Herbs and Supplements

Reviewed by: HU Medical Review Board | Last reviewed: January 2023

If you have axial spondyloarthritis (axSpA), you may want to add vitamins, minerals, or herbs to your diet through supplements. Supplements are taken by mouth and can come in pill, liquid, powder, or other form. Certain supplements may help you manage some symptoms of axSpA.1

How do supplements work?

Vitamins and minerals are nutrients your body needs for healthy growth and development. They help to keep your bones, muscles, heart, and brain functioning properly.2,3

Getting enough of certain vitamins and minerals may be especially important for people with axSpA. Taking these vitamins and minerals may reduce inflammation in the body. This can improve pain, stiffness, and mobility in people with axSpA.2,3

Herbal supplements are made of substances found in plants. Some people with axSpA find that certain herbs may help with symptoms such as pain, inflammation, and stiffness.4

Examples of vitamins and minerals

Vitamins can come from foods like fruits and vegetables, or from supplements. Minerals also can come from various food sources, such as shellfish, dairy products, and nuts, or from supplements. Supplements that people with axSpA commonly take include folic acid, calcium, and vitamin D.2

Folic acid

Folic acid is a type of B vitamin that has been studied for its effects on axSpA. It may also help reduce fatigue, which is often linked to axSpA. Folic acid is found in foods like leafy greens, fortified cereal, and whole grains. It can also be taken in supplement form.3,4

Some people with axSpA take the drug methotrexate to help manage their condition. Studies have shown that this drug reduces folic acid levels in the blood. Your doctor might ask you to take a folic acid supplement if you are taking methotrexate for axSpA.3,4

Folic acid may interact with some other drugs and vitamin supplements. Talk to your doctor before you begin taking a supplement that contains it.3

Calcium and vitamin D

People with axSpA have an increased risk of developing osteoporosis. Osteoporosis is a condition in which bones are weakened and more likely to break. Getting enough calcium and vitamin D is important for general bone health. It also helps to prevent and treat osteoporosis.3,5

Vitamin D helps the body absorb calcium more effectively. This is why these 2 supplements are often taken together.3,5

Calcium may interact with some other drugs and vitamin supplements. Talk to your doctor before you begin taking a calcium supplement.3

Examples of herbs and other supplements for axSpA

Certain herbs and other nutrients also may help manage symptoms of axSpA. These include omega-3 fatty acids, white willow bark, curcumin, and boswellia.4

Omega-3 fatty acids

Omega-3 fatty acids, found in fish oil, have also been studied for axSpA. Omega-3s can help reduce inflammation and may help improve joint stiffness. Studies suggest that omega-3s may help reduce pain and make it easier to move around for people with axSpA. The American Heart Association recommends fish and fish oil supplements for improving heart health.4,6

Omega-3s are generally safe for people to take. But if you have a bleeding problem or are taking a blood-thinning drug, speak to your doctor before taking omega-3 supplements.4,6

White willow bark

White willow bark has been used for centuries by many cultures as a natural pain reliever. It has a similar ingredient to that of aspirin. It works like aspirin to reduce swelling and ease pain.7

White willow bark may help reduce pain or stiffness common in axSpA. But if you are taking a blood thinner or pain medicine, talk to your doctor before taking white willow bark.7

Curcumin (turmeric)

Curcumin is a compound found in turmeric, a yellow spice often used in curries. Turmeric has powerful anti-inflammatory properties. Curcumin can also help reduce pain and improve mobility in people with axSpA. If you are taking a blood-thinner, talk to your doctor before taking curcumin.4,8,9


Boswellia is a tree resin called frankincense. In the past, it has been used for religious ceremonies and to make medicines. More recently, it has been studied for its potential to reduce inflammation and improve mobility in people with axSpA.4,10,11

Boswellia may help reduce pain and stiffness. However, more studies are needed to confirm its effectiveness. It also may increase the side effects of other drugs you are taking, so talk to your doctor before taking it.4,10,11

What are the possible side effects?

Most supplements are safe when used as directed. However, some of them can interfere with other medicines you are taking. This means that the medicines might not work as well or might cause worse side effects. Sometimes, herbs or other supplements can cause problems like liver or kidney damage.3,4

Before taking any new herbal or vitamin supplements for your axSpA, talk to your doctor. Make sure to tell them about all the medicines and other supplements you are taking. Ask them what you can expect when taking the supplement. Also, call your doctor if you have any changes that concern you while taking herbs or supplements.

Other things to know

Supplements are not regulated by the US Food and Drug Administration (FDA) the same way other drugs are. This means that no outside agency confirms the ingredients or suggested dose.12,13

For example, a fish oil supplement may have more or less fish oil than listed on the label. A supplement may also contain ingredients that are not labeled correctly or at all. This can be dangerous. It can lead to taking too much or taking unwanted ingredients.12,13

The FDA created good manufacturing practices (GMPs) to help with this situation. GMPs are guidelines for companies to follow when making supplements. The FDA rarely inspects facilities making supplements in the United States. Companies outside the United States do not have these inspections. But many more supplements are sold than are tested. Your doctor can help you decide if a supplement is safe.12,13

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