Health Condition

Rheumatoid Arthritis

About This Condition

Rheumatoid arthritis (RA) is a chronic inflammatory disease in which the immune system attacks the joints and sometimes other parts of the body. The cause of RA remains unknown.

Symptoms

The most common symptom of RA is joint pain and morning joint stiffness. Several joints on both sides of the body are usually affected, especially those of the hands, wrists, knees, and feet. Affected joints may feel warm or appear swollen. People with RA may have other symptoms, including weakness, fatigue, weight loss, and, occasionally, fever.

Other Therapies

Joint replacement surgery is sometimes used in cases of severe deformity or disability.

References

1. Pullman-Mooar S, Laposata M, Lem D, et al. Alteration of the cellular fatty acid profile and the production of eicosanoids in human monocytes by gamma-linolenic acid. Arthritis Rheum 1990;33:1526-33.

2. Leventhal LJ, Boyce EG, Zurier RB. Treatment of rheumatoid arthritis with gammalinolenic acid. Ann Intern Med 1993;119:867-73.

3. Zurier RB, Rossetti RG, Jacobson EW, et al. Gamma-linolenic acid treatment of rheumatoid arthritis. A randomized, placebo-controlled trial. Arthritis Rheum 1996;39:1808-17.

4. Leventahn LJ, Boyce EG, Zuerier RB. Treatment of rheumatoid arthritis with black currant seed oil. Br J Rheumatol 1994;33:847-52.

5. Brzeski M, Madhok R, Capell HA. Evening primrose oil in patients with rheumatoid arthritis and side­effects of non­steroidal anti­inflammatory drugs. Brit J Rheumatol 1991;30:370-2.

6. Jantti J, Seppala E, Vapaatalo H, Isomaki H. Evening primrose oil and olive oil in treatment of rheumatoid arthritis. Clin Rheumatol 1989;8:238-44.

7. Belch JJ, Ansell D, Madhok R, et al. Effects of altering dietary essential fatty acids on requirements for non­steroidal anti­inflammatory drugs in patients with rheumatoid arthritis: a double blind placebo controlled study. Ann Rheum Dis 1988;47:96-104.

8. Kremer JM, Jubiz W, Michalek A, et al. Fish­oil fatty acid supplementation in active rheumatoid arthritis. Ann Int Med 1987;106(4):497-503.

9. Kremer JM, Lawrence DA, Jubiz W, et al. Dietary fish oil and olive oil supplementation in patients with rheumatoid arthritis. Clinical and immunologic effects. Arthritis Rheum 1990;33:810-20.

10. Geusens P, Wouters C, Nijs J, et al. Long­term effect of omega­3 fatty acid supplementation in active rheumatoid arthritis. Arthrit Rheum 1994;37:824-9.

11. Van der Tempel H, Tulleken JE, Limburg PC, et al. Effects of fish oil supplementation in rheumatoid arthritis. Ann Rheum Dis 1990;49:76-80.

12. Cleland LG, French JK, Betts WH, et al. Clinical and biochemical effects of dietary fish oil supplements in rheumatoid arthritis. J Rheumatol 1988;15(10):1471-5.

13. Kremer JM, Lawrence DA, Petrillow GF, et al. Effects of high­dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Arthritis Rheum 1995;38:1107-14.

14. Galarraga B, Ho M, Youssef HM, Hill A, McMahon H, Hall C, et al. Cod liver oil (n-3 fatty acids) as an non-steroidal anti-inflammatory drug sparing agent in rheumatoid arthritis. Rheumatology 2008;47:665-9.

15. Proudman SM, James MJ, Spargo LD, et al. Fish oil in recent onset rheumatoid arthritis: a randomised, double-blind controlled trial within algorithm-based drug use. Ann Rheum Dis 2015;74:89–95.

16. Rajaei E, Mowla K, Ghorbani A, et al. The effect of omega-3 fatty acids in patients with active rheumatoid arthritis receiving DMARDs therapy: double-blind randomized controlled trial. Glob J Health Sci 2015;8:18–25.

