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Most arthritis supplements fail not because they're useless, but because you bought the wrong form or dose. Glucosamine hydrochloride is not glucosamine sulfate, and standard curcumin absorbs so poorly it barely reaches your joints. The right ingredient in the wrong formulation won't reduce your pain. Here's what clinical trials show about which forms, doses, and combinations actually work for joint pain. Let's dig in.
Superpower tests 100+ biomarkers, including hs-CRP, ESR, and uric acid, so you can measure your baseline inflammation before starting supplements and track whether they're actually working. See what's in the Baseline Panel.
What Arthritis Supplements Do in Your Joints
Arthritis pain comes from two overlapping problems: cartilage breakdown and inflammation in the joint lining. Enzymes called matrix metalloproteinases degrade the collagen and proteoglycans that give cartilage its structure. Inflammatory cytokines like IL-1β and TNF-α flood the synovial fluid, triggering pain receptors and accelerating tissue damage.
Among the supplements with the strongest clinical evidence for joint health support are glucosamine sulfate (1,500 mg/day), curcumin in an enhanced-absorption form (500–1,000 mg/day), fish oil at 2.7 grams or more EPA/DHA daily, MSM at 3.4–6 grams/day, and boswellia extract. Form and dose matter as much as the ingredient itself.
Each works through a distinct mechanism. Curcumin and fish oil target systemic inflammation. Glucosamine and chondroitin support cartilage structure. MSM dampens pain amplification after mechanical stress. Boswellia inhibits a separate inflammatory enzyme pathway that NSAIDs and curcumin don't reach. Understanding the mechanism tells you which supplements match your type of arthritis.
Glucosamine
Glucosamine is an amino sugar that serves as a building block for glycosaminoglycans, the molecules that make up cartilage matrix. Glucosamine sulfate absorbs into the bloodstream and reaches cartilage within four hours. It stimulates chondrocytes to produce more proteoglycans while inhibiting cartilage-degrading enzymes.
Chondroitin
Chondroitin sulfate attracts water into cartilage, maintaining its shock-absorbing properties. Oral bioavailability is lower than glucosamine, around 5 to 10%, but absorbed molecules reach synovial fluid intact. Chondroitin blocks inflammatory pathways and slows enzyme activity, though its primary role appears structural rather than analgesic.
MSM
Methylsulfonylmethane is an organic sulfur compound that reduces oxidative stress and inflammatory signaling in joint tissue. It absorbs quickly and modulates immune cell activity. MSM doesn't rebuild cartilage, but it dampens the inflammatory cascade that amplifies pain, especially after exercise or mechanical loading.
Curcumin
Curcumin, the active compound in turmeric, inhibits NF-κB, a master regulator of inflammation driving both osteoarthritis and rheumatoid arthritis. Standard curcumin has poor bioavailability (under 1%), but piperine-enhanced or phospholipid-bound formulations increase absorption dramatically. Once in circulation, curcumin blocks COX-2 and lipoxygenase enzymes much like NSAIDs, with a different GI risk profile than NSAIDs.
Omega-3 fatty acids
Fish oil provides EPA and DHA, which your body converts into specialized pro-resolving mediators. These molecules actively resolve inflammation rather than just blocking it, a different mechanism than NSAIDs or curcumin. Omega-3s have the strongest research base in the context of rheumatoid arthritis, where systemic inflammation drives joint damage.
Boswellia
Boswellia serrata contains boswellic acids that inhibit 5-lipoxygenase, an enzyme driving leukotriene production in joint tissue. This pathway differs from those targeted by NSAIDs and curcumin, making boswellia a useful addition rather than a replacement. Studies suggest measurable benefit within four to eight weeks of consistent use.
What the Research Shows About Each Supplement
The evidence for joint supplements is uneven, some have large, rigorous trials; others have only small pilot studies. Here's how each one holds up.
Glucosamine sulfate: head-to-head trial data against celecoxib
The MOVES trial (n=606) found glucosamine plus chondroitin produced a 50.1% decrease in WOMAC pain scores, versus 50.2% for celecoxib (p=0.92), a non-inferiority result. Meta-analyses show a more mixed picture: a 2018 meta-analysis of 30 RCTs found chondroitin alleviated pain versus placebo, but the combination's superiority over placebo for pain was not consistent across studies. A 2022 meta-analysis of 8 trials found the combination improved WOMAC composite scores but did not reach significance on VAS pain, likely because it pooled hydrochloride and sulfate glucosamine studies together. Form matters more than ingredient name.
