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When arthritis pain first strikes, the over-the-counter painkiller acetaminophen (the ingredient in Tylenol) is sometimes the first drug used for relief. the recommended dose supplied on the bottle, however, it is advisable to check with your doctor before taking pain medication.

Your doctor may recommend that you take another pain remedy such as aspirin, ibuprofen (Motrin or Aleve); these drugs are called nonsteroidal anti-inflammatory drugs or NSAIDS.

NSAIDs can definitely ease the pain and inflammation of osteoarthritis, but they also greatly increase the risks of bleeding ulcers, especially in people over 60. Over 100,000 arthritis sufferers are hospitalized each year for serious stomach trouble caused by NSAIDs, and about 16,500 die.

Now there's another option for those people who cannot tolerate NSAIDS. Drugs known as Cox-2 inhibitors, Celebrex and Bextra, inhibit the action of Cox-2 -- an enzyme involved in the inflammatory process -- but don't inhibit Cox-1, an enzyme that protects the stomach. These new drugs aren't more effective than the older drugs, but they seem to be less likely to cause a stomach ulcer and other gastrointestinal complications, such as nausea.

Another Cox-2 inhibitor, Vioxx, was removed from the market in September 2004 because it increased the risk of heart attack and stroke. So far, there's no evidence that the other two Cox-2 inhibitors cause these problems. Talk to your doctor if you have questions about these drugs.

If you're over 60 or have a history of stomach ulcers, however, talk to your doctor about switching to one of the newer drugs. Also, some people benefit from taking low doses of opiates or morphine-like drugs. These should probably only be used when the pain cannot be relieved by other means.

Besides painkillers, studies are now supporting the use of a supplement called glucosamine. This is probably most effective in the early stages of arthritis, but studies suggest that it helps control pain and decreases progression of some types of arthritis. Chondroitin sulfate may be another supplement with some benefit.

For severe cases, some doctors advocate the use of steroid injections into the joints, but since this may also damage the joint, it should be done sparingly.

Whatever medication you take, it should only be a part of your fight against arthritis. Here are some other things you can do to relieve the pain and improve your mobility.

• Exercise. Your joints may ache, but they aren't calling out for rest. A combination of stretching, weight lifting, and aerobic exercises such as swimming and cycling can give you strength, flexibility, and dramatic relief from pain. Your doctor can help you find an exercise program that gives you maximum benefits with little discomfort. There are even special stretching exercises for the fingers.

• Maintain a healthy weight. If you're overweight, shedding a few pounds can help take strain off of your joints and reduce pain.

• Get plenty of calcium. Studies suggest that weak bones such as with osteoporosis can increase the progression of some forms of osteoarthritis. Doctors recommend about 3 servings of low-fat dairy products per day to get your calcium. But other fortified foods and supplements would be good as well.

• Watch your posture. Good posture can help ease and prevent osteoarthritis pain in your back, hips, and knees.

• Adapt to your condition. If you have arthritis in your fingers, for instance, you may need shoes that fasten with Velcro instead of laces.

• Find a support group. Sharing your experiences with others can deeply rewarding. Support groups are also an excellent place to learn practical tips for coping with arthritis.

Reviewed by Michael W. Smith, MD, April 2002.
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