Medicines, injections, and supplements for arthritis

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.

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.

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.

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.

Arthritis - medications; Arthritis - steroid injections; Arthritis - supplements; Arthritis - hyaluronic acid

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 pubmed.ncbi.nlm.nih.gov/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 pubmed.ncbi.nlm.nih.gov/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 pubmed.ncbi.nlm.nih.gov/33887408/.

Updated 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.