A Guide To The Prescription Medication Used To Treat Osteoarthritis

Osteoarthritis (OA), also known as degenerative joint disease, is the most common form of arthritis. In fact, research¹ shows that of the 54.4 million U.S. adults that have arthritis, more than half (32.5 million) have been diagnosed with osteoarthritis. The condition can occur in your hips, hands, and knees, and often limits the activities you can do, as well as affect your sleep and mood. In many cases, the pain can even be debilitating.

While osteoarthritis medication will not cure the condition, it can relieve some symptoms and improve your quality of life.

What drugs are prescribed for osteoarthritis?

Drug treatments for osteoarthritis come in three forms: pills, injections, and topicals. Topicals are typically recommended first since they can generate similar results to pill forms of medications with the benefit of fewer side effects. However, they might not work for everyone and might not be as effective in certain types of OA e.g. that which affects the hips.

Nonsteroidal anti-inflammatory drugs (NSAIDs) in particular, are among the most effective drug treatments but can cause problems if self-used in the long term without physician monitoring. Joint injections can also be a very effective form of treatment in certain types of OA, such as of the knee, but pain relief duration is strongly influenced by the location and severity of the condition.

Pills

Oral drug treatments for osteoarthritis often include NSAIDs and acetaminophen (Tylenol). Both types of oral treatment can be obtained over-the-counter (OTC). However, they will be prescribed in higher dosages if your symptoms are not subsiding and you're still having difficulty with everyday activities due to your OA.

NSAIDs

NSAIDs are most commonly recommended for OA treatment because they're more effective than acetaminophen² and don't require you to be sedated for treatment like injections. There are at least eight main types of NSAIDs: mefenamic acid, indomethacin, ibuprofen, naproxen, diclofenac, celecoxib, aspirin, and etoricoxib.

All types are thought to be as effective in treating osteoarthritis, but results vary from person to person. When determining which one is best for you, the safety profile of the medication along with the potential side effects are taken into account.

Milder OA may require topical NSAIDs or OTC NSAIDs before prescription use to reduce risks and side effects associated with the medication. Keep in mind that recommendations will differ according to your physician and the specifics of your condition in particular.

General side effects of NSAIDs may include:

• Headaches

• Dizziness 

• Sleepiness

• Stomach aches, indigestion, heartburn, and nausea 

More serious side effects³:

• Blurred vision

• Shortness of breath

• Difficulty breathing

• Swelling

• Unusual bleeding or bruising

• Fast heartbeat

• Loss of appetite

• Flu-like symptoms

NSAIDS⁴  can also cause stomach ulcers and cardiovascular issues. The FDA has mandated a warning on prescription labels to inform users that NSAIDs can increase risks of cardiovascular thrombotic events, stroke, and heart attacks.

Stomach ulcers, on the other hand, can cause internal bleeding and even death in some cases. Additional medications are sometimes prescribed to reduce the likelihood or severity of this side effect when taking NSAIDs.

Other types of analgesics

There are many other forms of analgesics that are used in the treatment of OA. Although they do not reduce inflammation like NSAIDs, they are known to reduce chronic pain, so they can be a good option for individuals with osteoarthritis.

Common types of analgesics that your physician can prescribe for OA are:

• acetaminophen 

• duloxetine

• opioids like hydrocodone or oxycodone

Opioids are typically prescribed in low doses or not at all due to their addictive nature.

As for duloxetine, it is not explicitly FDA-approved for OA but rather an approved treatment for depression. A physician might consider using it as an off-label treatment option for the management of chronic pain resulting from OA, however, acetaminophen is more likely to be used instead.

Research regarding the effectiveness of acetaminophen treatment for OA is inconclusive; one research study showed that it was more effective than a placebo whilst the other study did not.  However, studies have shown that NSAIDs and injections were more effective than acetaminophen in the management of OA.

For instance, a 2003 study⁵ revealed that acetaminophen had better results than placebo, but NSAIDs were superior. There were also no significant safety differences identified between the two types of medications. On the other hand, studies⁶ have also revealed that acetaminophen is ineffective in the symptomatic treatment of osteoarthritis and have concluded that it should be reconsidered as a treatment.

With a maximum daily dosage of 4,000 milligrams (mg), acetaminophen is usually prescribed for patients who have very little to no other alternatives for treatment, have allergic reactions to NSAIDs, are pregnant or trying to be, or are 65 years old or older (due to higher risks of heart and other problems).

Potential side effects of acetaminophen⁷ can include:

• Dark urine

• Headaches

• Skin or eye yellowing 

• Stomach discomfort or pain

• Rashes and itching

• Nausea 

Topical NSAIDs

NSAIDs also come in topical forms such as liquid, gel, and patches. The purpose and severity of your OA will determine the strength of your topical treatment. While this option does not work for everyone, it can be an excellent replacement for those who can't use oral NSAID medications.

According to a systematic review⁸ of the efficacy of topical solutions in osteoarthritis, researchers concluded that topical treatment was more effective in pain relief than placebos and improved joint function in participants. It also noted that diclofenac patches had the most significant impact on pain relief than any other topical NSAIDs in the study.

