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Medications, injections, and supplements for arthritis

Introduction

The pain, swelling, and stiffness of arthritis can limit your movement. Medicines can help manage your symptoms so that you can continue to lead an active life. Talk to your doctor about medicines that are right for you.

Over-the-counter pain relievers

Over-the-counter pain relievers can help with your arthritis symptoms. "Over-the-counter" means you can buy these medicines without a prescription.

Most doctors recommend acetaminophen (such as Tylenol) first. It has fewer side effects than other drugs. Do not take more than 43 grams (43,000 mg) a day.

If your pain continues, your doctor may suggest non-steroidal anti-inflammatory drugs (NSAIDs). Types of NSAIDs include aspirin, ibuprofen, and naproxen.

Taking acetaminophen or another pain pill before exercising is OK. But do not overdo the exercise because you have taken medicine.

Both NSAIDs and acetaminophen in high doses, or taken for a long time, can cause serious side effects. If you are taking pain relievers on most days, tell your doctor. You may need to be watched for side effects. Your doctor may want to monitor you with certain blood tests.

Capsaicin (Zostrix) is a skin cream that may help relieve pain. You may feel a warm, stinging sensation when you first apply the cream. This sensation goes away after a few days of use. Pain relief usually begins within 1 to 2 weeks.

NSAIDs in the form of skin cream are available over-the-counter or by prescription. Ask your doctor if these might be right for you.

Steroid shots for arthritis

Medicine called corticosteroids can be injected into the joint to help with swelling and pain. Relief only lasts for a short time. More than two or three shots a year may be a harmful. These shots are usually done at your doctor's office.

When the pain seems to go away after these injections, it may be tempting to go back to activities that may have caused your pain. When you receive these injections, ask your doctor or physical therapist to give you exercises and stretches that will decrease the chance of your pain returning.

Other shots for knee arthritis

Hyaluronic acid is a substance already in the fluid of your knee. It helps lubricate the joint. When you have arthritis, the hyaluronic acid in your joint becomes thinner and less effective.

Your doctor can inject a form of hyaluronic acid into your joint to help lubricate and protect it. This is sometimes called artificial joint fluid, or visco supplementation.

These injections cannot help everyone. If they do help, relief may last 3 to 6 months. Hyaluronic acid use is approved only for knee arthritis.

Supplements

The body naturally makes both glucosamine and chondroitin sulfate. They are important for healthy cartilage in your joints. These two substances come in supplement form and can be bought over-the-counter.

Glucosamine and chondroitin sulfate supplements may help control pain. But they do not seem to help the joint grow new cartilage or keep arthritis from getting worse. Some doctors recommend a trial period of 3 months to see whether glucosamine and chondroitin help.

S-adenosylmethionine (SAMe, pronounced "sammy") is a man-made form of a natural chemical in the body. Claims that SAMe can help arthritis are not well proven.

References

Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet. 2011 Jun 18;377(9783):2115-26.

Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology: 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;4:465-474.

Lane NE, Schnitzer TJ. Osteoarthritis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 270.

Updated: 8/12/2013

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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