For over 3,000 years, ginger – a member of the Zingiberaceae family – has been used as a spice and medicinal plant. The use of ginger root for digestive complaints and nausea is recommended by both Commission E (the Commission for Phytotherapy at the Federal Institute for Drugs and Medical Devices (BfArM)) and the European Scientific Cooperative on Phytotherapy (ESCOP).
Its rhizome contains bioactive substances traditionally used in Ayurvedic and Chinese medicine, particularly for gastrointestinal complaints, rheumatic conditions and colds [1–3]. The pharmacological properties of ginger are attributed to active phytochemicals such as phenols and terpenes [4]. The rhizomes contain non-volatile oleoresin, which gives it its pungent taste, and volatile essential oils. The oleoresin contains physiologically active substances such as gingerols, shogaols, paradols and zingerone [5]. The essential oils mainly contain sesquiterpenes such as α-zingiberene, as well as less common monoterpenes such as borneol, 1,8-cineole, β-linalool and geranial [6]. One of the main components of ginger, 6-gingerol, has anti-inflammatory and analgesic effects in the unprocessed rhizome and gives ginger its pungency [7,8]. At higher temperatures, it becomes unstable and converts into 6-shogaol. Dried ginger rhizomes contain mainly 6-shogaol, which has various biological properties [9]. Shogaols have been shown in vitro to possess pronounced bioactive properties, such as the ability to scavenge free radicals, as well as anti-inflammatory and anti-carcinogenic properties similar to those of gingerols [10–13].
The composition of fresh and dried ginger influences the efficacy of formulations, a factor that should be taken into account when selecting active ingredients or ginger extracts for medicinal purposes. However, storage, thermal processing and extraction methods also influence the composition of ginger. Studies suggest that the quality of the product depends heavily on the drying technique, with freeze-drying considered the best method for preserving high-quality ginger essential oils [14]. Contradictory data showed that heat drying was the most effective technique, yielding greater quantities of shogaols with stronger antioxidant and antibacterial properties [15]. The amount of phenolic compounds in an extract varies depending on the solvent used. Methanol yields the highest levels, whilst acetone yields the lowest – presumably due to differences in viscosity [16].
The bioavailability of ginger components in the gastrointestinal tract is also crucial to product quality. Studies show that oral administration leads to hydroxylation and conjugation in the liver and tissues, particularly in the intestinal mucosa and microflora [17]. Pharmacokinetic analyses following oral administration of 2.0 g of ginger extract revealed a half-life of 1 to 3 hours for various gingerols and shogaols [18]. Animal studies showed that intravenously administered 6-gingerol is rapidly metabolised, with a short half-life [19]. An experimental study reported that 6-, 8- and 10-gingerol suppress human cytochrome P450 activity, whilst 8- and 10-gingerol may inhibit CYP3A4 expression. These findings could have implications for the therapeutic use of ginger or ginger products when combined with medicines metabolised by cytochrome P450 enzymes [20].
Standardised preparations available on the German market include, for example, Zintona®, which is used to prevent travel sickness such as dizziness, nausea and vomiting [21], or GingerinPlus® from Cellavent Healthcare. As dietary supplements, ginger capsules containing ginger root powder or ginger root extract (dosage 500–650 mg) are available from various manufacturers.
A PubMed search (as of 20 May 2025) using the terms ‘ginger and rheumatoid arthritis’ yielded 73 articles; five results were found for the search term ‘ginger and spondyloarthritis’ and seven results for ‘ginger and lupus’, although these were not relevant to the respective clinical conditions. The majority of results (106) were found for “ginger and osteoarthritis”, although there was some overlap with the search results for rheumatoid arthritis (RA).
