Mild pain relievers (oral analgesics). The stiffness and pain of osteoarthritis are often relieved by an over-the-counter pain reliever, such as acetaminophen (Tylenol). Because acetaminophen is considered safe and potentially effective, most health-care providers suggest that treatment begin with this drug.
Anti-inflammatory drugs and other pain relievers. If an over-the-counter pain reliever fails to relieve your symptoms, your health-care provider may suggest a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin and others) or naproxen (Aleve, Naprosyn and others). You should only use NSAIDs, especially if you use them regularly, under the supervision of your health-care provider. Do not combine them with other drugs without talking with your health-care provider first. Stomach problems, including ulcers, are the most common side effects. A newer NSAID, the cyclooxygenase-2 (COX-2) inhibitors (celecoxib), may be safer for people who are at risk of stomach ulcers, such as those who have had ulcers in the past and the elderly.
Stronger pain medications, such as tramadol or even narcotics such as codeine, are sometimes suggested if over-the-counter pain relievers and NSAIDs fail to relieve osteoarthritic symptoms.
Topical pain relievers (topical analgesics). Topical pain relievers can be applied to the skin over the affected joint as an alternative to, or in addition to, oral pain relievers. Topical pain relievers include methyl salicylate, diclofenac and capsaicin cream. Capsaicin, a substance obtained from hot chilies, may cause mild skin irritation or a burning sensation when applied to the skin.
Corticosteroid injections. When osteoarthritis is accompanied by inflammation, as indicated by warmth and an accumulation of fluid in the joint, your health-care provider may recommend that some joint fluid be removed. After fluid is removed, a corticosteroid drug can be injected into the joint. This procedure usually has short-term effects and is used almost exclusively for acute (sudden) and severe symptoms, especially for osteoarthritis of the knee.
It is important to recognize that overuse of this procedure has risks, including an increased risk of infection, thinning of the skin and tendon rupture. Because of these potential dangers, your health-care provider will recommend this treatment infrequently (perhaps two or three times a year) — and only when absolutely necessary.
Dietary supplements. The dietary supplements glucosamine sulfate and chondroitin sulfate are over-the-counter agents currently under investigation for the treatment of osteoarthritis. Recent research suggests that glucosamine may safely provide modest pain relief for people with osteoarthritis in the knee. A well-designed study published in 2008 found that neither glucosamine nor chondroitin slowed the progression of osteoarthritis.
Hyaluronate. Hyaluronate is a newer treatment for osteoarthritis that may provide mild relief of symptoms in some people. This chemical ordinarily provides the joint with lubrication and nutrition. Synthesized forms can be injected directly into an osteoarthritic knee; it is not clear whether repeated courses are effective. Some health care providers do not believe the modest benefits are worth the risk and discomfort of the injections, and some experts believe that these injections are of no benefit at all.