Aging & Health A to Z
Care & Treatment
Medicines for Pain and Inflammation
The following are the most commonly used medications for osteoarthritis:
This is an effective medication and available over-the-counter (Tylenol). In older people, the maximum dosage is lower than for younger people, and overdoses are not uncommon, resulting in liver damage. Follow your healthcare provider’s instructions carefully.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are used for pain relief and to reduce swelling and inflammation (some are by prescription only). NSAIDs include:
- Ibuprofen (Advil, Motrin, and others)
- Ketoprofen (Orudis)
- Naproxen (Aleve)
NSAIDs can be used for 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 medicines can be very helpful, they can have serious side effects that are more common as you get older.
If you are taking aspirin or an NSAID type of pain medication, make sure to follow your healthcare provider’s instructions exactly.
Your provider should monitor you carefully for any signs of bleeding or kidney abnormalities. Use buffered aspirin, and take it with food. If you have a history of ulcers or need this medication for more than a few days, discuss with your provider whether you also need another medication to protect your stomach.
Narcotic pain relievers (opioids)
Opioids are prescription drugs that contain controlled substances like codeine, hydrocodone, or morphine. There is a danger of addiction with these medications, so they are usually prescribed very carefully, and using the lowest effective dose you can get by with.
Steroids are used to reduce pain, inflammation, and joint damage. Commonly used steroids are prednisone and methylprednisone (Medrol). They may be taken as pills, although this is rare for most types of arthritis. More commonly, they are given by injection into the affected joint.
However, serious side effects such as bone thinning (osteoporosis), cataracts, and weight gain may occur with steroid use. 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 products that are injected into knee joints to help lubricate and protect the bone, but these have not been shown to be more effective than placebo (no medicine at all).
Creams or sprays
These are pain-relieving products that have various ingredients that soothe or distract the nerves. Applying an analgesic balm, capsaicin, or topical NSAID can be helpful for hand or knee osteoarthritis.
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. These types of medicines are known as:
DMARDs (disease-modifying antirheumatic drugs)
DMARDS can reduce joint damage by slowing down the disease. Your healthcare team must monitor you regularly for side 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)
Methotrexate is well tolerated, but older adults may require a lower dose and should also take folic acid supplements daily.
These drugs work by slowing down your immune system. Your doctor will find a delicate balance between reducing damage to your joints while 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 one of your immune system’s molecules 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 limited, so their use is generally reserved for patients for whom conventional triple therapy with oral DMARDs has not been effective. The agents are given by subcutaneous injection or infusion. Some examples of TNF-alpha inhibitors are:
- etanercept (Enbrel)
- adalimumab (Humira)
- infliximab (Remicade)
- Other drugs have been developed that can slow down different components of your malfunctioning immune system. Some examples of these drugs are:
- anakinra (Kineret)
- rituximab (Rituxan)
- abatacept (Orencia)
If your healthcare provider feels that exercise and medications have not adequately controlled your symptoms, he or she may suggest surgery to 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. For example, recent studies question whether arthroscopy helps patients with knee pain.
If the joint damage is severe, your healthcare professional 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 to reduce pain
- Tendon repair, if your 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 physiotherapy and occupational therapy, and learn to care for yourself once you return home.
Once you know your diagnosis, your healthcare provider will schedule regular appointments depending on the seriousness of your condition. This is especially important if you have been diagnosed with rheumatoid arthritis, since a specialist is often needed to manage the disease and medications. For some of the drugs, you may need regular monitoring with blood tests.
Updated: November 2016
Posted: March 2012