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Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Sep 11, 2020.

What is Osteoarthritis?

Osteoarthritis, often just called arthritis or degenerative joint disease, is the most common form of arthritis and affects over 32 million Americans.1 It’s a chronic (long-term) disease of the joint cartilage and bone that worsens over time. 

  • Osteoarthritis is most frequently diagnosed in the hands, knees, hips and spine.
  • Osteoarthritis can affect any joint and results from the gradual wearing away of the cushioning (cartilage) between the bone joints that eventually results in bone rubbing against bone. Sometimes new pieces of bone, called bone spurs, grow around the joints.
  • All of these effects result in pain, stiffness, trouble moving the joint, and inflammation (swelling).

Osteoarthritis differs from another type of arthritis called rheumatoid arthritis. Although they are both forms of arthritis, osteoarthritis and rheumatoid arthritis require different treatments. Rheumatoid arthritis is an "autoimmune" inflammatory disease of the joints, meaning healthy tissues are attacked leading to painful inflammation. However, osteoarthritis and rheumatoid arthritis do have some similarities -- both can occur in the hands, feet or wrist, no cures exist for either at this time, and treatments for both can lead to substantial relief.

What Causes Osteoarthritis? Who is at Risk?

Osteoarthritis is primarily associated with the aging process. Osteoarthritis is thought to result from the mechanical "wear and tear" on a joint, although there are other causes such as congenital (birth) defects, trauma and metabolic disorders. The symptoms of osteoarthritis usually appear in middle age but they are present in almost everyone by the age of 70. Before the age of 55, the condition occurs equally in both sexes, but after age 55 it is more common in women.

However, injuries, obesity, family history and weak muscles also play a part in osteoarthritis development, and symptoms can occur at a younger age. For example, in younger people who have had a sports-related or vehicle accident, cartilage can wear away and cause joint disorders. Excess weight can lead to wear-and-tear on the knees.

Types of Osteoarthritis

Osteoarthritis is classified as either idiopathic (occurs without any type of injury or identifiable cause) or secondary (develops as a result of another disease or underlying condition).

The most common causes of secondary osteoarthritis are metabolic conditions, such as:

  • Acromegaly
  • Anatomical problems (for example, being bow-legged)
  • Trauma or injury
  • Inflammatory disorders like septic arthritis.

What are the Symptoms of Osteoarthritis?

Symptoms of osteoarthritis can vary from mild to disabling. Some of the most common symptoms of osteoarthritis are:

  • A gradual and subtle onset of deep aching joint pain that is worse after exercise or weight bearing and is often relieved by rest
  • Joint swelling/inflammation
  • Limited movement
  • Morning stiffness and pain
  • Grating of the joint with motion
  • Joint pain in rainy weather
  • Pain with vigorous activity

However, it is also possible, although not common, for osteoarthritis to develop without any symptoms.

How is Osteoarthritis Diagnosed?

Your doctor will diagnose osteoarthritis using a combination of family and medical history, symptoms, physical exam, and laboratory tests.3

A physical exam can show limited range of motion, grating of a joint with motion, joint swelling, and tenderness. They will ask:

  • Has your joint ever been injured?
  • Is your pain worse at night, does pain worsen with walking, running or at rest?
  • Does your pain come and go?

Your doctor may then request an x-ray of the affected joints. If you have osteoarthritis, the x-ray will show a loss of joint space and, in advanced cases, wearing down of the ends of the bone and bone spurs.

Your doctor may also use the following tests to confirm the diagnosis of osteoarthritis:

  • Joint Aspiration: Under local anesthesia, joint fluid is withdrawn to look for evidence of joint deterioration or crystals.
  • X-ray: The physical effects of OA, like bone/cartilage changes, can be shown with imaging techniques. Your doctor may look for narrowing of the joint spaces, bone erosion, fluid in the joint, and bone spurs. X-rays can help your provider to distinguish between different types of arthritis.
  • MRI: MRIs provide a two-dimensional view that offers better images of soft tissues, such as cartilage.

