Best over the counter medicine for arthritis

Ask a Doctor

I have arthritis, but since I was diagnosed recently, I’ve had trouble finding a pain medication that really makes my joints feel better. What’s the best painkiller for arthritis?

Doctor’s Response

There is no “one size fits all” pain remedy to treat arthritis. Effective pain relief can vary depending on the type of arthritis you have the severity.

Common over-the-counter (OTC) medications include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve), and pain relievers such as acetaminophen (Tylenol). It is sometimes possible to use NSAIDs temporarily and then discontinue them for periods of time without recurrent symptoms, thereby decreasing the risk of side effects. This is more often possible with osteoarthritis because the symptoms vary in intensity and can be intermittent. The most common side effects of NSAIDs involve gastrointestinal distress, such as stomach upset, cramping diarrhea, ulcers, and even bleeding. The risk of these and other side effects increases in the elderly. Newer NSAIDs called cox-2 inhibitors have been designed that have less toxicity to the stomach and bowels.

Prescription medications include biologics such as etanercept (Enbrel) and tofacitinib (Xeljanz), disease-modifying antirheumatic drugs (DMARDs) such as azathioprine (Azasan, Imuran), cyclosporine (Neoral, Gengraf, Sandimmune), and Methotrexate (Rheumatrex, Trexall), and corticosteroids such as prednisone.

Cortisone is used in many forms to treat arthritis. It can be taken by mouth (in the form of prednisone [Deltasone] or methylprednisolone [Medrol]), given intravenously, and injected directly into the inflamed joints to rapidly decrease inflammation and pain while restoring function. Since repetitive cortisone injections can be harmful to the tissue and bones, they are reserved for patients with more pronounced symptoms.

For persisting pain of severe osteoarthritis of the knee that does not respond to weight reduction, exercise, or medications, a series of injections of hyaluronic acid (Synvisc, Hyalgan, and others) into the joint can sometimes be helpful, especially if surgery is not being considered. These products seem to work by temporarily restoring the thickness of the joint fluid, allowing better joint lubrication and impact capability, and perhaps by directly affecting pain receptors.

Arthritis that is characterized by a misdirected, overactive immune system (such as rheumatoid arthritis or ankylosing spondylitis) frequently requires medications that suppress the immune system. Medications such as methotrexate (Rheumatrex, Trexall) and sulfasalazine (Azulfidine) are examples. Newer medications that target specific areas of immune activation are referred to as biologics (or biological response modifiers). Sometimes combinations of medications are used. All of these medications require diligent, regular dosing and monitoring.

Other types of pain relief include topical creams and gels, transcutaneous electrical nerve stimulation (TENS), steroid injections, exercise, physical therapy, heating pads or warm compresses, trigger point injections, and other treatments.

Some studies, but not all, have suggested that the food supplements glucosamine and chondroitin can relieve symptoms of pain and stiffness for some people with osteoarthritis. These supplements are available in pharmacies and health-food stores without a prescription, although there is no certainty about the purity of the products or the dose of the active ingredients because they are not monitored by the FDA. The U.S. National Institutes of Health (NIH) is studying glucosamine and chondroitin in the treatment of osteoarthritis. Their initial research demonstrated only a minor benefit in relieving pain for those with the most severe osteoarthritis. Further studies, it is hoped, will clarify many issues regarding dosing, safety, and effectiveness of these products for osteoarthritis. Patients taking blood-thinners should be careful taking chondroitin as it can increase the blood-thinning effect and cause excessive bleeding. Fish oil supplements have been shown to have some anti-inflammation properties, and increasing the dietary fish intake and/or taking fish oil capsules (omega-3 capsules) can sometimes reduce the inflammation of arthritis.

For more information, read our full medical article on arthritis.

Most people who have rheumatoid arthritis take some type of medication. Medications for RA typically fall into five categories: Non-steroidal anti-inflammatory drugs (NSAIDs); steroids; disease-modifying anti-rheumatic drugs (DMARDs); biologics; and Janus kinase (JAK) inhibitors.

