Ginger is sold as a "natural anti-inflammatory," and osteoarthritis is where this promise is put to the test: a common, chronic, painful disease where patients seek to limit pharmaceutical anti-inflammatories. Ginger has been seriously tested there, against placebo, and once against ibuprofen.
The result can be summed up in three sentences that this article develops. There is an effect, and it is small. It is accompanied by digestive disorders that cause twice as many patients to discontinue. And in the only direct comparison, ibuprofen wins. We sell ginger. We're going to tell you this anyway, because the person with knee pain deserves an accurate answer rather than a flattering one.
The effect. A meta-analysis of five placebo-controlled trials and 593 patients found a reduction in pain with an effect size of 0.30, and in disability of 0.22. It is significant, homogeneous, and small. The best trial, 261 patients with knee osteoarthritis over six weeks, showed 63% responders versus 50% under placebo, with an extract that combined galangal.
The price. Patients on ginger discontinue 2.3 times more often treatment, due to digestive disorders, mild but real. The comparison. Against ibuprofen, in a crossover trial, the ranking is ibuprofen, then ginger, then placebo, and ginger does not stand out from placebo overall. The red line. Swollen joint, warm, stiff for more than thirty minutes in the morning, painful at rest: this is probably not osteoarthritis, and requires a medical consultation.
- Osteoarthritis or arthritis: the distinction that comes first
- What the meta-analysis shows, and what 0.30 is worth
- The best trial, and its extract that is more than just ginger
- Against ibuprofen: the ranking
- The price to pay: gastrointestinal dropouts
- Extract or powder: what changes here
- Frequently asked questions
Osteoarthritis or arthritis: the distinction that comes first
The term "joint pain" covers two families of diseases that differ in cause, management, and degree of urgency.
| Osteoarthritis | Inflammatory arthritis | |
|---|---|---|
| Mechanism | Mechanical wear of cartilage | Joint attack by the immune system |
| Pain | Increases with activity, eases with rest | Present at rest, often wakes at night |
| Morning stiffness | Brief, less than thirty minutes | Prolonged, often more than one hour |
| Appearance | Little or no swelling, no warmth | Swelling, warmth, sometimes redness |
| Joints | Knees, hips, hands, spine, often asymmetrical | Small joints of hands and feet, often symmetrical |
| What this article covers | Yes : all trials focus on osteoarthritis | No : falls under a rheumatologist's scope |
Untreated inflammatory arthritis destroys the joint in a matter of months or years, and treatments that stop it exist. The risk of this topic is not that ginger causes harm; it's that it delays diagnosis of a treatable disease, by slightly easing a pain that may have been mistaken for osteoarthritis.
Swelling, warmth, prolonged morning stiffness, multiple symmetrical joints, pain at rest or at night, fever, fatigue: facing any of these signs, the first step is a consultation, not a supplement.
What the meta-analysis says, and what a 0.30 is worth
A Danish and international team, publishing in Osteoarthritis and Cartilage, screened 122 references retaining only five randomized placebo-controlled trials, totaling 593 patients with osteoarthritis. It's a small number, but these are the only methodologically sound ones.
| Criterion | Result | Interpretation |
|---|---|---|
| Pain | Effect size 0.30, p = 0.005, heterogeneity 27% | Significant, consistent between trials, small |
| Functional disability | Effect size 0.22, p = 0.01, heterogeneity 0% | Significant, perfectly homogeneous, small |
| Discontinuations due to adverse events | Relative risk 2.33, p = 0.04 | More than twice as many discontinuations with ginger |
| Quality of evidence | Moderate | Few participants, inadequate intention-to-treat analyses |
The standardized effect size makes it possible to compare trials that do not use the same scale. By convention, 0.2 is small, 0.5 is moderate, 0.8 is large. At 0.30, ginger is firmly in the zone of small effects.
Concretely: at the level of a patient group, average pain decreases somewhat more with ginger than with placebo. At the individual level, the effect may be noticeable, or not at all. The authors of the meta-analysis say it with the exact word: ginger was "modestly effective". We will not find a more flattering word, because there is no more accurate one.