Treatment Options

The goals of treatment for osteoarthritis are to relieve pain, maintain or improve joint mobility, increase strength of the joints, and minimize the disabling effects of the disease. The specific treatment prescribed depends on which joints are involved, medication preferences, and disease progression. No drug treatment, to date, has shown to delay the progression or cure osteoarthritis.

In patients who do not respond to initial non-drug therapy and lifestyle changes, symptomatic medication management may be used.4 Medication management of osteoarthritis involves simple analgesics like:

Intra-articular steroid injections to provide symptomatic relief have been commonly used to treat knee pain due to osteoarthritis in the past, although a study5 in the Journal of the American Medical Association found knee osteoarthritis patients who received steroid injections every 3 months for two years had no less pain than those taking a placebo treatment. In addition, these patients had greater loss of cartilage, the rubbery tissue that acts as a cushion between the bones of joints. For patients who are at the early stages of knee osteoarthritis, or do not yet have significant cartilage loss, continued corticosteroid injection may hasten the full onset of osteoarthritis.

Most patients with osteoarthritis have pain as a result of damage to bone and cartilage. In the absence of inflammation, regular or “as required” acetaminophen 1 gram (g) every 6-8 hours (with a max dose of 3 to 4 grams per day) is appropriate for most patients. Acetaminophen is a safer choice for most patients due to a lower risk of heart and stomach side effects compared to NSAIDs. However, acetaminophen may not provide adequate relief in patients who have inflammation and may offer only modest benefit. In addition, excessive, chronic alcohol use with acetaminophen can lead to, or worsen, liver damage.

With inflammatory osteoarthritis, NSAIDS can provide better pain control than simple analgesics and also reduce swelling, but with a greater chance for serious side effects. As many osteoarthritis patients are older, the choice of NSAID should be strongly influenced by the side effect profile, including heart, kidney and gastrointestinal effects. Topical NSAIDS or rubefacients may be useful when the pain is localized to one area. However, topical NSAID use can also produce side effects due to systemic absorption into the bloodstream.

Medicines for Osteoarthritis


Most people can take acetaminophen (Tylenol) without any problems as long as they do not exceed the recommended dose.

Acetaminophen reduces mild pain but does not help with inflammation or swelling. Some patients, but not all, may have pain relief from mild forms of arthritis.

Combinations of acetaminophen with narcotics (opioids), are also available, although long-term treatment with opioids for osteoarthritis should be avoided due to the potential for addiction and fatal overdose.

  • The use of narcotic pain relievers for arthritic conditions is discouraged as arthritis is a chronic, long-term condition that requires ongoing treatment.
  • Narcotics are addictive and can be linked with many other side effects, such as drowsiness, constipation, and withdrawal.

Excessive acetaminophen dosing or combining with alcohol can lead to severe liver toxicity and should be avoided. Be aware of the total dose of acetaminophen you are taking from different products, especially if you combine over-the-counter (OTC) and prescription pain medications.

  • Your total acetaminophen adult dose should not exceed 3,000 to 4,000 milligrams per day, including OTC and prescription products. If your doctor has recommended lower doses, follow their advice. Severe liver damage may occur if you take more than 4 grams (4,000 mg) of acetaminophen per 24 hours.
  • If you are using an over-the-counter product without specific recommendations from your doctor, follow the directions on the package labeling.
  • In addition, do not use acetaminophen if you consume 3 or more alcoholic drinks per day while using this product due to the risk for severe liver damage.
  • Severe liver damage may also occur if you take acetaminophen with other medicines also containing acetaminophen. Ask your doctor or pharmacist if you are taking too much acetaminophen with either prescription or OTC products.
Brand Name Generic Name
Tylenol, Tylenol 8-Hour, Tylenol Extra Strength, Tylenol Rapid Release Gelcaps, Infant's Tylenol, Children's Tylenol Acetaminophen

NSAIDs (non-steroidal anti-inflammatory drugs)

Although NSAIDs work well to control inflammation and pain, long-term use of these drugs can cause stomach problems, such as ulcers and bleeding.

