Medicines, injections, and supplements for arthritis
Arthritis - medications; Arthritis - steroid injections; Arthritis - supplements; Arthritis - hyaluronic acid
Arthritis, inflammation of one or more joints, is the most common cause of disability in the United States, limiting the activities of millions of adults. So, what causes arthritis? Cartilage, which is the tough but flexible tissue that covers the ends of your bones, normally protects and cushions a joint, allowing it to move smoothly. When this covering starts to break down, your bones rub together, causing pain, swelling, and stiffness. This is arthritis. Joint inflammation may result from an autoimmune disease like rheumatoid arthritis, which is when your immune system mistakenly attacks health tissue, or a broken bone, or general wear and tear on joints from osteoarthritis, or an infection from bacteria or a virus. If you have arthritis, you'll probably know it before you see your doctor. You may have joint pain, joint swelling, a reduced ability to move your joint, redness of the skin around your joint, and stiffness, especially in the morning. So, what do you do about arthritis? Your doctor will give you a physical exam and ask questions about your symptoms. Your doctor might find that you have fluid around a joint, warm, red, tender joints, and trouble moving your joints. You may have blood tests and x-rays to check for infection or other arthritis causes. Your doctor may take a sample of joint fluid with a needle and send it to a lab for examination. Once your doctor confirms that you have arthritis, your treatment will focus on reducing your pain, improving your mobility, and limiting further joint damage. Lifestyle changes are a big part of the treatment for arthritis. Exercise can help relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. Your health care team can help you design an exercise program that is best for you. Physical therapy may also be very helpful. You may use treatments like heat or ice, splints or orthotics to support your joints, water therapy, and even massage. You can take other steps to ease your pain. For example, sleeping 8 to 10 hours a night and taking naps during the day can help you recover from a flare-up more quickly, and may even help prevent them. Avoid staying in one position for too long, and avoid positions or movements that place extra stress on your joints. Install grab bars in the shower, tub, and near the toilet, to help you get around easier. Try stress reducing activities, such as meditation, yoga, or tai chi. Get more fruits, vegetables, cold water fish, and nuts into your diet. Weight loss through dieting and exercise can also take pressure off your joints. After lifestyle factors, medicine can help relieve your arthritis pain. If over-the-counter medicines like acetaminophen, ibuprofen, or aspirin are not enough, your doctor may prescribe stronger medicines. Most forms of arthritis are long-term, and life-long, conditions. But if you make lifestyle changes, and work with your health care team to manage your pain, you should be able to move more freely and hopefully feel less pain.
Rheumatoid arthritis is another form of arthritis. The body's own immune system attacks a joint's synovial membrane, which secretes fluid and lines the joint. The synovium becomes inflamed, produces excess fluid, and the cartilage becomes rough and pitted.
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 providers recommend acetaminophen (such as Tylenol) first. It has fewer side effects than other medicines. Do not take more than 3 grams (3,000 milligrams) a day. If you have liver problems, talk to your provider first about how much acetaminophen is right for you.
If your pain continues, your provider 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 provider. You may need to be watched for side effects. Your provider 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 provider 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 can last for months. More than 2 or 3 shots a year may be harmful. These shots are usually done at your provider'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 provider 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 provider can inject a form of hyaluronic acid into your joint to help lubricate and protect it. This is sometimes called artificial joint fluid, or viscosupplementation.
- These injections cannot help everyone and fewer health plans cover these injections.
Platelet rich plasma or PRP injection is a newer treatment. The results have shown it to be safe and perhaps helpful for people with early arthritis. Blood is drawn from your veins and is prepared before being placed back in your joint. It can help reduce pain and inflammation. Talk to your provider before having the injection.
There are other injections such as stem cells or amniotic cells. These treatments are quite new and mostly experimental. Please talk with your provider first before having them.
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 providers 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
Block JA, Malfait AM. Clinical features of osteoarthritis. In: Hochberg MC, Gravallese EM, Smolen JS, van der Heijde D, Weinblatt ME, Weisman MH, eds. Rheumatology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 183.
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 (Hoboken). 2012;64(4):465-474. PMID: 22563589
Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2020;72(2):149-162. PMID: 31908149
Louis ML, Dumonceau RG, Jouve E, et al. Intra-articular injection of autologous microfat and platelet-rich plasma in the treatment of knee osteoarthritis: a double-blind randomized comparative study. Arthroscopy. 2021;37(10):3125-3137. PMID: 33887408
Version Info
Last reviewed on: 8/12/2023
Reviewed by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
