Before you reach for that arthritis supplement, take note: Over-the-counter supplements could contain surreptitious glucocorticoids, notes a new case series study published in The Journal of The Endocrine Society. The study describes 12 patients who developed Cushing syndrome (CS) and/or adrenal insufficiency (AI) after consuming commonly used supplements such as Artri King, Ardosons, and Ajo Rey — none of which disclosed glucocorticoid content on their labeling.
While the phenomenon of adulterated supplements is not new, this report is the largest case series to date linking unlabeled glucocorticoids in OTC arthritis remedies to serious endocrine disorders. It also expands the clinical picture with data on cortisol levels, cosyntropin test results, and treatment outcomes — information previously missing from the scattered reports in the literature.
Products like Artri King and Ardosons, often purchased in community stores, online, or imported from Latin America, are marketed for joint and back pain relief. They appeal to patients seeking “natural” alternatives to prescription drugs — yet are anything but natural in composition.
Researchers in the study, “Impact of Surreptitious Glucocorticoids in Over-the-Counter Arthritis Supplements,” reviewed data from the electronic medical records for all patients, including patient demographics, length of supplement use, presenting symptoms and physical examination findings, cortisol testing for AI, and initiation of glucocorticoid replacement after initial evaluation.
Clinical signs of Cushing’s syndrome — commonly associated with long-term steroid exposure — were observed in 83.3% of patients. These included classic features such as moon face (66%), central obesity (66%), and abdominal purple stretch marks (50%). Additionally, 66.7% of patients exhibited symptoms of adrenal insufficiency, including nausea, vomiting, fatigue, and abdominal pain — especially after discontinuing the supplements.
“These findings are a wake-up call,” says Trevor Angell, associate professor of clinical medicine at Keck School of Medicine at the University of Southern California and lead study author. “The patients included in our case series did not represent rare occurrences identified only after extensive record reviews. Since drafting our report, we have continued to observe an increasing number of additional cases, likely due to improved recognition. This suggests that the issue may be more widespread, particularly within certain populations.”
Of the 12 patients, with a mean age of 51.6 years and a third of them female, 10 required glucocorticoid replacement therapy due to adrenal suppression. At the time of reporting, four patients continued replacement therapy, three had successfully tapered off, and three were lost to follow-up.
“For patients on such supplements, immediate discontinuation may not be possible without cortisol replacement and should be done with caution,” the researchers write.
This case series not only exceeds the total number of previously reported cases in the literature but also provides the most detailed clinical, biochemical, and therapeutic follow-up data to date. It underscores the importance of recognizing supplement use as a potential source of exogenous steroid exposure, particularly in patients presenting with symptoms suggestive of CS or AI.
The authors call for increased clinician vigilance in obtaining supplement histories, especially in populations with usage of OTC arthritis products. They also urge regulatory agencies to improve oversight of OTC supplements and mandate accurate labeling to protect consumers from harmful, hidden ingredients. The U.S. Food and Drug Administration has issued warnings about Artri King in 2022, but enforcement is limited and inconsistent.
Lastly, the authors emphasize a key clinical message: Health professionals should maintain a high index of suspicion for OTC supplement use in patients presenting with unexplained features of hypercortisolism or adrenal crisis. Importantly, discontinuation of such products without medical oversight can precipitate acute adrenal insufficiency, a potentially life-threatening condition.
In the meantime, health providers are on alert: That bottle of joint pain relief might be hiding more than it claims.
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