  • In April 2005, the FDA asked manufacturers of NSAIDs to include a warning label on their products that alerts users of an increased risk of cardiovascular events (heart attacks and strokes) and gastrointestinal (stomach) bleeding.
  • Taking more than one NSAID at the same time or NSAIDs and aspirin together increases the incidence of stomach ulcers or bleeding. Do not use more than one NSAID at a time.
  • Due to an elevated risk for side effects, NSAIDs should be discontinued after an adequate trial (2 to 4 weeks) if there is no further relief compared to pain relief with acetaminophen.

Also, due to an important drug interaction, speak to your doctor about regular NSAID use if you take low dose aspirin to help protect your heart.

  • NSAIDs may decrease the beneficial effect of aspirin on the heart.
  • You may need to change to another pain medication, a dose adjustment or more frequent monitoring by your doctor to safely use aspirin.
Brand Name Generic Name
Advil, Motrin, Motrin IB ibuprofen
Aleve, Anaprox, Naprosyn, EC-Naprosyn, Naprelan 500 naproxen, naproxen sodium
Vimovo esomeprazole/ naproxen
Ansaid (brand discontinued) flurbiprofen
Cambia, Voltaren, Zipsor, Zorvolex diclofenac sodium, diclofenac potassium
Arthrotec diclofenac/misoprostol
Clinoril (brand discontinued) sulindac
Daypro oxaprozin
Duexis famotidine/ibuprofen
Lodine, Lodine XL (brands discontinued) etodolac
Feldene piroxicam
Indocin, Tivorbex indomethacin
Oruvail, Orudis KT (brands discontinued) ketoprofen
Sprix ketorolac
Mobic, Vivlodex meloxicam
Relafen (brand discontinued) nabumetone
Nalfon fenoprofen
Tolectin (brand discontinued) tolmetin
Meclomen (brand discontinued) meclofenamate

Cyclo-oxygenase 2 inhibitors (COX-2 inhibitors)

COX-2 Inhibitors block an enzyme called COX-2 that promotes inflammation. This class of drug was initially believed to work as well as traditional NSAIDs, but with fewer stomach problems. However, numerous reports of heart attacks and strokes prompted the FDA to re-evaluate the risks and benefits of the COX-2 inhibitors. Rofecoxib (Vioxx) and valdecoxib (Bextra) have been withdrawn from the U.S. market following reports of heart attacks in some patients taking the drugs.

The available prescription drug in this class, Celebrex (celecoxib), has been labeled with strong heart and stomach warnings and a recommendation that it be prescribed at the lowest possible dose and for the shortest duration possible. Additionally, COX-2 inhibitors should not be used in the peri-operative period (time before, during, or after) coronary artery bypass graft surgery. View the entire boxed warning for Celebrex here.

For relief of the signs and symptoms of osteoarthritis, the recommended oral dose of celecoxib is 200 mg per day administered as a single dose or as 100 mg twice daily.

Selective COX-2 inhibitors have no action on platelet function.

Brand Name Generic Name
Bextra (withdrawn from market) valdecoxib
Celebrex celecoxib
Vioxx (withdrawn from market) rofecoxib

In 2018, the FDA approved Consensi, from Kitov Pharma, a once-daiy, fixed-dose combination tablet of amlodipine besylate, a calcium channel blocker used for blood pressure control, and celecoxib, used for pain associated with osteoarthritis. The reasoning is that a pill combination for osteoarthritis and hypertension that may enhance adherence for the blood pressure medication, as high blood pressure tends not to have symptoms for patients, who may then skip treatment. Important NSAID warnings such as cardiovascular and gastrointestinal risk remain on the Consensi label.

