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Medications, injections, and supplements for arthritis

Introduction

Ask your health care provider about medications that may help relieve your arthritis pain.

Over-the-Counter Pain Relievers

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

Most doctors recommend acetaminophen (such as Tylenol) first, because it has fewer side effects than other drugs. Do not take more than 4 grams (4,000 mg) on any one day.

If your pain continues, your doctor may suggest non-steroidal anti-inflammatory drugs (NSAIDs). You can buy some NSAIDs, such as ibuprofen and naproxen, without a prescription.

Taking acetaminophen or another pain pill before exercising is okay. But do not overdo the exercise because you have taken the 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 check 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 - 2 weeks.

You can also buy over-the-counter or prescription NSAIDs that come in the form of a skin cream.

Steroid Shots for Arthritis

Corticosteroids injected (steroid shot) right into the joint can also be used to help with swelling and pain.

However, relief lasts only for a short time. More than two or three injections a year may be a harmful. These injections can be performed at your health care provider’s office or with the guidance of ultrasound or x-rays.

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 Injections for Knee Arthritis

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

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

These injections cannot help everyone, but if they do help, the relief may last 3 - 6 months. Hyaluronic acid is used mostly for knee arthritis.

Supplements

The body naturally makes both glucosamine and chondroitin sulfate. They are important for healthy cartilage in your joints. They both can also be bought over the counter as supplements.

  • Glucosamine comes as glucosamine sulfate, glucosamine hydrochloride, and n-acetyl glucosamine. These products may come in tablet, capsule, and powder forms.
  • Chondroitin sulfate comes in capsules or tablets. It is often combined with glucosamine.

These supplements may help control pain. However, they do not seem to help your joint grow new cartilage or keep your 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 byproduct of the amino acid methionine. It has been marketed as a remedy for arthritis, but scientific evidence to support these claims is lacking.

References

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

Wildi LM, Raynauld JP, Martel-Pelletier J, Beaulieu A, Bessette L, Morin F, Abram F, Dorais M, Pelletier JP. Chondroitin sulphate reduces both cartilage volume loss and bone marrow lesions in knee osteoarthritis patients starting as early as 6 months after initiation of therapy: a randomised, double-blind, placebo-controlled pilot study using MRI. Ann Rheum Dis. 2011 Jun;70(6):982-9.

Wandel S, Jüni P, Tendal B, Nüesch E, Villiger PM, Welton NJ, Reichenbach S, Trelle S. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ. 2010 Sep 16;341:c4675. doi: 10.1136/bmj.c4675.


Review Date: 8/12/2011
Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, and Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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