Understanding Your Osteoarthritis Medication

Osteoarthritis treatments aim to relieve pain and reduce stiffness.

Osteoarthritis (OA), also called degenerative joint disease, most often affects weight-bearing joints such as the knees and hips. It also can affect the hands and spine. OA usually appears after age 45, in both men and women, according to the U.S. Food and Drug Administration. Joint trauma, obesity and repetitive joint use also can bring on OA.

Treatment includes exercise; heat or cold; not overworking the joint; weight loss, if needed; and medication.

The medication your health care provider recommends depends on the severity of your OA, your health risks, your age and your health history, says Scott Zashin, M.D., a clinical professor of medicine at the University of Texas Southwestern Medical School in Dallas.

Here is information about specific kinds of medication for osteoarthritis.

Pain relievers

Over-the-counter (OTC) pain relievers, or analgesics, are often the first medication prescribed for people with OA.

“Because of its low cost, effectiveness and safety, rheumatologists recommend acetaminophen as a first-line option against osteoarthritis pain,” says Dr. Zashin. “This drug has a high benefit-to-risk ratio and is safe for people who are unable -- due to allergies or stomach problems, for example -- to take anti-inflammatory drugs.”

Acetaminophen does not reduce inflammation, however, and it can have serious side effects if taken in too large a dose or if a person drinks too much alcohol.

For severe pain, doctors sometimes prescribe codeine or hydrocodone.

NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) relieve both pain and inflammation and are widely recommended for people with OA. A common side effect of NSAIDs is stomach irritation, which can often be reduced by changing the dosage or medication.

“Doctors usually start by having people take low doses of OTC medications,” says Dr. Zashin. “If that doesn’t provide relief, they might be prescribed a prescription-strength medication.”

NSAIDs fall into two categories:

1. Traditional NSAIDs, including aspirin and ibuprofen, make up the largest group of drugs in this class and are available OTC and by prescription. They can have serious side effects such as easy bruising and nosebleeds if taken in high doses or with some other medications. Check with your health care provider if you take these medications frequently or at higher doses.

2. COX-2 inhibitors are available by prescription. They help reduce pain and inflammation but are safer for the stomach than NSAIDs. After the recall of the COX-2 inhibitors Vioxx and Bextra, studies of other NSAIDs have been conducted. The studies found an increased risk for cardiovascular problems among certain people. If you’ve been taking a COX-2 inhibitor, check with your doctor to determine the safest drugs for you.

Other treatments

OA also can be treated with surgery, steroid injections, preparations injected into the knee that mimic hyaluronic acid, a naturally occurring body substance that lubricates the knee joint.

Transcutaneous electrical nerve stimulation (TENS) can help with pain relief. TENS blocks pain messages to the brain by directing mild electric pulses to nerve endings that are associated with the painful joint.

“Some people find relief from alternative treatments, such as taking glucosamine and chondroitin, and from acupuncture treatments,” says Dr. Zashin. “The key is to work with your doctor to find the most effective pain relief that controls your pain but doesn’t increase your risk factors for heart or stomach problems.”