Salicylates and Non-acetylated Salicylates

The non-acetylated salicylates, such as salsalate, diflunisal, and choline magnesium trisalicylate, have no appreciable effect on platelets at normal doses and may be safer for the stomach than regular NSAIDs. However, onset of action for pain relief can take longer with non-acetylated salicylates. Some patients may report only modest benefit with non-acetylated salicylates, similar to pain relief with acetaminophen, while other patients may have good pain relief.

Aspirin is now primarily used for cardiovascular (heart) protection and not on a chronic, daily basis for pain due to gastrointestinal toxicity, risk of bleeding with higher doses in the elderly, and Reye’s Syndrome in patients under 20 years of age. It is important to remember that aspirin irreversibly inhibits platelet functioning for life of the platelet, roughly 7 to 10 days, further increasing the risk of bleeding.

Brand Name Generic Name
Amigesic, Disalcid, Salflex, Salsitab (brands discontinued) salsalate
Bayer Aspirin, Ecotrin, Bufferin, St. Joseph’s (other brands available) aspirin
Dolobid (brand discontinued) diflunisal
Tricosal, Trilisate (brands discontinued) choline magnesium trisalicylate


Cymbalta (duloxetine) is an FDA-approved antidepressant also approved for the use of osteoarthritis and chronic pain like fibromyalgia and diabetic peripheral neuropathic pain.

Brand Name Generic Name
Cymbalta Duloxetine

Steroids (Glucocorticoids)

Steroid injections formulated for intra-articular injection, such as methylprednisolone acetate and betamethasone, are given directly into the joint. They reduce pain and inflammation, and efficacy has been shown in knee and hip joints.

However, a 2017 study5,6 in JAMA found that patients with osteoarthritis and knee pain receiving steroid injections over 2 years had no less pain than those receiving a placebo. Also, patients on steroids had loss of cartilage in the knee, which in the long run can worsen pain. Ongoing corticosteroid injections may result in loss of knee cartilage and lead to osteoarthritis in some patients. Similar results have been seen in hip studies.7

Intra-articular glucocorticoids may be appropriate for select patients with moderate-to-severe joint pain not relieved by acetaminophen, NSAIDs or COX-2 inhibitors or in patients who have contraindications to use of these agents.

Injections can be repeated every 3 months, but other options should be considered in patients who have early disease or pain not due to osteoarthritis due to possible loss of cartilage.

Relief is typically short-lived with intra-articular glucocorticoids, with peak effects only within the first few weeks after injection. Physical therapy should be instituted to help strengthen the joint, maintain mobility, and lessen pain.

Brand Name Generic Name
Celestone Soluspan Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension
Depo-Medrol Methylprednisolone acetate injection
Kenalog-10, Aristospan, Zilretta Triamcinolone

Supplements / Nutraceuticals

Some people state that over-the-counter nutraceuticals and vitamins, such as glucosamine and chondroitin sulfate help relieve the symptoms of osteoarthritis; however, strong clinical evidence for these agents is lacking.

  • There is some evidence that these supplements are helpful in controlling pain, although they do not appear to lead to new cartilage growth.
  • There are few risks associated with these agents; however, if no benefit is seen after 6 months, glucosamine and/or chondroitin sulfate should be discontinued.
  • Glucosamine should not be used in patients allergic to shellfish.

Bioflavonoids have also been promoted as having anti-inflammatory properties for osteoarthritis. Bioflavonoids are found in the rind of green citrus fruits, in rose hips and in black currants. These agents are said to lessen inflammation by inhibition of cyclo-oxygenase (COX) and lipo-oxygenase pathways, and they may also possess general analgesic, antioxidant, and anti-inflammatory properties.

Bioflavonoids are often sold as an herbal supplement over-the-counter (OTC), and are not FDA approved for treatment of osteoarthritis. Always check with your doctor before using any OTC or herbal product.