17. Lee TH, Hoover RL, Williams JD, et al. Effect of dietary enrichment with eicosapentaenoic and docosahexaenoic acids on in vitro neutrophil and monocyte leukotriene generation and neutrophil function. N Engl J Med 1985;312(19):1217-24.

18. Nordstrom DC, Honkanen VE, Nasu Y, et al. Alpha-linolenic acid in the treatment of rheumatoid arthritis. A double-blind, placebo-controlled and randomized study: flaxseed vs. safflower seed. Rheumatol Int 1995;14:231-4.

19. Tao X, Cush JJ, Garret M, Lipsky PE. A phase I study of ethyl acetate extract of the Chinese antirheumatic herb Tripterygium wilfordii hook F in rheumatoid arthritis. J Rheumatol2001;28:2160-7.

20. Tao X, Younger J, Fan FZ, et al. Benefit of an extract of Tripterygium wilfordii Hook F in patients with rheumatoid arthritis: A double-blind, placebo-controlled study. Arthritis Rheum2002;46:1735-43.

21. Ozturk HS, Cimen MY, Cimen OB, et al. Oxidant/antioxidant status of plasma samples from patients with rheumatoid arthritis. Rheumatol Int 1999;19:35-7.

22. Fairburn K, Grootveld M, Ward RJ, et al. Alpha-tocopherol, lipids and lipoproteins in knee-joint synovial fluid and serum from patients with inflammatory joint disease. Clin Sci 1992;83:657-64.

23. Scherak O, Kolarz G. Vitamin E and rheumatoid arthritis. Arthrit Rheum 1991;34:1205-6 [letter].

24. Wittenborg A, Petersen G, Lorkowski G, Brabant T. Effectiveness of vitamin E in comparison with diclofenac sodium in treatment of patients with chronic polyarthritis. Z Rheumatol 1998;57:215-21 [in German].

25. Kolarz G, Scherak O, El Shohoumi M, Blankenhorn G. High dose vitamin E for chronic arthritis. Akt Rheumatol 1990;15:233-7 [in German].

26. Edmonds SE, Winyard PG, Guo R, et al. Putative analgesic activity of repeated oral doses of vitamin E in the treatment of rheumatoid arthritis. Results of a prospective placebo controlled double-blind trial. Ann Rheum Dis 1997;56:649-55.

27. Miehle W. Vitamin E in active arthroses and chronic polyarthritis. What is the value of alpha-tocopherol in therapy? Fortschr Med 1997;115:39-42.

28. Etzel R. Special extract of Boswellia serrata (H15) in the treatment of rheumatoid arthritis. Phytomed 1996;3:91-4.

29. Singh GB, Singh S, Bani S. New phytotherapeutic agent for the treatment of arthritis and allied disorders with novel mode of action. 4th International Congress on Phytotherapy, Munich, Germany, Sep 10-3, 1992.

30. Chopra A, Lavin P, Patwardhan B, Chitre D. Randomized double blind trial of an Ayurvedic plant derived formulation for treatment of rheumatoid arthritis. J Rheumatol 2000;27:1365-72.

31. Sander O, Herborn G, Rau R. Is H15 (resin extract of Boswellia serrata, “incense”) a useful supplement to established drug therapy of chronic polyarthritis? Results of a double-blind pilot study. Z Rheumatol 1998 ;57:11-6 [in German].

32. Srivastava KC, Mustafa T. Ginger (Zingiber officinale) in rheumatism and musculoskeletal disorders. Med Hypoth 1992;39:342-8.

33. Mur E, Hartig F, Eibl G, Schirmer M. Randomized double blind trial of an extract from the pentacyclic alkaloid-chemotype of Uncaria tomentosa for the treatment of rheumatoid arthritis. J Rheumatol 2002;29:678-81.

34. Siemandi H. The effect of cis-9-cetyl myristoleate (CMO) and adjunctive therapy on arthritis and auto-immune disease: a randomized trial. Townsend Letter for Doctors and Patients 1997;Aug/Sept:58-63.

35. Deal CL, Schnitzer TJ, Lipstein E, et al. Treatment of arthritis with topical capsaicin: A double-blind trial. Clin Ther 1991;13:383-95.