See Pain Medications for Arthritis Pain Relief

A rheumatologist can recommend a tailored plan to treat your rheumatoid arthritis symptoms.
See Rheumatologist's Role in Patient Care

When prescribing a medication, a physician will take into account the patient’s age, disease activity, and other medical conditions, but each patient is unique. Figuring out which medication or combination of medications work best for an individual can be challenging and often requires a process of trial and error.

See Rheumatologist for Arthritis Treatment

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1. NSAIDs

Most people with RA are advised to take a non-steroidal anti-inflammatory drug to decrease pain and inflammation. NSAIDs are sold over-the-counter, under such names as Advil and Aleve, as well as by prescription, under names such as Mobic and Celebrex.

See Pill-Swallowing Techniques and Alternatives to Oral Medications

2. Steroids (Corticosteroids)

Fast-acting steroids, such as prednisone, are particularly useful during initial treatment, before other RA medications have had a chance to take effect (often 12 weeks or more).

One advantage of steroids is that they can be injected into joints. Injected steroids can provide targeted pain relief to one or two painful joints with limited side effects.

Experts recommend taking the lowest possible dose of steroids and advise against relying on them longer than necessary. Steroids’ effectiveness often diminishes over time—meaning the longer a person takes a steroid, the less likely it is to relieve symptoms. In addition, people who take steroids continuously for several months or years can experience side effects such as weight gain, increases in blood pressure, diabetes, and heart disease.

See Cortisone Injections (Steroid Injections)

3. Methotrexate and Other Traditional DMARDs

Disease-modifying antirheumatic drugs (DMARDs) are used used to slow or stop rheumatoid arthritis by suppressing the immune system. The generic names for commonly used DMARDs include:

• Hydroxychloroquine
• Methotrexate
• Sulfasalazine
• Azathioprine
• Lefludomide

Methotrexate is often the first drug prescribed for people newly diagnosed with rheumatoid arthritis. RA patients take this medication weekly, alone or in combination with other medications.

High dose methotrexate is also used to treat some cancers. RA patients take significantly lower doses than cancer patients.

See Treatments for Rheumatoid Arthritis in Hands

4. Biologics for Rheumatoid Arthritis

Biologic drugs target and prevent a specific reaction from happening, stopping the inflammatory process.

This class of medications, called biologic response modifiers, is technically a subset of DMARDs. They may be used with traditional DMARDs or as an alternative to them. Biologics:

• Disrupt certain parts of the cascade of events that lead to RA inflammation and have the potential to stop the disease process.
• Increase a person’s risk of infection and tend to be expensive. Because of these potential downsides, biologics are used when methotrexate or other DMARDs prove insufficient or cause unacceptable side-effects.
• May become less effective and/or cause worsening side effects over time. The doctor and patient can work together to monitor changes and decide if and when switching medication is advisable.

See Biologics for RA and Other Autoimmune Conditions

Biologics fall into four categories: Tumor necrosis factor (TNF) inhibitors; Interleukin (IL) inhibitors; B-cells inhibitors; and T-cells inhibitors. These medications are administered by injection or infusion. Examples include Remicade, Enbrel, and Humira.

See The Science Behind Biologics

In This Article:

Testing for Tuberculosis
Before taking any type of biologic medication, a person must be tested for tuberculosis. People who have latent tuberculosis carry the Mycobacterium tuberculosis bacterium without having tuberculosis symptoms. If a person with latent tuberculosis takes immune-suppressing biologic medications the bacterium can multiply and cause symptomatic tuberculosis.

See Risks and Side Effects of Biologics

5. Janus Kinase (JAK) Inhibitors

JAK enzymes are essential messengers in the immune system’s inflammatory process. When JAK enzymes bind with other cells, called X cells, they trigger inflammation. JAK inhibitors bind to JAK enzymes, preventing them from binding with X Cells and stopping the inflammatory process.

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The first FDA-approved JAK inhibitor is called Tofacitinib, and it is sold under the names Xeljanz and Xeljanz XR (extended release).

As with biologic mediations, people considering taking JAK inhibitors must have a tuberculosis test.

People taking JAK inhibitors are advised to work with their doctors to monitor risks and side effects.

What is the most effective medication for arthritis?

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