Proteolytic enzymes for arthritis pain: Do they help?

Some people report that taking proteolytic enzymes alleviates arthritis pain. Limited research suggests that these enzymes may have anti-inflammatory properties, which may explain how they work.

However, there are only a few high quality studies on proteolytic enzyme supplements for arthritis, so more research is necessary.

Proteolytic enzymes are a group of substances that help the body digest food by breaking down proteins into smaller peptides and amino acids. Some examples include bromelain, papain, pancreatin, and trypsin. Certain foods contain these enzymes, and people can also take them as dietary supplements.

This article discusses whether proteolytic enzymes help with arthritis pain, how effective they are, and how to use them safely.

Some studies suggest proteolytic enzymes may help with arthritis.

For example, a 2022 review looked at nine clinical studies in which people with osteoarthritis (OA) took an oral enzyme combination containing bromelain, trypsin, and an antioxidant known as rutin.

The authors found the enzyme combination was as effective as nonsteroidal anti-inflammatory drugs (NSAIDs) for reducing joint pain and stiffness, with fewer side effects.

Additionally, a 2015 study evaluated the impact of proteolytic enzymes in comparison with the medication diclofenac in adults with moderate to severe knee OA of the knee. The improvement in pain scores was the same in both groups and greater than the placebo. Furthermore, the side effects were similar in the enzyme and placebo groups.

The authors concluded the enzymes had a similar effect to diclofenac in relieving pain and increasing function.

However, there are not enough data yet to confirm if proteolytic enzymes reliably and safely work in large numbers of people. More extensive clinical trials are necessary to explore this.

Learn more about arthritis causes and treatments.

Proteolytic enzymes may have several beneficial effects for those living with arthritis.

Research in animals with arthritis suggests proteolytic enzymes may help reduce inflammation in the joints and surrounding tissue. The enzymes appear to reduce levels of substances that drive inflammation in the body, including prostaglandins and pro-inflammatory cytokines.

However, this research focused on animals. Human trials are necessary to see if they work in the same way.

Proteolytic enzymes may help improve joint function and reduce pain by breaking down damaged tissues in the joints, promoting tissue repair and regeneration.

An animal study suggests they may also keep the cartilage from breaking down. However, this research did not involve human participants.

Studies suggest that proteolytic enzymes improve circulation and blood flow in people with vascular conditions. These benefits may translate to people with arthritis.

When circulation improves, so does the supply of oxygen and nutrients to damaged tissue, which may help speed up healing.

However, more research is necessary to confirm if this is true for people with arthritis.

Few studies have tested whether just eating more foods that contain proteolytic enzymes is enough to help reduce arthritis symptoms in humans.

However, researchers have created an anti-inflammatory (ITIS) diet for people with rheumatoid arthritis (RA) that encourages daily consumption of these foods, including:

The creators of the ITIS diet also recommend:

Research into whether this diet helps with RA or any other type of arthritis is still ongoing. People may find it helpful to try making one change at a time while keeping track of what helps and does not.

For example, a person might try eating more pineapple, papaya, or mango for a week and see if it helps. They may wish to try other dietary changes or a proteolytic enzyme supplement if it does not.

It is always best to speak with a doctor or dietitian before making significant dietary changes.

Learn more about diet and RA.

There is no standard dosage for proteolytic enzyme supplements. People trying these supplements should follow dosage instructions on the product label or from a doctor.

In studies, participants have taken 500–2,000 milligrams per day, divided into two or more doses.

People may tolerate these supplements better when taking enteric-coated or delayed-release capsules. These stop the supplement from breaking down too early in the stomach.

Doctors consider proteolytic enzymes, such as bromelain, generally safe when a person takes them at recommended doses.

However, there are some potential risks, including:

For these reasons, speaking with a doctor before trying these supplements is important. They can ensure they are safe for each individual and monitor people for any side effects.

Because the Food and Drug Administration (FDA) does not fully regulate dietary supplements, anyone considering taking a proteolytic enzyme supplement will need to choose carefully.

Some factors to consider include:

A person’s doctor may also be able to recommend a trustworthy brand.

Some evidence suggests proteolytic enzymes can help with arthritis. However, further scientific evidence is necessary to confirm their effects.

People who want to try these enzymes can eat foods that contain them, such as pineapples and mangoes, or choose a dietary supplement. It is best to speak with a doctor before taking any supplement, so they can check for possible drug interactions and advise on the best dose.