Chondroitin: better at slowing progression than relieving pain
MRI studies tracking cartilage volume over 12 months suggest chondroitin sulfate may slow the rate of cartilage loss in knee osteoarthritis, particularly in moderate disease. Evidence for direct pain relief is weaker, some trials show modest WOMAC improvement, others show no difference from placebo. Think of chondroitin as a structure-preserving supplement rather than an analgesic.
MSM: consistent short-term benefit
A pilot RCT of 50 adults with knee osteoarthritis found MSM at 6 g/day (3 g twice daily) significantly reduced pain and improved physical function scores after 12 weeks versus placebo. A subsequent RCT using approximately 3.4 g/day found modest improvements in physical function, though pain and stiffness scores did not reach statistical significance. The evidence base is smaller than for glucosamine, and effect sizes are generally modest. Data beyond 12 weeks are lacking.
Curcumin: head-to-head trial data against NSAIDs
A meta-analysis of 6 RCTs in rheumatoid arthritis found curcumin significantly lowered disease activity scores, reduced CRP and ESR, and decreased tender and swollen joint counts. In osteoarthritis, a 2021 meta-analysis of 11 RCTs found curcumin performed comparably or better than NSAIDs for pain reduction, but only when researchers used enhanced-absorption formulations. This is where most people fail with turmeric supplements.
Omega-3s: strongest trial evidence in rheumatoid arthritis
A meta-analysis of 10 RCTs found omega-3 PUFAs at 2.7 grams or more daily significantly reduced NSAID consumption in rheumatoid arthritis; trends toward reduced tender joint count were consistent across trials but did not reach statistical significance. A more recent meta-analysis of 23 RCTs found only modest effects on pain and inflammation, noting most of the evidence was low-to-very-low quality. For osteoarthritis, evidence is more limited, studies in older adults show reduced pain, but data are less robust. Consistent daily dosing for at least 12 weeks is necessary before assessing response.
Boswellia: consistent across randomized trials
A meta-analysis of 7 RCTs in 545 patients found boswellia was associated with reduced pain and stiffness and improved joint function in people with osteoarthritis. Benefits appear after at least four weeks of consistent use. Most individual studies are small and short-term, but findings are consistent across trials, which may indicate genuine effect rather than statistical noise.
Dose, Timing, and Formulation: What Changes Results
The doses below reflect amounts used in published clinical trials, not personal recommendations. Consult a healthcare provider before starting any supplement regimen, particularly if you take medications or have an underlying health condition.
Glucosamine: sulfate, not hydrochloride
Use crystalline glucosamine sulfate at 1,500 mg as a single daily dose. The GUIDE trial (n=318, 6 months) demonstrated symptom relief versus placebo using this prescription crystalline form; two separate long-term RCTs, Reginster et al. (Lancet, 2001) and Pavelka et al. (2002), each running three years, found both sustained symptom relief and slowed joint space narrowing on x-ray with the same glucosamine sulfate form. Glucosamine hydrochloride shows less consistent results, particularly for structural outcomes, and most negative trials have used this form. Most mass-market products use hydrochloride to cut costs. Check the Supplement Facts panel for the salt form, the label won't always make it obvious.
Chondroitin: pharmaceutical-grade matters
The effective dose is 800 to 1,200 mg daily, typically split into two doses. Pharmaceutical-grade chondroitin shows more consistent results than over-the-counter versions, which often use lower-purity material. Taking chondroitin with food may improve absorption. The strongest RCTs have combined chondroitin with glucosamine, the MOVES trial tested this pairing, though it used glucosamine hydrochloride; trials using crystalline glucosamine sulfate alongside chondroitin show the most consistent structural benefits.
MSM: dose range matters, split across the day
Clinical trials have used doses ranging from approximately 3.4 to 6 grams daily, split across two or three doses. The higher end of this range (6 g/day) produced the clearest pain reduction in the largest pilot trial; a trial using 3.4 g/day found functional improvement but not statistically significant pain relief. MSM is water-soluble and absorbs quickly, so timing relative to meals doesn't matter. Most trials lasted 12 weeks, and it's unclear whether benefits persist with longer use or return after stopping.