36. Bone K. The story of devil's claw: Is it an herbal antirheumatic? Nutrition and Healing 1998;October:3,4,8 [review].

37. American Medical Association. Dimethyl sulfoxide. Controversy and Current Status-1981. JAMA 1982;248:1369-71 [review].

38. Jimenez RAH, Willkens RF. Dimethyl sulfoxide: A perspective of its use in rheumatic diseases. J Lab Clin Med 1982;100:489-500.

39. Jacob SW, Wood DC. Dimethyl sulfoxide (DMSO). Toxicology, pharmacology, and clinical experience. Am J Surg 1967;114:414-26.

40. Pullman-Mooar S, Laposata M, Lem D, et al. Alteration of the cellular fatty acid profile and the production of eicosanoids in human monocytes by gamma-linolenic acid. Arthritis Rheum 1990;33:1526-33.

41. Leventhal LJ, Boyce EG, Zurier RB. Treatment of rheumatoid arthritis with gammalinolenic acid. Ann Intern Med 1993;119:867-73.

42. Zurier RB, Rossetti RG, Jacobson EW, et al. Gamma-linolenic acid treatment of rheumatoid arthritis. A randomized, placebo-controlled trial. Arthritis Rheum 1996;39:1808-17.

43. Leventahn LJ, Boyce EG, Zuerier RB. Treatment of rheumatoid arthritis with black currant seed oil. Br J Rheumatol 1994;33:847-52.

44. Brzeski M, Madhok R, Capell HA. Evening primrose oil in patients with rheumatoid arthritis and side­effects of non­steroidal anti­inflammatory drugs. Brit J Rheumatol 1991;30:370-2.

45. Jantti J, Seppala E, Vapaatalo H, Isomaki H. Evening primrose oil and olive oil in treatment of rheumatoid arthritis. Clin Rheumatol 1989;8:238-44.

46. Belch JJ, Ansell D, Madhok R, et al. Effects of altering dietary essential fatty acids on requirements for non­steroidal anti­inflammatory drugs in patients with rheumatoid arthritis: a double blind placebo controlled study. Ann Rheum Dis 1988;47:96-104.

47. Gibson RG, Gibson SLM, Conway V, Chappell D. Perna canaliculus in the treatment of arthritis. Practitioner 1980;224:955-660.

48. Audeval B, Bouchacourt P. Etude controle en double aveugle contra placebo de l'extrait de moule Perna canaliculus dans las gonarthrose. Gazette Medicale 1986;38:111-6.

49. Huskisson EC, Scott J, Bryans R. Seatone is ineffective in rheumatoid arthritis. BMJ 1981;282:1358-9.

50. Caughey DE, Grigor RR, Caughey EB, et al. Perna canaliculus in the treatment of rheumatoid arthritis. Eur J Rheumatol Inflamm 1983;6:197-200.

51. Larkin JG, Capell HA, Sturrock RD. Seatone in rheumatoid arthritis: a six-month placebo controlled study. Ann Rheum Dis 1985;44:199-201.

52. Highton TC, McArthur AW. Pilot study on the effect of New Zealand green mussel on rheumatoid arthritis. N Z Med J 1975;81:261-2.

53. Gibson SLM, Gibson RG. The treatment of arthritis with a lipid extract of Perna canaliculus: a randomized trial. Comp Ther Med 1998;6:122-6.

54. Brooks PM. Side effects from Seatone. Med J Aust 1980;2:158 [letter].

55. Barton-Wright EC, Elliott WA. The pantothenic acid metabolism of rheumatoid arthritis. Lancet 1963;ii:862-3.

56. General Practitioner Research Group. Calcium pantothenate in arthritic conditions. Practitioner 1980;224:208-11.

57. Park EH, Kahng JH. Suppressive effects of propolis in rat adjuvant arthritis. Arch Pharm Res 1999;22:554-8.

58. Siro B, Szelekovszky S, Lakatos B, et al. Local treatment of rheumatic diseases with propolis compounds. Orv Hetil 1996;137:1365-70 [in Hungarian].

