Tea: While commercially produced kombucha is generally safe, homemade versions carry a higher risk of bacterial contamination and potential liver toxicity.
Borage Oil: Some borage oil products contain pyrrolizidine alkaloids (PAs), which can be toxic to the liver. Safer, PA-free varieties exist, but careful sourcing is critical.

Immune-Stimulating Supplements to Avoid

As an autoimmune condition, RA is characterized by an overactive immune system. Therefore, supplements that 'boost' or stimulate the immune response can be detrimental, potentially triggering a flare-up of symptoms.

Cat's Claw: While sometimes marketed for its anti-inflammatory properties, cat's claw can increase immune system activity. For RA patients, this can worsen symptoms and cause painful flare-ups.
Blue-Green Algae (Spirulina): This popular supplement can overstimulate the immune system, making it a poor choice for individuals with autoimmune diseases like RA.
Echinacea: Known for its immune-boosting properties, echinacea can worsen autoimmune symptoms and is not recommended for RA patients.
Alfalfa: This herb contains L-canavine, an amino acid that can trigger autoimmune responses.
Elderberry: Several studies have linked elderberry supplements to flare-ups in autoimmune conditions by promoting the production of inflammatory cytokines.

Supplements with Dangerous Drug Interactions

Before taking any supplement, it is vital to check for potential interactions with your prescribed RA medications. Certain combinations can render your treatment ineffective or cause severe side effects.

Folic Acid and Methotrexate (MTX): Methotrexate works by interfering with the body's use of folic acid. While doctors often prescribe a specific folic acid supplement to mitigate MTX side effects, taking other folate-containing supplements (like multivitamins) can reduce the efficacy of the medication. It is crucial to follow your doctor's instructions precisely regarding folic acid timing and dosage.
Fish Oil (Omega-3s) and Blood Thinners: High doses of omega-3 fatty acids can slow blood clotting. This can be dangerous for individuals taking anticoagulant medications like warfarin, significantly increasing the risk of bleeding.
Red Yeast Rice and Certain RA Medications: Used to lower cholesterol, red yeast rice can cause muscle pain and weakness, side effects similar to statins. It may also interact with RA medications such as methotrexate and azathioprine, increasing the risk of liver injury.
Turmeric and Blood Thinners: High doses of turmeric or its active ingredient, curcumin, can have a blood-thinning effect, posing a risk when combined with anticoagulant medications.

Supplements with Other Serious Risks

Some supplements carry risks unrelated to specific drug interactions but are still hazardous for RA patients.

Oral Arnica: This herb is poisonous when ingested orally and can lead to severe adverse effects, including nausea, vomiting, heart problems, and even death. Topical arnica cream is a different formulation, but oral consumption is extremely dangerous and should never be attempted.
Thunder God Vine: While some studies have suggested potential anti-inflammatory benefits, thunder god vine can cause serious side effects like diarrhea, nausea, kidney damage, and bone loss. It can also be poisonous if not prepared correctly.
Glucosamine/Chondroitin: Research on the effectiveness of these supplements for RA is inconclusive, and some evidence suggests they are not particularly helpful for managing RA joint pain. Furthermore, glucosamine can interact with blood thinners and may not be safe for those with shellfish allergies.

Why Consulting Your Healthcare Provider is Essential

Given the complexity of rheumatoid arthritis and its treatment, professional guidance is non-negotiable. Only your rheumatologist and other healthcare providers can offer informed advice based on your specific medical history, current medications, and overall health status. They can help you weigh the potential benefits and risks of any supplement and ensure it won't interfere with your treatment plan. Remember, complementary treatments should always be used alongside your conventional therapy, not as a replacement.

Comparing Risky Supplements for Rheumatoid Arthritis


Supplement	Primary Risk	Specific Concerns for RA Patients
Chaparral	Liver Toxicity	Highly dangerous with methotrexate; no proven benefit for RA.
Cat's Claw	Immune Stimulation	Can worsen autoimmune activity and trigger flare-ups.
Red Yeast Rice	Muscle Pain, Liver Injury	Interferes with methotrexate; potential for severe liver problems.
Oral Arnica	Poisonous	Extreme toxicity when ingested; oral use is fatal in high doses.
Fish Oil (high dose)	Bleeding Risk	Increases risk of bleeding, especially with blood thinners like warfarin.
Blue-Green Algae (Spirulina)	Immune Stimulation	Can overstimulate an already overactive immune system.

The Bottom Line on Supplements and RA

While the market is flooded with supplements promising relief, it is essential for those with rheumatoid arthritis to be vigilant. The risk of serious side effects, liver damage, autoimmune flares, and dangerous drug interactions far outweighs the unproven benefits of many products. Always prioritize a treatment plan developed with your medical team and avoid any supplement with known risks. A balanced, anti-inflammatory diet and regular physical activity are far safer and more effective complementary strategies than unvetted supplements.

Frequently Asked Questions

Herbal supplements to avoid with rheumatoid arthritis include chaparral, thunder god vine, and immune-stimulating herbs like cat's claw, blue-green algae (spirulina), and echinacea. These can cause liver damage, dangerous side effects, or trigger autoimmune flares.

If you are on methotrexate, you should only take the folic acid prescribed by your doctor and not take additional folate-containing supplements. Taking extra folic acid can reduce the effectiveness of your methotrexate.

Fish oil can be beneficial, but high doses should be used with caution. High-dose fish oil can have blood-thinning effects and increase the risk of bleeding, especially if you are also taking anticoagulant medications like warfarin.

Red yeast rice can cause muscle pain and weakness. It can also interact with certain RA medications, like methotrexate, and increase the risk of liver injury.

Oral arnica is highly poisonous and can cause severe, sometimes fatal, side effects including heart problems and organ damage. It should never be ingested, even in diluted or homeopathic forms.

Research on glucosamine and chondroitin for rheumatoid arthritis is inconclusive, and some evidence suggests limited effectiveness. The American College of Rheumatology does not recommend them for knee or hip arthritis.

It is important because supplements can interact with your RA medications, cause harmful side effects, or trigger autoimmune flares. Unlike drugs, they are not strictly regulated by the FDA. Your doctor can ensure any complementary treatment is safe and appropriate for your health.