Curcumin: bioavailability is everything
Standard curcumin powder is poorly absorbed, most reaches the colon without entering circulation. Effective formulations include curcumin with piperine (black pepper extract), phospholipid-bound curcumin (phytosome form), or nanoparticle curcumin. A 1998 pharmacokinetic study found 20 mg of piperine increased curcumin bioavailability approximately 20-fold, though the human arm of this study enrolled only three volunteers, and the finding awaits larger-scale replication. The effective dose of enhanced curcumin is 500 to 1,000 mg daily. Take it with a meal containing fat, curcumin is fat-soluble.
Fish oil: EPA+DHA content, not total oil
Trials showing rheumatoid arthritis benefit used at least 2.7 grams of combined EPA and DHA daily, not total fish oil. Many products list total oil rather than EPA/DHA content, obscuring the active dose. Read labels carefully. Consistent daily use for 12 or more weeks is necessary before assessing response.
Combination products and broader joint support
Many people take glucosamine, chondroitin, and MSM together. The MOVES trial confirmed the glucosamine-chondroitin combination works as well as celecoxib, whether adding MSM improves results further remains unclear. For broader connective tissue support, collagen peptides and products like Ligament Restore take a wider approach to connective tissue health beyond cartilage alone, though the research base is less mature than for glucosamine or curcumin.
Why Response Varies by Person
Baseline cartilage damage determines who benefits most from glucosamine and chondroitin. People with mild to moderate osteoarthritis tend to respond better than those with severe cartilage loss, these supplements support remaining tissue, not destroyed tissue. If your joint space is already bone-on-bone, structural supplements have little to work with.
Inflammatory phenotype shapes response to curcumin and omega-3s. People with elevated baseline CRP or ESR may respond better to anti-inflammatory supplements. People with rheumatoid arthritis, a systemic autoimmune condition, may see a more pronounced benefit from fish oil than people with osteoarthritis, whose inflammation is more localized and mechanical.
- Gut absorption varies widely. Glucosamine bioavailability ranges from roughly 12 to 44% depending on gut transit time, stomach acid, and intestinal health. Curcumin absorption is even more variable, enhanced formulations help considerably, but individual response still differs.
- Medication interactions shape outcomes. NSAIDs and glucosamine may overlap mechanistically, reducing apparent benefit from adding glucosamine. Curcumin and omega-3s have mild blood-thinning effects, use caution alongside warfarin or other anticoagulants.
- Metabolic health influences baseline inflammation. Insulin resistance and metabolic syndrome elevate systemic inflammation, which can blunt the effects of anti-inflammatory supplements or require higher doses to show meaningful change.
- Arthritis type changes what you need. Glucosamine and chondroitin address local cartilage mechanics. Fish oil and curcumin target systemic inflammation. Using the wrong category for your arthritis type produces disappointing results.
What Supplements Are Good for Joints: Tracking What Works
Supplementing without testing is guessing. Knowing your inflammatory baseline before you start, and retesting after 12 weeks, turns self-experimentation into actual data. Here's what to measure.
Inflammatory markers
High-sensitivity CRP and ESR may decrease if curcumin or fish oil is having an effect. These markers won't shift much with glucosamine or chondroitin, which act locally in joints rather than systemically. A drop in hs-CRP after 12 weeks of supplementation is meaningful evidence of effect, even if both values fall within the standard "normal" range. The key inflammation and recovery biomarkers tell you whether your anti-inflammatory supplements are hitting their target.
Uric acid
If you have sudden-onset, excruciating joint pain, especially in the big toe or ankle, check uric acid before spending money on glucosamine. Gout is a form of joint pain that won't respond to cartilage supplements at all. Optimal uric acid levels sit narrower than standard lab references suggest, and gout requires a completely different intervention.
Kidney and liver function
Some arthritis supplements clear through the kidneys, impaired kidney function may require dose adjustments. High-dose curcumin or boswellia can affect liver metabolism in some people over time. It's worth monitoring liver enzymes if you take either at therapeutic doses consistently. Subclinical elevations can appear well before standard "abnormal" flags trigger on a lab report.