59. Tarp U, Overvad K, Hansen JC, Thorling EB. Low selenium level in severe rheumatoid arthritis. Scand J Rheumatol 1985;14:97-101.

60. Aaseth J, Munthe E, Forre O, Steinnes E. Trace elements in serum and urine of patients with rheumatoid arthritis. Scand J Rheumatol 1978;7:237-40.

61. Peretz A, Neve J, Duchateau J, Famaey JP. Adjuvant treatment of recent onset rheumatoid arthritis by selenium supplementation: preliminary observations. Br J Rheumatol 1992;31:281-2 [letter].

62. Tarp U, Overvad K, Thorling EB, et al. Selenium treatment in rheumatoid arthritis. Scand J Rheumatol 1985;14:364-8.

63. Kulkarni RR, Patki PS, Jog VP, et al. Treatment of osteoarthritis with a herbomineral formulation: A double-blind, placebo-controlled, cross-over study. J Ethnopharmacol 1991;33:91-5.

64. Deodhar SD, Sethi R, Srimal RC. Preliminary studies on antirheumatic activity of curcumin (diferuloyl methane). Ind J Med Res 1980;71:632-4.

65. Srivastava KC, Mustafa T. Ginger (Zingiber officinale) in rheumatism and musculoskeletal disorders. Med Hypoth 1992;39:342-8.

66. Chopra A, Lavin P, Patwardhan B, Chitre D. Randomized double blind trial of an Ayurvedic plant derived formulation for treatment of rheumatoid arthritis. J Rheumatol 2000;27:1365-72.

67. Aaseth J, Munthe E, Forre O, Steinnes E. Trace elements in serum and urine of patients with rheumatoid arthritis. Scand J Rheumatol 1978;7:237-40.

68. Simkin PA. Oral zinc sulphate in rheumatoid arthritis. Lancet 1976;ii:539-42.

69. Peretz A, Neve J, Jeghers O, Pelen F. Zinc distribution in blood components, inflammatory status, and clinical indexes of disease activity during zinc supplementation in inflammatory rheumatic diseases. Am J Clin Nutr 1993;57:690-4.

70. Job C, Menkes CJ, de Gery A, et al. Zinc sulphate in the treatment of rheumatoid arthritis. Arthrit Rheum 1980;23:1408.

71. Simkin PA. Treatment of rheumatoid arthritis with oral zinc sulfate. Agents Actions 1981;8(suppl):587-96.

72. Hartung EF, Steinbroker O. Gastric acidity in chronic arthritis. Ann Intern Med 1935;9:252.

73. Newnham RE. Arthritis or skeletal fluorosis and boron. Int Clin Nutr Rev 1991;11:68-70 [letter].

74. Cohen A, Goldman J. Bromelain therapy in rheumatoid arthritis. Pennsylvania Med J 1964;67:27-30.

75. Blumenthal M, Busse WR, Goldberg A, et al., eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council and Boston: Integrative Medicine Communications, 1998, 430-1.

76. Blumenthal M, Busse WR, Goldberg A, et al., eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council and Boston: Integrative Medicine Communications, 1998, 430-1.

77. DiSilvestro RA, Marten J, Skehan M. Effects of copper supplementation on ceruloplasmin and copper­zinc superoxide dismutase in free­living rheumatoid arthritis patients. J Am Coll Nutr 1992;11:177-80.

78. Jones AA, DiSilvestro RA, Coleman M, Wagner TL. Copper supplementation of adult men: effects on blood copper enzyme activities and indicators of cardiovascular disease risk. Metabolism 1997;46:1380-3.

79. Medical News. Copper boosts activity of anti-inflammatory drugs. JAMA 1974;229:1268-9.

80. Sorenson JRJ. Copper complexes—a unique class of anti­arthritic drugs. Progress Med Chem 1978;15:211-60 [review].

81. Walker WR, Keats DM. An investigation of the therapeutic value of the ‘copper bracelet'—dermal assimilation of copper in arthritic/rheumatoid conditions. Agents Actions 1976;6:454-9.