The best trial, and its extract that is not just ginger
The largest trial in this review was published in Arthritis & Rheumatism. 261 patients with knee osteoarthritis and moderate to severe pain received, for six weeks, twice daily, a standardized extract or placebo, with acetaminophen allowed as rescue medication.
| Criterion | Extract | Placebo |
|---|---|---|
| Responders, standing pain reduced by at least 15 mm | 63% | 50% |
| Reduction in standing pain, on 100 mm scale | 24.5 mm | 16.4 mm |
| Reduction in pain after 15 m of walking | 15.1 mm | 8.7 mm |
| Composite functional score | 12.9 mm | 9.0 mm, difference not statistically significant |
| Quality of life | Unchanged | Unchanged |
| Digestive effects | 59 patients | 21 patients |
Read the first line carefully: half of the patients in the placebo group experienced a clinically relevant reduction in their pain. This is the typical magnitude of the placebo effect in osteoarthritis, and this is what makes the 63% for ginger far less spectacular than it appears in isolation. The actual difference is 13 points, and quality of life remained unchanged. The authors describe the effect as "moderate."
The extract tested, named EV.EXT 77, was a highly concentrated and standardized extract of two plants : Zingiber officinale, ginger, and Alpinia galanga, galangal, a rhizome from the same family used in Thai cuisine.
This is therefore not a trial on ginger in the strict sense, and even less on a rhizome powder. Its result applies to this specific extract, at this concentration, with this combination. Transposing it to a ginger powder capsule is a shortcut that the protocol does not permit.
Against ibuprofen: the ranking
The question an osteoarthritis patient asks is not "does ginger beat placebo," it's "can ginger replace my anti-inflammatory." One trial posed exactly this question.
In patients with hip or knee osteoarthritis, a crossover double-blind trial compared three three-week periods each, in random order: ginger extract, ibuprofen, placebo, with acetaminophen as rescue medication.
| What was measured | Result |
|---|---|
| Pain ranking | Ibuprofen > ginger > placebo, p < 0.00001 |
| Ranking on the functional index | Ibuprofen > ginger > placebo, p < 0.00005 |
| Ginger versus placebo, over the entire trial | No significant difference |
| Ginger versus placebo, first period only | Ginger advantage, in exploratory analysis |
| Serious adverse effects | None |
Ibuprofen is clearly superior. The ranking is clear, highly significant, and it places the anti-inflammatory ahead of ginger for both pain and function. Anyone considering replacing their anti-inflammatory with ginger should know they will lose efficacy.
Ginger did not beat placebo overall. The effect appears only in the first period, before crossovers, in exploratory analysis. The authors say it themselves: a significant effect could only be demonstrated using exploratory methods in the first period, not in the study taken as a whole. This is a weak result, and it is part of the evidence just as much as the favorable results.
The price to pay: gastrointestinal withdrawals
In a chronic disease where the expected benefit is small, tolerability becomes the deciding factor. And on this point, the data are convergent and not very favorable.
- In the meta-analysis, patients taking ginger were 2.33 times more likely to discontinue treatment than those on placebo, with perfect homogeneity between trials.
- In the 261-patient trial, 59 patients on extract reported gastrointestinal effects, versus 21 on placebo, nearly three times more. They were most often mild.
- In the crossover trial, no serious adverse effects, but ginger was taken for only three weeks.
Extract or powder: what makes a difference here
In our articles on pregnancy nausea and painful periods, we emphasized that the trials used rhizome powder in capsules, the form we sell. With osteoarthritis, this is not the case.
The osteoarthritis trials used concentrated and standardized extracts, one of which also contained galangal. An extract is not a powder: it concentrates certain compounds, eliminates others, and its dose in milligrams cannot be converted to a rhizome dose. The molecule is the same, gingerols and shogaols; the concentration, profile, and quantity actually ingested are not.
Ginger powder does not have, for osteoarthritis, the fidelity to clinical trials that it has for other uses. We cannot tell you what quantity of our powder corresponds to the tested extract, because no one knows. What we can say: the active compounds are present, the dose is defined, and the expected effect is at best the small one that extracts have shown, with no guarantee of achieving it.
A reader who wants to exactly reproduce what was studied in osteoarthritis will look for a standardized extract. We prefer to say it rather than let you discover it. Our article on forms of ginger details the matter.
