What medications are used to treat osteoarthritis?

From the Guidelines

Medications for osteoarthritis should be individualized, starting with acetaminophen or topical nonsteroidal anti-inflammatory drugs (NSAIDs) for mild pain, and considering oral NSAIDs, duloxetine, or intra-articular corticosteroid injections for moderate to severe pain, as recommended by the most recent guidelines 1.

Treatment Options

• For mild pain, acetaminophen is often recommended first at doses up to 3000 mg daily divided into 3-4 doses.
• Topical options include diclofenac gel (apply to affected joint 4 times daily) or capsaicin cream (apply 3-4 times daily).
• Oral NSAIDs like ibuprofen (400-800 mg three times daily), naproxen (220-500 mg twice daily), or celecoxib (100-200 mg daily) can help reduce both pain and inflammation.
• Duloxetine (60 mg daily) may help with chronic pain.
• Intra-articular corticosteroid injections can provide temporary relief for 1-3 months.

Key Considerations

• Treatment should be individualized based on pain severity, other medical conditions, and potential side effects.
• The lowest effective dose should be used for the shortest duration necessary to control symptoms.
• Opioids, including tramadol, are not recommended due to limited benefit and high risk of adverse effects 1.
• Non-pharmacological interventions, such as exercise, weight loss, and self-efficacy programs, should also be considered as part of a comprehensive treatment plan 1.

From the FDA Drug Label

NSAID medicines are used to treat pain and redness, swelling, and heat (inflammation) from medical conditions such as: different types of arthritis NSAID medicines that need a prescription Generic Name Trade Name Celecoxib Celebrex® Diclofenac Cataflam®, Voltaren®, ArthrotecTM (combined with misoprostol) Diflunisal Dolobid® Etodolac Lodine®, Lodine® XL Fenoprofen Nalfon®, Nalfon® 200 Flurbiprofen Ansaid® Ibuprofen Motrin®, Tab-Profen®, Vicoprofen®* (combined with hydrocodone), CombunoxTM (combined with oxycodone) Indomethacin Indocin®, Indocin® SR, Indo-LemmonTM, IndomethaganTM Ketoprofen Oruvail® Ketorolac Toradol® Mefenamic Acid Ponstel® Meloxicam Mobic® Nabumetone Relafen® Naproxen Naprosyn®, Anaprox®, Anaprox® DS, EC-Naproxyn®, Naprelan®, Naprapac® (copackaged with lansoprazole) Oxaprozin Daypro® Piroxicam Feldene® Sulindac Clinoril® Tolmetin Tolectin®, Tolectin® DS, Tolectin® 600

Medications for Osteoarthritis include:

• NSAIDs: such as naproxen, ibuprofen, and celecoxib
• Examples of NSAIDs:
  • Celecoxib (Celebrex®)
  • Diclofenac (Cataflam®, Voltaren®, ArthrotecTM)
  • Ibuprofen (Motrin®, Tab-Profen®, Vicoprofen®)
  • Naproxen (Naprosyn®, Anaprox®, Anaprox® DS, EC-Naproxyn®, Naprelan®, Naprapac®) 2

From the Research

Medications for Osteoarthritis

• The primary objective of osteoarthritis (OA) treatment is to manage pain and improve the patient's quality of life, as there is no known cure for the disease 3.
• Nonpharmacologic measures, such as patient education, weight loss, physical therapy, and exercise, should be tried first, with pharmacologic intervention used as an adjunct 3.
• Paracetamol (acetaminophen) is the first-line drug of choice for managing OA pain, with a recommended dose of up to 4000 mg/day 3, 4.
• If paracetamol is ineffective, nonsteroidal anti-inflammatory drugs (NSAIDs) may be used as an alternative, but with caution due to their potential gastrointestinal toxicity 3, 5, 6.
• Topical NSAIDs can be recommended for patients with mild OA, while oral NSAIDs are suggested for those with moderate to severe OA at the lowest effective dose for the shortest possible duration 5.
• Other treatment options, such as duloxetine, metamizole, and symptomatic slow-acting drugs, may be considered, but their evidence is uncertain 5.
• Intraarticular injections with glucocorticoids can provide short-term pain relief for patients with severe OA-related pain 5.
• The choice of medication should take into account the patient's comorbidities, potential side effects, and the need for nonpharmacologic therapies 3, 5, 6.

Comparison of Medications

• Acetaminophen is less effective than NSAIDs in reducing pain, but has a similar safety profile 6.
• NSAIDs are more effective than acetaminophen in improving knee and hip pain in patients with OA, but may have more gastrointestinal side effects 6, 7.
• Patients may prefer NSAIDs over acetaminophen due to their perceived effectiveness, but may also experience more toxicity and discontinuation of treatment 7.