Choosing and adjusting based on your data
Your inflammatory and metabolic baseline helps you decide what supplements are good for your specific joints, not just what worked on average in a clinical trial. Elevated CRP points toward curcumin and fish oil. Normal CRP with structural joint symptoms points toward glucosamine and chondroitin. Retesting after 12 weeks tells you whether to continue, adjust dose, or switch approaches. The full list of biomarkers relevant to joint health shows what to track and what ranges to target.
What Arthritis Supplements Do in Your Joints
Arthritis pain comes from two overlapping problems: cartilage breakdown and inflammation in the joint lining. Enzymes called matrix metalloproteinases degrade the collagen and proteoglycans that give cartilage its structure. Inflammatory cytokines like IL-1β and TNF-α flood the synovial fluid, triggering pain receptors and accelerating tissue damage.
Among the supplements with the strongest clinical evidence for joint health support are glucosamine sulfate (1,500 mg/day), curcumin in an enhanced-absorption form (500–1,000 mg/day), fish oil at 2.7 grams or more EPA/DHA daily, MSM at 3.4–6 grams/day, and boswellia extract. Form and dose matter as much as the ingredient itself.
Each works through a distinct mechanism. Curcumin and fish oil target systemic inflammation. Glucosamine and chondroitin support cartilage structure. MSM dampens pain amplification after mechanical stress. Boswellia inhibits a separate inflammatory enzyme pathway that NSAIDs and curcumin don't reach. Understanding the mechanism tells you which supplements match your type of arthritis.
Glucosamine
Glucosamine is an amino sugar that serves as a building block for glycosaminoglycans, the molecules that make up cartilage matrix. Glucosamine sulfate absorbs into the bloodstream and reaches cartilage within four hours. It stimulates chondrocytes to produce more proteoglycans while inhibiting cartilage-degrading enzymes.
Chondroitin
Chondroitin sulfate attracts water into cartilage, maintaining its shock-absorbing properties. Oral bioavailability is lower than glucosamine, around 5 to 10%, but absorbed molecules reach synovial fluid intact. Chondroitin blocks inflammatory pathways and slows enzyme activity, though its primary role appears structural rather than analgesic.
MSM
Methylsulfonylmethane is an organic sulfur compound that reduces oxidative stress and inflammatory signaling in joint tissue. It absorbs quickly and modulates immune cell activity. MSM doesn't rebuild cartilage, but it dampens the inflammatory cascade that amplifies pain, especially after exercise or mechanical loading.
Curcumin
Curcumin, the active compound in turmeric, inhibits NF-κB, a master regulator of inflammation driving both osteoarthritis and rheumatoid arthritis. Standard curcumin has poor bioavailability (under 1%), but piperine-enhanced or phospholipid-bound formulations increase absorption dramatically. Once in circulation, curcumin blocks COX-2 and lipoxygenase enzymes much like NSAIDs, with a different GI risk profile than NSAIDs.
Omega-3 fatty acids
Fish oil provides EPA and DHA, which your body converts into specialized pro-resolving mediators. These molecules actively resolve inflammation rather than just blocking it, a different mechanism than NSAIDs or curcumin. Omega-3s have the strongest research base in the context of rheumatoid arthritis, where systemic inflammation drives joint damage.
Boswellia
Boswellia serrata contains boswellic acids that inhibit 5-lipoxygenase, an enzyme driving leukotriene production in joint tissue. This pathway differs from those targeted by NSAIDs and curcumin, making boswellia a useful addition rather than a replacement. Studies suggest measurable benefit within four to eight weeks of consistent use.
What the Research Shows About Each Supplement
The evidence for joint supplements is uneven, some have large, rigorous trials; others have only small pilot studies. Here's how each one holds up.
Glucosamine sulfate: head-to-head trial data against celecoxib
The MOVES trial (n=606) found glucosamine plus chondroitin produced a 50.1% decrease in WOMAC pain scores, versus 50.2% for celecoxib (p=0.92), a non-inferiority result. Meta-analyses show a more mixed picture: a 2018 meta-analysis of 30 RCTs found chondroitin alleviated pain versus placebo, but the combination's superiority over placebo for pain was not consistent across studies. A 2022 meta-analysis of 8 trials found the combination improved WOMAC composite scores but did not reach significance on VAS pain, likely because it pooled hydrochloride and sulfate glucosamine studies together. Form matters more than ingredient name.