82. Blake DR, Lunec J. Copper, iron, free radicals and arthritis. Brit J Rheumatol 1985;24:123-7 [editorial].

83. Blumenthal M, Busse WR, Goldberg A, et al., eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council and Boston: Integrative Medicine Communications, 1998, 430-1.

84. Blumenthal M, Busse WR, Goldberg A, et al., eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council and Boston: Integrative Medicine Communications, 1998, 430-1.

85. Srivastava KC, Mustafa T. Ginger (Zingiber officinale) in rheumatism and musculoskeletal disorders. Med Hypoth 1992;39:342-8.

86. Chopra A, Lavin P, Patwardhan B, Chitre D. Randomized double blind trial of an Ayurvedic plant derived formulation for treatment of rheumatoid arthritis. J Rheumatol 2000;27:1365-72.

87. Nakamura H, Masuko K, Yudoh K, et al. Effects of glucosamine administration on patients with rheumatoid arthritis. Rheumatol Int 2007;27:213-8.

88. Zeylstra H. Filipendila ulmaria. Br J Phytotherapy 1998;5:8-12.

89. Randall C, Meethan K, Randall H, Dobbs F. Nettle sting of Urtica dioica for joint pain—an exploratory study of this complementary therapy. Compl Ther Med 1999;7:126-31.

90. Balagot RC, Ehrenpreis S, Kubota K, Greenberg J. Analgesia in mice and humans by D-phenylalanine: Relation to inhibition of enkephalin degradation and enkephalin levels. In: Bonica JJ, Liebeskind JC, Albe-Fessard DG, eds., Advances in Pain Research and Therapy, Vol 5. New York: Raven Press, 1983, 289-93.

91. Langer JG, Gupta OP, Atal CK. Clinical trials on Picrorhiza kurroa. Ind J Pharmacol 1981;13:98-103 [review].

92. Blumenthal M, Busse WR, Goldberg A, et al., eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council and Boston: Integrative Medicine Communications, 1998, 430-1.

93. Blumenthal M, Busse WR, Goldberg A, et al., eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council and Boston: Integrative Medicine Communications, 1998, 430-1.

94. Mills SY, Jacoby RK, Chacksfield M, Willoughby M. Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: A double-blind study. Br J Rheum 1996;35:874-8.

95. Upton R, Petrone C, eds. Willow bark (Salix spp.) monograph. Santa Cruz, CA: American Herbal Pharmacopoeia, 1999.

96. Dhondt W, Willaeys T, Verbruggen LA, et al. Pain threshold in patients with rheumatoid arthritis and effect on manual oscillations. Scand J Rheumatol 1999;28:88-93.

97. Hafström I, Ringertz B, Gyllenhammar H, et al. Effects of fasting on disease activity, neutrophil function, fatty acid composition, and leukotriene biosynthesis in patients with rheumatoid arthritis. Arthritis Rheum 1988;31:585-92.

98. Skoldstam L, Magnusson KE. Fasting, intestinal permeability, and rheumatoid arthritis. Rheum Dis Clin North Am 1991;17:363-71 [review].

99. Kjeldsen­Kragh J, Haugen M, Borchgrevink CF, et al. Controlled trial of fasting and one­year vegetarian diet in rheumatoid arthritis. Lancet 1991;338:899-902.

100. Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, Forre O. Vegetarian diet for patients with rheumatoid arthritis-status: two years after introduction of the diet. Clin Rheumatol 1994;13:475-82.

101. Seignalet J. Diet, fasting, and rheumatoid arthritis. Lancet 1992;339:68-9 [letter].

102. Abuzakouk M, O'Farrelly C. Diet, fasting, and rheumatoid arthritis. Lancet 1992;339:68 [letter].

103. Panayi GS. Diet, fasting, and rheumatoid arthritis. Lancet 1992;339:69 [letter].

104. Skoldstam L. Fasting and vegan diet in rheumatoid arthritis. Scand J Rheumatol 1987;15:219-21.

105. Nenonen M, Helve T, Hanninen O. Effects of uncooked vegan food—“living food”—on rheumatoid arthritis, a three month controlled and randomised study. Am J Clin Nutr 1992;56:762 [abstract #48].