Effects in vitro and in animal models
Most experimental studies have investigated the anti-inflammatory effects of ginger extracts. Ribel-Madsen et al. compared the effects of betamethasone, ibuprofen and ginger extract on pro-inflammatory factors in synovial cell cultures. They isolated cells from patients with rheumatoid arthritis, osteoarthritis and healthy volunteers, which were activated by TNF-α. A standardised ginger extract, EV.EXT®77, was used, containing active compounds from Zingiber officinale and Alpinia galanga. This extract demonstrated similar anti-inflammatory properties to betamethasone by reducing the production of the pro-inflammatory cytokine IL-8 [22]. In a further study, it was found that the extract reduced the expression of TNF-α and COX-2, inhibited the synthesis of prostaglandin E2 and suppressed the activation of NF-κB and IκB-α [23]. The potential anti-inflammatory effects demonstrated experimentally were confirmed by further studies, including clinical trials, in patients with osteoarthritis [24, 25].
Another experimental study reported that ginger extracts can reduce the production of chemokines in synoviocytes [26]. The combination of extracts from Zingiber officinale and Alpinia galanga (galangal or Thai ginger) suppresses monocyte chemoattractant protein-1 and interferon-gamma-inducible protein 10 kD. Zingiber officinale was more effective than Alpinia galanga, but the combined effect of both extracts was stronger.
Another component of ginger, zingerone, demonstrated in vitro that it could inhibit cartilage degradation in osteoarthritis. This effect appears to be mediated via inhibition of the p38 and JNK signalling pathways (mitogen-activated protein kinase pathway). This reduces pro-inflammatory cytokines and cartilage-degrading enzymes [27]. 6-Shogaol exhibited a dose-dependent anti-inflammatory effect by inducing cell apoptosis and reducing cytokine synthesis (TNF-α, IL-6, and IL-8) in synovial tissue [28]. In both synoviocytes and chondrocytes, ginger preparations were shown to increase the expression of antioxidant enzymes and reduce mitochondrial damage [29, 30]. In animal models, an orally administered ginger extract (50 mg/kg/day) demonstrated significant anti-arthritic effects. It lowered the levels of pro-inflammatory cytokines (TNF-α, IL-6, IL-17) as well as the expression of COX-2 and NF-κB in joint tissue. Furthermore, synovial inflammation, hyperplasia and cartilage degradation were reduced [31]. The same group described anti-arthritic effects of ginger essential oil, which is rich in sesquiterpenes, in animal experiments [32]. The anti-arthritic effects in cell cultures from RA patients and in animal models are supported by a further publication by Jo et al. [33].
In an experimental study by Ali et al., the potential therapeutic effects of ginger compounds in relation to systemic lupus erythematosus (SLE) were discussed. The authors demonstrated that 6-gingerol reduces NET release in mice in various models of lupus and APS, whilst simultaneously improving other disease-relevant endpoints such as the formation of autoantibodies and thrombosis of large veins [34].
2.2 Effects in clinical trials - overall assessment of the medicinal effects of ginger
An umbrella review on the effects of ginger in various areas of medicine was published in the American Journal of Clinical Nutrition in 2022 [35]. The 24 systematic reviews analysed provided evidence of pain-relieving effects in osteoarthritis (effect size: small; level of evidence: high), as well as statistically significant evidence for antiemetic effects in pregnant women, antidiabetic and antihypertensive effects, and statistically significant effects on dysmenorrhoea symptoms, post-operative nausea and chemotherapy-induced vomiting. There was considerable heterogeneity in dosing (mostly 0.5–3 g/day in capsule form). The dosages used and dietary consumption were safe.
Six randomised clinical trials in patients with RA or osteoarthritis [36] investigated the anti-inflammatory and analgesic effects of ginger.
2.3 Clinical efficacy in rheumatoid arthritis
In a 2019 publication, an Iranian research group investigated the effect of 1.5 grams of ginger powder daily (750 mg twice daily for 12 weeks) in 66 patients with RA. The endpoints were laboratory parameters [37]. Ginger was found to reduce CRP and IL-1β mRNA from PBMCs in whole blood samples. Patient-reported outcomes or the DAS28 were not reported. The same research group published the results of a further randomised, double-blind, placebo-controlled study in 2019. 70 RA patients (63 of whom were evaluable) received 1500 mg of ginger powder or a placebo daily over 12 weeks. Before and after the intervention, DAS28 and the gene expression of NF-κB, PPAR-γ, FoxP3, T-bet, GATA-3 and RORγt in PBMCs were analysed using quantitative real-time PCR. The authors concluded that ginger can influence disease activity in RA by modulating T-cell differentiation. In particular, the expression of FoxP3 (regulatory T cells) is significantly increased (p-value = 0.02), whilst the expression of the transcription factors RORγt and T-bet (Th17 and Th1 cells, respectively) is significantly reduced (p-value < 0.05), which was interpreted as a shift towards an anti-inflammatory immune profile. The reduction in the DAS28 score was statistically significant within the ginger group and between the two groups following the intervention; however, no details were provided regarding changes in the individual components of the DAS28 [38].