A joint that is swollen, warm, or red. Morning stiffness lasting more than thirty minutes. Involvement of multiple joints, especially symmetrical, affecting the hands or feet. Pain that wakes you at night or persists at rest. A fever, unusual fatigue, weight loss. Joint pain that is new and severe without injury. These signs suggest something other than osteoarthritis, and the answer is a doctor, not a supplement.
What to do in practice
Frequently Asked Questions
The Effect
Does ginger relieve osteoarthritis?
Somewhat, and it is measurable. A meta-analysis of five randomized controlled trials versus placebo, totaling 593 osteoarthritis patients, found a significant reduction in pain and disability, with a standardized effect size of 0.30 for pain. This is a real effect, consistent across trials, and small. The authors themselves describe it as modest, and judge the quality of evidence as moderate.
What is an effect size of 0.30?
It is a way to measure an effect independent of the scale used. By convention, 0.2 is a small effect, 0.5 a medium effect, 0.8 a large effect. At 0.30, ginger falls in the range of small effects: perceptible at the group level, but that a given individual may very well not feel. For comparison, oral anti-inflammatory drugs in osteoarthritis generally have higher effect sizes.
What is the best trial on the subject?
A double-blind multicenter trial in 261 patients with knee osteoarthritis and moderate to severe pain, over six weeks. With a standardized extract taken twice daily, 63% of patients had a clinically relevant reduction in pain while standing, compared to 50% under placebo. Pain while standing decreased by 24.5 mm versus 16.4 mm on a 100-point scale. The authors describe the effect as moderate.
Was this extract pure ginger?
No, and this is a point often omitted. The extract tested in the 261-patient trial combined two species: Zingiber officinale, ginger, and Alpinia galanga, galangal, a plant from the same family. It was a highly concentrated and standardized extract. The result therefore does not transfer directly to a powder of ginger alone, nor to a rhizome dose.
Does ginger act on cartilage?
No human trial shows that ginger slows cartilage wear or modifies the progression of osteoarthritis. The criteria measured are pain and function, that is, what you feel and your ability to move, not joint structure. A product that promises to rebuild or protect cartilage goes beyond what the data on ginger allow us to say.
Is ginger a natural anti-inflammatory?
Its compounds, gingerols and shogaols, act in the laboratory on inflammatory pathways, notably prostaglandins, which gives biological plausibility to its effect on arthritic pain. But natural anti-inflammatory is a shortcut: the clinical effect measured is small, well below that of a pharmaceutical anti-inflammatory, and it comes with digestive effects. The term describes a mechanism, not potency.
Comparisons and Tolerability
Does ginger work as well as ibuprofen?
No. A double-blind crossover trial compared ginger extract, ibuprofen, and placebo in patients with hip or knee osteoarthritis, each treatment for three weeks. The ranking was unambiguous: ibuprofen, then ginger, then placebo. And across the entire trial, no significant difference between ginger and placebo could be demonstrated; only the first treatment period showed an advantage. Ibuprofen was clearly superior.
Does ginger have adverse effects in osteoarthritis?
Yes, digestive ones, and more frequent than often stated. In the meta-analysis, patients on ginger were more than twice as likely to stop treatment as those on placebo, with a relative risk of 2.33. In the 261-patient trial, 59 patients on the extract had digestive effects versus 21 on placebo. These were usually mild, but they influenced treatment continuation.
Does ginger replace anti-inflammatory drugs?
No, and the only comparative trial shows this: ibuprofen was clearly superior. Ginger can be considered as an adjunct, for someone who wishes to limit anti-inflammatory drugs, knowing that the expected effect is small. It does not substitute for prescribed treatment, and the question of adding it or alternating it is one to discuss with your doctor, especially since both act on similar pathways.
Can ginger and anti-inflammatory drugs be combined?
The combination has not been studied in osteoarthritis. Both act on similar pathways and both can irritate the stomach, making an additive digestive effect plausible. If you are taking an anti-inflammatory, even over-the-counter, the question should be posed to your pharmacist or doctor, and especially so if you are taking an anticoagulant.
Form, Dose, Duration
What dose has been studied?
Osteoarthritis trials have primarily used concentrated and standardized extracts, taken twice daily, not raw rhizome powder. Doses in milligrams of extract do not convert simply to powder dose. This makes the transfer to a ginger powder supplement uncertain: the molecule is the same, the concentration and profile are not. Our article on forms of ginger details this difficulty.