Chondroitin: better at slowing progression than relieving pain
MRI studies tracking cartilage volume over 12 months suggest chondroitin sulfate may slow the rate of cartilage loss in knee osteoarthritis, particularly in moderate disease. Evidence for direct pain relief is weaker, some trials show modest WOMAC improvement, others show no difference from placebo. Think of chondroitin as a structure-preserving supplement rather than an analgesic.
MSM: consistent short-term benefit
A pilot RCT of 50 adults with knee osteoarthritis found MSM at 6 g/day (3 g twice daily) significantly reduced pain and improved physical function scores after 12 weeks versus placebo. A subsequent RCT using approximately 3.4 g/day found modest improvements in physical function, though pain and stiffness scores did not reach statistical significance. The evidence base is smaller than for glucosamine, and effect sizes are generally modest. Data beyond 12 weeks are lacking.
Curcumin: head-to-head trial data against NSAIDs
A meta-analysis of 6 RCTs in rheumatoid arthritis found curcumin significantly lowered disease activity scores, reduced CRP and ESR, and decreased tender and swollen joint counts. In osteoarthritis, a 2021 meta-analysis of 11 RCTs found curcumin performed comparably or better than NSAIDs for pain reduction, but only when researchers used enhanced-absorption formulations. This is where most people fail with turmeric supplements.
Omega-3s: strongest trial evidence in rheumatoid arthritis
A meta-analysis of 10 RCTs found omega-3 PUFAs at 2.7 grams or more daily significantly reduced NSAID consumption in rheumatoid arthritis; trends toward reduced tender joint count were consistent across trials but did not reach statistical significance. A more recent meta-analysis of 23 RCTs found only modest effects on pain and inflammation, noting most of the evidence was low-to-very-low quality. For osteoarthritis, evidence is more limited, studies in older adults show reduced pain, but data are less robust. Consistent daily dosing for at least 12 weeks is necessary before assessing response.
Boswellia: consistent across randomized trials
A meta-analysis of 7 RCTs in 545 patients found boswellia was associated with reduced pain and stiffness and improved joint function in people with osteoarthritis. Benefits appear after at least four weeks of consistent use. Most individual studies are small and short-term, but findings are consistent across trials, which may indicate genuine effect rather than statistical noise.
Dose, Timing, and Formulation: What Changes Results
The doses below reflect amounts used in published clinical trials, not personal recommendations. Consult a healthcare provider before starting any supplement regimen, particularly if you take medications or have an underlying health condition.
Glucosamine: sulfate, not hydrochloride
Use crystalline glucosamine sulfate at 1,500 mg as a single daily dose. The GUIDE trial (n=318, 6 months) demonstrated symptom relief versus placebo using this prescription crystalline form; two separate long-term RCTs, Reginster et al. (Lancet, 2001) and Pavelka et al. (2002), each running three years, found both sustained symptom relief and slowed joint space narrowing on x-ray with the same glucosamine sulfate form. Glucosamine hydrochloride shows less consistent results, particularly for structural outcomes, and most negative trials have used this form. Most mass-market products use hydrochloride to cut costs. Check the Supplement Facts panel for the salt form, the label won't always make it obvious.
Chondroitin: pharmaceutical-grade matters
The effective dose is 800 to 1,200 mg daily, typically split into two doses. Pharmaceutical-grade chondroitin shows more consistent results than over-the-counter versions, which often use lower-purity material. Taking chondroitin with food may improve absorption. The strongest RCTs have combined chondroitin with glucosamine, the MOVES trial tested this pairing, though it used glucosamine hydrochloride; trials using crystalline glucosamine sulfate alongside chondroitin show the most consistent structural benefits.
MSM: dose range matters, split across the day
Clinical trials have used doses ranging from approximately 3.4 to 6 grams daily, split across two or three doses. The higher end of this range (6 g/day) produced the clearest pain reduction in the largest pilot trial; a trial using 3.4 g/day found functional improvement but not statistically significant pain relief. MSM is water-soluble and absorbs quickly, so timing relative to meals doesn't matter. Most trials lasted 12 weeks, and it's unclear whether benefits persist with longer use or return after stopping.