The efficacy of ginger in osteoarthritis has been studied more extensively than in rheumatoid arthritis. A meta-analysis by Bartels et al. examined five RCTs involving a total of 593 patients with knee osteoarthritis. The results showed that ginger extract produced significant improvements in pain and joint function compared with placebo. The effect size for pain relief was 0.3 (p=0.0005); for the ‘disability index’, the effect size was smaller (0.22). The dose used was highly variable (250–1000 mg of ginger extract daily, over 6–12 weeks). In a study directly comparing ginger with NSAIDs, ginger was inferior in clinical efficacy for osteoarthritis, but it had a better side-effect profile [39]. Similar results were observed in patients with knee osteoarthritis who took ginger powder. The studies used doses of 250–500 mg per day over a period of 6–12 weeks. Even after three months of supplementation with ginger extract, cytokines (TNF-α and IL-1β) as well as NO and CRP decreased in patients with knee osteoarthritis, and the effects persisted for up to 12 months [40, 41]. No relevant side effects were reported with oral administration; only mild gastrointestinal complaints such as reflux were documented. Clinical parameters or patient-reported outcomes were not documented.
In a randomised, placebo-controlled study published in 2011 involving 204 patients with knee osteoarthritis, the effect of ginger extract was investigated over six weeks. The ginger group showed a significantly greater reduction in pain on the visual analogue scale, as well as a marked decrease in stiffness and functional limitations compared with the placebo group (p < 0.05). There were no differences in side effects between the groups [42].
A double-blind, randomised, placebo-controlled clinical trial published in 2001, involving 261 patients with knee osteoarthritis, investigated the standardised extract (EV.EXT®77), which contained the two species Zingiber officinale and Alpinia galanga (255 mg twice daily), over a six-week period. The active treatment group showed a statistically significant effect on the relief of knee osteoarthritis symptoms. This effect was moderate. The effect was assessed based on the reduction in knee pain when standing up (24.5 mm versus 16.4 mm; P = 0.005), reduction in knee pain after walking 15 metres (15.1 mm versus 8.7 mm; P = 0.016) and reduction in the WOMAC Osteoarthritis Total Score (12.9 mm versus 9.0 mm; P = 0.087) (WOMAC: Western Ontario and McMaster Universities) . The safety profile was good, with predominantly mild gastrointestinal side effects in the active treatment group [43].
In a 2024 study from Korea, heated ginger extract was compared with placebo in 100 patients with knee osteoarthritis. After 12 weeks, a significant improvement in the WOMAC index was observed for ginger [44].
Another study from Iran conducted in 2022 investigated a ginger and honey syrup (‘G-RUP’) [45]. Here too, statistically significant benefits were observed for ginger in terms of pain and WOMAC scores. A similar result was found by Rondanelli et al. from Italy with a product containing ginger, lecithin and Acmella oleracea (Jambu) in 50 patients with knee osteoarthritis [46].
Bliddal et al. compared the analgesic effect of a herbal combination preparation (ginger extract and black pepper) with that of naproxen and ibuprofen in 56 osteoarthritis patients as part of a double-blind controlled clinical trial. No statistically significant improvements were observed [47].
Other studies suggest that ginger (Zingiber officinale), when combined with other phytotherapeutically active plants of the Zingiberaceae family, such as Curcuma longa (turmeric) and Alpinia galanga (galangal), exhibits synergistic effects [48].