106. Warmbrand M. How Thousands of My Arthritis Patients Regained Their Health. New York: Arco Publishing, 1974.

107. Panush RS, Carter RL, Katz P, et al. Diet therapy for rheumatoid arthritis. Arthrit Rheum 1983;26:462-71.

108. Kjeldsen­Kragh J, Haugen M, Borchgrevink CF, et al. Controlled trial of fasting and one­year vegetarian diet in rheumatoid arthritis. Lancet 1991;338:899-902.

109. Heliövaara M, Aho K, Knekt P, et al. Coffee consumption, rheumatoid factor, and the risk of rheumatoid arthritis. Ann Rheum Dis 2000;59:631-5.

110. Linos A, Kaklamani VG, Koukmantaki Y, et al. Dietary factors in relation to rheumatoid arthritis: a role for olive oil and cooked vegetables. Am J Clin Nutr 1999;70:1077-82.

111. Kremer JM, Lawrence DA, Jubiz W, et al. Dietary fish oil and olive oil supplementation in patients with rheumatoid arthritis. Clinical and immunologic effects. Arthritis Rheum 1990;33:810-20.

112. Levy JA, Ibrahim AB, Shirai T, et al. Dietary fat affects immune response, production of antiviral factors, and immune complex disease in NZP/NZW mice. Proc Natl Acad Sci 1982;79:1974-8.

113. Jacobsson I, Lindgarde F, Manthorpe R, et al. Correlation of fatty acid composition of adipose tissue lipids and serum phosphatidylcholine and serum concentrations of micronutrients with disease duration in rheumatoid arthritis. Ann Rheum Dis 1990;49:901-5.

114. Lucas CP, Power L. Dietary fat aggravates active rheumatoid arthritis. Clin Res 1981;29:754A [abstract].

115. Adam O, Beringer C, Kless T, et al. Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis. Rheumatol Int 2003;23:27-36.

116. Cordain L, Toohey L, Smith MJ, Hickey MS. Modulation of immune function by dietary lectins in rheumatoid arthritis. Br J Nutr 2000;83(3):207-17.

117. Zeller M. Rheumatoid arthritis—food allergy as a factor. Ann Allerg 1949;7:200-5,239.

118. Darlington LG, Ramsey NW, Mansfield JR. Placebo­controlled, blind study of dietary manipulation therapy in rheumatoid arthritis. Lancet 1986;i:236-8.

119. Beri D, Malaviya AN, Shandilya R, Singh RR. Effect of dietary restrictions on disease activity in rheumatoid arthritis. Ann Rheum Dis 1988;47:69-72.

120. Panush RS. Possible role of food sensitivity in arthritis. Ann Allerg 1988;61(part 2):31-5.

121. Taylor MR. Food allergy as an etiological factor in arthropathies: a survey. J Internat Acad Prev Med 1983;8:28-38 [review].

122. O'Farrelly C, Price R, McGillivray AJ, Fernandes L. IgA rheumatoid factor and IgG dietary protein antibodies are associated in rheumatoid arthritis. Immunol Invest 1989;18(6):753-64.

123. Darlington LG, Ramsey NW. Diets for rheumatoid arthritis. Lancet 1991;338:1209 [letter].

124. Kay DR, Webel RB, Drisinger TE, et al. Aerobic exercise improves performance in arthritis patients. Clin Res 1985;33:919A [abstract].

125. Harkcom TM, Lampman RM, Banwell BF, Castor CW. Therapeutic value of graded aerobic exercise training in rheumatoid arthritis. Arthrit Rheum 1985;28:32-8.

126. Westby MD, Wade JP, Rangno KK, Berkowitz J. A randomized controlled trial to evaluate the effectiveness of an exercise program in women with rheumatoid arthritis taking low dose prednisone. J Rheumatol 2000;27:1674-80.

Copyright © 2025 TraceGains, Inc. All rights reserved.

Learn more about TraceGains, the company.

The information presented by TraceGains is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2025.