Curcumin: bioavailability is everything
Standard curcumin powder is poorly absorbed, most reaches the colon without entering circulation. Effective formulations include curcumin with piperine (black pepper extract), phospholipid-bound curcumin (phytosome form), or nanoparticle curcumin. A 1998 pharmacokinetic study found 20 mg of piperine increased curcumin bioavailability approximately 20-fold, though the human arm of this study enrolled only three volunteers, and the finding awaits larger-scale replication. The effective dose of enhanced curcumin is 500 to 1,000 mg daily. Take it with a meal containing fat, curcumin is fat-soluble.
Fish oil: EPA+DHA content, not total oil
Trials showing rheumatoid arthritis benefit used at least 2.7 grams of combined EPA and DHA daily, not total fish oil. Many products list total oil rather than EPA/DHA content, obscuring the active dose. Read labels carefully. Consistent daily use for 12 or more weeks is necessary before assessing response.
Combination products and broader joint support
Many people take glucosamine, chondroitin, and MSM together. The MOVES trial confirmed the glucosamine-chondroitin combination works as well as celecoxib, whether adding MSM improves results further remains unclear. For broader connective tissue support, collagen peptides and products like Ligament Restore take a wider approach to connective tissue health beyond cartilage alone, though the research base is less mature than for glucosamine or curcumin.
Why Response Varies by Person
Baseline cartilage damage determines who benefits most from glucosamine and chondroitin. People with mild to moderate osteoarthritis tend to respond better than those with severe cartilage loss, these supplements support remaining tissue, not destroyed tissue. If your joint space is already bone-on-bone, structural supplements have little to work with.
Inflammatory phenotype shapes response to curcumin and omega-3s. People with elevated baseline CRP or ESR may respond better to anti-inflammatory supplements. People with rheumatoid arthritis, a systemic autoimmune condition, may see a more pronounced benefit from fish oil than people with osteoarthritis, whose inflammation is more localized and mechanical.
- Gut absorption varies widely. Glucosamine bioavailability ranges from roughly 12 to 44% depending on gut transit time, stomach acid, and intestinal health. Curcumin absorption is even more variable, enhanced formulations help considerably, but individual response still differs.
- Medication interactions shape outcomes. NSAIDs and glucosamine may overlap mechanistically, reducing apparent benefit from adding glucosamine. Curcumin and omega-3s have mild blood-thinning effects, use caution alongside warfarin or other anticoagulants.
- Metabolic health influences baseline inflammation. Insulin resistance and metabolic syndrome elevate systemic inflammation, which can blunt the effects of anti-inflammatory supplements or require higher doses to show meaningful change.
- Arthritis type changes what you need. Glucosamine and chondroitin address local cartilage mechanics. Fish oil and curcumin target systemic inflammation. Using the wrong category for your arthritis type produces disappointing results.
What Supplements Are Good for Joints: Tracking What Works
Supplementing without testing is guessing. Knowing your inflammatory baseline before you start, and retesting after 12 weeks, turns self-experimentation into actual data. Here's what to measure.
Inflammatory markers
High-sensitivity CRP and ESR may decrease if curcumin or fish oil is having an effect. These markers won't shift much with glucosamine or chondroitin, which act locally in joints rather than systemically. A drop in hs-CRP after 12 weeks of supplementation is meaningful evidence of effect, even if both values fall within the standard "normal" range. The key inflammation and recovery biomarkers tell you whether your anti-inflammatory supplements are hitting their target.
Uric acid
If you have sudden-onset, excruciating joint pain, especially in the big toe or ankle, check uric acid before spending money on glucosamine. Gout is a form of joint pain that won't respond to cartilage supplements at all. Optimal uric acid levels sit narrower than standard lab references suggest, and gout requires a completely different intervention.
Kidney and liver function
Some arthritis supplements clear through the kidneys, impaired kidney function may require dose adjustments. High-dose curcumin or boswellia can affect liver metabolism in some people over time. It's worth monitoring liver enzymes if you take either at therapeutic doses consistently. Subclinical elevations can appear well before standard "abnormal" flags trigger on a lab report.
Choosing and adjusting based on your data
Your inflammatory and metabolic baseline helps you decide what supplements are good for your specific joints, not just what worked on average in a clinical trial. Elevated CRP points toward curcumin and fish oil. Normal CRP with structural joint symptoms points toward glucosamine and chondroitin. Retesting after 12 weeks tells you whether to continue, adjust dose, or switch approaches. The full list of biomarkers relevant to joint health shows what to track and what ranges to target.
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