A clinical trial compared the combined treatment of phonophoresis and the topical effect of a 5% ginger gel with conventional phonophoresis in 40 patients with moderate knee osteoarthritis, as an adjunct to physiotherapy. The treatment was administered daily over a 14-day period. Both methods resulted in pain relief and improved function. The within-group comparison showed a statistically significant improvement in all outcome measures in both groups, with the exception of the Timed Up and Go test in the control group. The intervention group showed statistically significantly greater improvements in all outcome measures compared to the control group. Furthermore, the reduced pain scores in the ginger group remained significantly stable for up to three months after treatment [49].
Two smaller, uncontrolled studies reported an improvement in osteoarthritis symptoms following the application of local ginger compresses [50, 51].
The topical application of ginger, or ginger combined with other herbal extracts, in the form of gels has been investigated in two randomised controlled clinical trials. In a Thai study, the so-called Plygersic gel, which contains extracts of Zingiber officinale and Z. cassumunar, reduced pain in patients with knee osteoarthritis (n=100) to a similar extent as a 1% diclofenac gel [52]. Another herbal ointment containing cinnamon, ginger, mastic and sesame oil showed comparable positive effects to a salicylate-containing control ointment in the 92 participating patients with knee osteoarthritis [53]. Two cases of contact dermatitis have been reported as side effects. No experimental data are available on the absorption of ginger or its constituents. According to the current S3 guideline on the prevention and treatment of knee osteoarthritis, there is no recommendation for or against the use of comfrey extract, arnica gel and other topical phytotherapeutics [54] (https://register.awmf.org/assets/guidelines/187-050k_S3_Gonarthrose_2025-05.pdf).
The compounds in ginger modulate signalling pathways that are important for the pathophysiology of osteoarthritis and rheumatoid arthritis, and lead to the suppression of pro-inflammatory cytokines. Preclinical studies suggest that ginger and its phytochemicals, including 6-shogaol, zingerone and cedrol, exhibit anti-inflammatory and antioxidant effects. These effects have been replicated in a small number of clinical trials. These relate mainly to (gon)arthrosis, and only one clinical trial was conducted with RA patients. This Iranian study involving 63 RA patients demonstrated a significant reduction in hsCRP (p = 0.050) and IL-1β (p = 0.021) [37,38,40] as well as in the DAS28 score after 12 weeks [38].
The clinical data on inflammatory rheumatic diseases is very limited. Due to insufficient data, it cannot be confirmed or ruled out whether ginger extracts have a positive effect on the disease activity of RA, in addition to reducing cytokine levels. The oral extracts were generally well tolerated. Moderate gastrointestinal side effects occurred. The occurrence of only mild side effects such as reflux and dermatitis suggests that ginger, administered orally at a dose of 0.5–1 g/day, as well as topical preparations containing approximately 5% ginger, are safe.
In some of the available clinical studies, the quantities of active ingredients used in the ginger products and extracts were not disclosed [52]. There is also evidence to suggest that the final ratio of bioactive substances may vary depending on the geographical origin of the rhizome and the extraction method used [55].
A 2002 publication reports that ginger may increase the risk of bleeding when taken concurrently with medicines such as diclofenac or ibuprofen [56]. The evidence regarding the concurrent use of anticoagulants / antiplatelet agents is inconsistent. As ginger can inhibit thromboxane formation and platelet aggregation, the simultaneous use of anticoagulants could increase the risk of bleeding [57], although a systematic review found that the current evidence is inconclusive [58].
There is insufficient scientific evidence to recommend the medical use of ginger or ginger extracts for inflammatory rheumatic diseases. There is no phytotherapeutic preparation based on ginger with a defined active ingredient content available on the German pharmaceutical market. However, as ginger also has other beneficial effects, particularly on metabolism, ginger in its natural form can be recommended as a food for patients with rheumatic diseases.
For the indication of osteoarthritis, there is evidence of moderate to high quality for a mild to moderate analgesic or anti-inflammatory effect. If patients with degenerative joint diseases wish to take ginger as a food or as a quality-assured pure extract in addition to established therapy, there is no reason to advise against this from a rheumatological perspective.
However, a large number of ginger extracts are available on the market as food supplements with correspondingly low quality standards. The use of such food supplements cannot be recommended.
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Stand: 10.03.2026