National Institute of Arthritis and Musculoskeletal and Skin Diseases
How Is Osteoarthritis Treated? continued...
NSAIDs (nonsteroidal anti-inflammatory drugs):
A large class of medications useful against both pain and inflammation, NSAIDs
are staples in arthritis treatment. A number of NSAIDs – ibuprofen (Advil,
Motrin), naproxen sodium (Aleve) and ketoprofen (Orudis, Oruvail) – are
available over the counter. More than a dozen others, including a subclass of
NSAIDs called COX-2 inhibitors, are available only with a prescription.
All NSAIDs work similarly: by blocking substances called
prostaglandins that contribute to inflammation and pain. However, each NSAID is
a different chemical, and each has a slightly different effect on the
1 Brand names included in this booklet are provided as
examples only, and their inclusion does not mean that these products are
endorsed by the National Institutes of Health or any other Government agency.
Also, if a particular brand name is not mentioned, this does not mean or imply
that the product is unsatisfactory.
2 Warning: NSAIDs can cause stomach irritation or, less
often, they can affect kidney function. The longer a person uses NSAIDs, the
more likely he or she is to have side effects, ranging from mild to serious.
Many other drugs cannot be taken when a patient is being treated with NSAIDs
because NSAIDs alter the way the body uses or eliminates these other drugs.
Check with your health-care provider or pharmacist before you take NSAIDs.
Also, NSAIDs sometimes are associated with serious gastrointestinal problems,
including ulcers, bleeding, and perforation of the stomach or intestine. People
over age 65 and those with any history of ulcers or gastrointestinal bleeding
should use NSAIDs with caution.
The U.S Food and Drug Administration has warned that long-term
use of NSAIDs, or use by people who have heart disease, may increase the chance
of a heart attack or stroke. So it’s important to work with your doctor to
choose the one that’s safest and most effective for you. Side effects can also
include stomach upset and stomach ulcers, heartburn, diarrhea, and fluid
retention. For unknown reasons, some people seem to respond better to one NSAID
Other medications: Doctors may prescribe
several other medicines for osteoarthritis. They include the following:
Topical pain-relieving creams, rubs, and
sprays: These products, which are applied directly to the skin over
painful joints, contain ingredients that work in one of three different ways:
by stimulating the nerve endings to distract the brain’s attention from the
joint pain; by depleting the amount of a neurotransmitter called substance P
that sends pain messages to the brain; or by blocking chemicals called
prostaglandins that cause pain and inflammation. Examples of topical
medications are Zostrix, Icy Hot, Therapeutic Mineral Ice, Aspercreme, and Ben
Tramadol (Ultram): A prescription
pain reliever that is sometimes prescribed when over-the-counter medications
don’t provide sufficient relief. It carries risks that don’t exist with
acetaminophen and NSAIDs, including the potential for addiction.
Mild narcotic painkillers:
Medications containing narcotic analgesics such as codeine or hydrocodone are
often effective against osteoarthritis pain. But because of concerns about the
potential for physical and psychological dependence on these drugs, doctors
generally reserve them for short-term use.
Corticosteroids: Corticosteroids are
powerful antiinflammatory hormones made naturally in the body or man-made for
use as medicine. They may be injected into the affected joints to temporarily
relieve pain. This is a short-term measure, generally not recommended for more
than two to four treatments per year. Oral corticosteroids are not routinely
used to treat osteoarthritis. They are occasionally used for inflammatory
Hyaluronic acid substitutes:
Sometimes called viscosupplements, these products are designed to replace a
normal component of the joint involved in joint lubrication and nutrition.
Depending on the particular product your doctor prescribes, it will be given in
a series of three to five injections. These products are approved only for
osteoarthritis of the knee.