The most popular topical options⁹ for OA include:

• Diclofenac sodium 1% gel 

• Diclofenac epolamine 1.3% patch

• Diclofenac sodium 1.5% liquid

• Diclofenac sodium 2% liquid

• Some NSAIDs, like ibuprofen and piroxicam, can be made into a topical treatment 

You should not use topical treatments if you are also taking oral NSAIDs or have multiple joints affected by OA. Taking both types of NSAIDs can cause adverse effects, and oral treatments are much more effective at treating several areas at once (and they're quicker).

Cortisone injections

Injections are a liquid medication option that is injected directly into your body via your joint, muscle, blood, or spine. The effects last longer between the times they are administered compared to alternative medications like pills and topical.

For OA, physicians often prescribe Intraarticular (IA) corticosteroid injections.

Research¹⁰ has shown that cortisone injections are safe and effective, although pain relief is only experienced for a short period of time following the shot. Although rare, the study also revealed side effects such as:

• Infrequent reactive flare-ups within the first six to twelve hours (resolves in one to three days)

• Potential cartilage destruction 

General side effects¹¹ to consider with this treatment include:

• Initial pain and discomfort 

• Infections and swelling

• Bruising 

• Increase blood pressure

• Potentially permanent pale skin and/or dimples around the injection site

This treatment option isn't for everyone but should be considered when discussing treatments with your doctor, especially since effectiveness depends on the specifics of the patient.

According to arthritis specialist Dr. Dane Hansen on Summit Orthopedics¹², "Cortisone shots are used to treat several conditions in joints throughout the body. As a result, factors including the condition treated, the joint affected, and the patient's overall health will have an impact on the effectiveness of the injection. Generally, a cortisone shot can suppress pain for anywhere from six weeks to six months."

How you can work with your doctor to find the best medication for you

There is no cure for OA yet, but there are many ways your doctor can help you improve your quality of life with the diagnosis and managing the severity of your pain. The best medication for treating OA varies from person to person, so it's important that you discuss all your options with your doctor.

Here are three tips for working with your doctor to find the best medication for you. 

Compare risks and benefits of all medication options

All osteoarthritis medications have the potential for general to severe side effects when taken. Comparing the risks and benefits of each as they specifically relate to you is important for making sure you receive the best treatment options available.

For instance, if you have serious heart problems, you may want to consider smaller dosage options of NSAIDs or might even want to consider acetaminophen first to reduce your risks. On the other hand, you may also want to consider which type of medication will benefit you the most. Severe OA in the knee¹³, for example, tends to react more positively to cortisone injections, while a mild case of OA¹⁴ in your wrist may only require oral or topical NSAIDs.

You will also want to consider your own preferences in this discussion. For instance, you may want to try topical solutions before their alternatives if you can't or don't want to take pill-form medications.

Keep track of the medications you use and monitor what works and what doesn't 

It might take some time to determine what treatment is best for you. While your discussion with your doctor may conclude that a specific dosage of ibuprofen will likely be the best option for you, you may notice that is not the case over time. This is common.

If you notice that your pain is not subsiding and, as a result, your quality of life is suffering, talk to your doctor about alternative options. This may include switching doses, NSAIDs, or another medication type altogether. Either way, you'll want to keep notes on what you have taken and how it has performed, so you can continue adjusting your treatment as you and your doctor see fit.

Discuss non-medication options to improve results

Medications shouldn't be your only option for treatment when you have osteoarthritis. There are several changes in your lifestyle that can be made to improve the effectiveness of your medications and reduce the severity of your symptoms.

The following lifestyle changes can make a big difference in your quality of life when diagnosed with OA:

• Exercise — research¹⁵ recommends low-impact aerobic exercises like swimming, biking, and walking if you have OA. This way, you may benefit from the positive effect of exercise on your body by reducing weight gain that impacts the strain on your joints while preventing any further damage. 

• Healthy eating — given that obesity can increase strain on joints (especially in the knees) and studies¹⁶ have also linked higher BMI with hand OA, participating in a healthy and well-balanced diet can make a big difference in treatment results. 

• Supplements — although it may not help with function, research¹⁷ has shown that supplements can make improvements in pain and stiffness when taken. However, results have been inconsistent throughout studies, so more research needs to be done. 

The lowdown

Osteoarthritis is the most common type of arthritis in the United States, affecting more than half of those affected by arthritis. Although OA cannot be cured yet, there are reliable ways for you to manage your symptoms and pain severity. Medication options come in the form of oral, topical, and injection solutions. For OA, medications include:

• Oral NSAIDs like ibuprofen, naproxen, mefenamic acid, indomethacin, diclofenac, celecoxib, aspirin, and etoricoxib.

• Topical NSAIDs in the form of gel, liquid, or patch (i.e., diclofenac sodium, diclofenac epolamine, etc.). 

• Analgesics like acetaminophen, duloxetine, and opioids.

• Intraarticular (IA) corticosteroid injections 

It's important to note that medication results differ from person to person, so you will want to discuss all your options with your doctor. These discussions will be ongoing throughout your treatment. They should include in-depth discussions comparing the risks and benefits of each medication, a track record of medications that have been tried and failed, and additional changes to your lifestyle that may increase the effectiveness of your treatments.