Should an extract or powder be preferred?
Trials on osteoarthritis used concentrated and standardized extracts, which supports this form if one wants to reproduce what was studied. Rhizome powder is the form used in trials for other uses, nausea or painful periods, but not those on osteoarthritis. A powder product therefore lacks, for this indication, the fidelity to trials that it has elsewhere, and this should be known when purchasing it.
How long before an effect?
The trials lasted three to six weeks, and the effect was measured at the end of this period. Osteoarthritis is a chronic condition and the effect of ginger, if it occurs, is not immediate like that of a painkiller. If nothing changes after six to eight weeks of regular intake, continuing has no basis in the data.
Is topical ginger application useful?
The trials cited here concern ginger taken orally. There are studies on local applications, compresses or gels, but they are small in scale and of variable quality, and we did not include them. What is documented at a moderate level of evidence concerns oral intake of extracts.
Is ginger useful for muscle pain after exercise?
This is a different question, with different trials, and it is not the subject of this article. Exercise-related muscle pain is not osteoarthritis, and results for one do not translate to the other. We remain here on what was measured in osteoarthritis patients.
When to consult
What is the difference between osteoarthritis and arthritis?
Osteoarthritis is mechanical wear of cartilage, with pain that increases with effort and subsides at rest, without major inflammation. Inflammatory arthritis, such as rheumatoid arthritis, are diseases of the immune system that attack the joint, with swelling, warmth, prolonged morning stiffness and often affecting multiple symmetric joints. The ginger trials concern osteoarthritis. Inflammatory arthritis requires a rheumatologist and specific treatments, and ginger has no place as a treatment.
What signs should prompt a consultation?
A swollen, warm or red joint. Morning stiffness lasting more than thirty minutes. Multiple joints affected, especially symmetrically and involving hands or feet. Pain that wakes you at night or persists at rest. Fever, unusual fatigue, weight loss. New and intense joint pain without trauma. These signs suggest something other than osteoarthritis and warrant prompt medical attention.
What to remember about ginger and osteoarthritis?
That there is a real effect on pain and function, small, with an effect size of 0.30 across 593 patients. That the trials used concentrated extracts, one of which combined galangal, not powder. That patients on ginger discontinued twice as often due to digestive side effects. That ibuprofen performs significantly better in the only comparative trial. And that a swollen, warm joint, stiff in the morning or painful at rest is probably not osteoarthritis and should be evaluated by a doctor.
Glossary
- Osteoarthritis
- Mechanical wear of articular cartilage, with pain on effort relieved at rest, without major inflammation.
- Inflammatory arthritis
- Disease in which the immune system attacks the joint, with swelling, warmth and prolonged morning stiffness; notably rheumatoid arthritis.
- Standardized effect size
- Difference between two groups expressed in standard deviations; 0.2 small, 0.5 medium, 0.8 large.
- Relative risk
- Ratio of the frequency of an event in one group to the other; 2.33 means 2.33 times more frequent.
- Crossover trial
- Trial in which each participant receives all compared treatments successively, in random order, separated by washout periods.
- Standardized extract
- Concentrated preparation with guaranteed content of marker compounds; distinct from raw rhizome powder.
- Galangal
- Alpinia galanga, rhizome of the ginger family, present in the extract of the main trial.
- Intention to treat
- Analysis including all randomized participants, including those who discontinued; its absence often overestimates the effect.
- Prostaglandins
- Mediators of inflammation and pain, targets of anti-inflammatory agents and, in laboratory studies, of ginger compounds.
Sources
The studies cited below were identified via PubMed.
- Bartels EM, et al. Efficacy and safety of ginger in osteoarthritis patients: meta-analysis of randomized trials versus placebo. Osteoarthritis and Cartilage, 2015;23(1):13-21. DOI
- Altman RD, Marcussen KC. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis & Rheumatism, 2001;44(11):2531-2538. DOI
- Bliddal H, et al. Randomized crossover placebo-controlled study of ginger extracts and ibuprofen in osteoarthritis. Osteoarthritis and Cartilage, 2000;8(1):9-12. DOI
