Arthritis

Care & Treatment

Medications for Pain and Inflammation Commonly Used for Osteoarthritis

Acetaminophen

Acetaminophen is also called Tylenol®. It is an effective and safe medication that is available over-the-counter. The maximum dosage is lower for older people than it is for younger people, 3g per day. Therefore, it is important to follow your healthcare provider’s instructions carefully so you don’t take too much, which can result in liver damage.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are used for pain relief and to reduce swelling and inflammation. Some NSAIDs are by prescription only. NSAIDs include:

  • Aspirin
  • Ibuprofen (Advil, Motrin, and others)
  • Ketoprofen (Orudis)
  • Naproxen (Aleve)

NSAIDs can be used to treat a flare-up of osteoarthritis, but they should be used at the lowest effective dose and for as brief a time as possible. Although these medications can be very helpful, they can have serious side effects that are more common as you get older. They should not be taken daily for a prolonged period of time (most providers recommend no more than five days in a row).

If you are taking an NSAID, make sure to follow your healthcare provider’s instructions exactly.

 

Your provider should monitor you carefully for any signs of bleeding or kidney abnormalities. If you take aspirin, use the buffered kind, and take it with food. If you have a history of ulcers or need NSAIDs for more than a few days, discuss with your provider whether you also need another medication to protect your stomach.

Opioid pain relievers

Opioids are prescription drugs that contain controlled substances like codeine, hydrocodone, or morphine. These medications can cause people to feel sleepy or, if taken in doses that are too high, cause breathing to slow to dangerous levels. They are usually prescribed very carefully with slow increases in dosing to find the lowest effective dose. These medications may be used for short periods, but the risks of dependence and adverse effects mean that they are never a first choice treatment for arthritis pain.

Steroids

Steroids, such as prednisone and methylprednisolone (Medrol) are used to reduce pain, inflammation, and joint damage. Most commonly, they are given by injection into the affected joint. They are sometimes taken as pills, but this is rare for most types of arthritis.

However, serious side effects may occur with steroid use, such as bone thinning (osteoporosis), cataracts, and weight gain. Therefore, long-term use is usually avoided, and injections are usually done no more than three or four times per year to minimize side effects.

Hyaluronic Acid-type preparations

These are preparations that are injected into knee joints to help lubricate and protect the bone. However, evidence from medical studies showing how well these injections work is not very strong. 

Creams or sprays

These are pain-relieving products that have various ingredients that soothe or distract the nerves that cause pain. Analgesic balms, capsaicin, or topical NSAIDs can be helpful for hand or knee osteoarthritis.

Additional Types of Drugs for Rheumatoid Arthritis

Patients with rheumatoid arthritis may take some of the medications mentioned above. Additional types of drugs are also used to control the malfunctioning immune system and minimize the resulting damage to joints. Although these drugs are often very helpful, they must be used carefully, and your healthcare provider has to monitor your progress closely. 

DMARDs (Disease-Modifying Antirheumatic Drugs)

DMARDs can reduce joint damage by slowing down the disease. During the time you take them, your healthcare team must monitor you regularly for adverse effects such as liver damage or lung infections. One or more of these drugs may be prescribed at the same time. They include drugs like:

  • methotrexate (Rheumatrex, Trexall)
  • leflunomide (Arava)
  • hydroxychloroquine (Plaquenil)
  • sulfasalazine (Azulfidine)
  • minocycline (Dynacin, Minocin)

When taking methotrexate, older adults may require a lower dose and should also take folic acid supplements daily.

Immunosuppressants

These drugs work by slowing down your immune system. Your healthcare provider will try to find a delicate balance between reducing damage to your joints while still keeping your immune system healthy enough to fight off infections. Careful monitoring is key. Immunosuppressants include:

  • azathioprine (Imuran, Azasan)
  • cyclophosphamide (Cytoxan)
  • cyclosporine (Neoral, Sandimmune, Gengraf)

TNF-alpha Inhibitors (tumor necrosis factor-alpha inhibitors)

TNF-alpha is a molecule in your immune system that contributes to swelling and inflammation in your joints. TNF-alpha inhibitors help reduce pain, tenderness, and swelling. Experience with these agents in older adults is more limited than experience with DMARDs or immunosuppressants. Therefore, their use is generally reserved for patients who have already received other medications, but whose treatment was not effective. The agents are given by injection under the skin or in a vein. Some examples of TNF-alpha inhibitors are:

  • etanercept (Enbrel)
  • adalimumab (Humira)
  • infliximab (Remicade)
  • golimumab (Simponi)
  • certolizumab (Cimzia)

Uric Acid Lowering Medications

If you have frequent gout flares, your healthcare provider may suggest a medicine to lower the level of uric acid in your body. This lower level of uric acid helps prevent it from building up in the joints and causing pain. These medicines include:

  • allopurinol
  • febuxostat (Uloric)
  • probenecid

Other drugs

Other drugs have been developed that can work on different components of your malfunctioning immune system. Some examples of these drugs are:

  • anakinra (Kineret)
  • rituximab (Rituxan)
  • abatacept (Orencia)
  • tocilizumab (Actemra)
  • tofacitinib (Xeljanz)

Non-Medication treatments

Surgery

If your healthcare provider feels that exercise and medications have not controlled your symptoms well enough, they may suggest surgery. Surgeries for arthritis can clear debris out of the joint (arthroscopy), reposition the bones, or smooth out the surfaces of the affected structures. Not all surgeries help all joints. 

If the joint damage is severe and impacting your ability to do daily activities, your healthcare provider may suggest a joint replacement.

For patients with rheumatoid arthritis, specialized surgeries may be considered to help you regain use of a damaged joint. These include:

  • Joint fusion, for stabilizing the joint and reducing pain
  • Tendon repair, if the disease has severely damaged tendons in the joint
  • Removal of the lining of the joint

After surgery, you will probably need a few weeks of rehabilitation, which may require moving to a specialized short-term residence. Here you will get physical and occupational therapy, and learn to care for yourself once you return home.

Monitoring

Once you know your diagnosis, your healthcare provider will work with you to figure out how often you should be seen in the office. This is especially important if you have been diagnosed with rheumatoid arthritis since a specialist is recommended to monitor the disease and medications closely. For some of the medications, you may need regular monitoring with blood tests.

 

Last Updated August 2020