Brand Name Generic Name
Cosamin DS, Osteo Bi-Flex, Schiff Move Free chondroitin/glucosamine
Limbrel, Pan C 500 Bioflavonoids

Topical Pain Relief Agents

Topical agents, such as diclofenac and capsaicin, may be an option for patients who cannot take or tolerate NSAIDs or have no effectiveness with acetaminophen. Topical agents may have an added advantage in the elderly at risk of bleeding.

Diclofenac topical is a non-steroidal anti-inflammatory drug available in a gel, patch, or topical solution by prescription. Diclofenac topical can be used in combination with acetaminophen, but should not be combined with oral NSAIDs, as up to 10% systemic absorption (into the blood) of diclofenac topical gel can occur. However, there is minimal systemic absorption with the patch. Local skin reactions, such as rash, burning, or itching, may occur.

Trolamine salicylate is a topical salicylate pain reliever, classified as a topical rubefacient and is used for minor pain and inflammation. It works by reducing swelling and inflammation in the muscle and joints by increasing blood flow. They are used in the treatment of pain in various musculoskeletal conditions. Other common topical rubefacients include menthol and methyl salicylate. These are available over-the-counter (OTC) at the pharmacy.

Capsaicin is extracted from the chili pepper (capsicum). Capsaicin is the active ingredient in chili peppers that makes them hot. When applied to the skin in cream form, capsaicin topical causes a decrease in a substance (substance P) in the body that causes pain. It is used to relieve minor aches and pains of muscle and joints associated with arthritis, simple backache, strains and sprains. Many products at the pharmacy contain capsaicin.

The FDA has warned health care providers and consumers that some OTC topical muscle and joint pain relievers that contain menthol, methyl salicylate, or capsaicin can lead to rare cases of serious first- to third-degree chemical burns where the products were applied. These products are marketed under various brand-names, such as:

  • Bengay
  • Capzasin
  • Flexall
  • Icy Hot
  • Mentholatum

The various formulations include creams, lotions, ointments, and patches. FDA recommends that consumers who experience signs of skin injury where these products are applied, such as pain, swelling, or blistering of the skin, should stop using the product and seek immediate medical care.

Brand Name Generic Name
Flector Patch, Voltaren Gel (prescription only) diclofenac topical
Myoflex Cream, Aspercreme, Sportscreme (OTC) trolamine salicylate
Brand Name Generic Name
Capsin, Capzasin-HP, Zostrix (OTC) capsaicin

Artificial Joint Fluid

Hyaluronic acid is normally present in joint fluid, which allows the joints to slide easily. In osteoarthritis sufferers this fluid may get thin and not work as well. This fluid acts as a lubricant and shock absorber for the joints.

Hyaluronic acid can be injected into the knee joint to help relieve discomfort, and may decrease pain for up to six months. Hyaluronic acid is typically used in patients who cannot tolerate or use NSAIDs, and those awaiting joint surgery.

Brand Name Generic Name
Synvisc hylan g-f 20
Orthovisc hyaluronan
Euflexxa, Hyalgan sodium hyaluronate

Combination Drug Preparations

These agents contain an NSAID with a stomach protective agent.

Brand Name Generic Name
Arthrotec diclofenac/misoprostol
Duexis ibuprofen/famotidine
Vimovo esomeprazole and naproxen

Non-Drug Treatment for Osteoarthritis

Non-drug treatment, exercise, physical therapy, and weight loss play an important role in osteoporosis treatment.

Exercise helps maintain joint and overall mobility. Non-weight bearing exercises, such as swimming, are especially helpful. A stationary bicycle can strengthen leg and knee muscles. Ask your health care provider to recommend an appropriate home exercise routine.

You also need to balance rest with activity. Non-drug pain relief techniques may help to control pain. Heat, cold and icepack treatments, protection of the joints and the use of assistive devices, such as a walker or cane, may be recommended.

Good nutrition and careful weight control are important. Weight loss for overweight individuals will reduce the strain placed on the knee and ankle joints, and can help to prevent acute injury.

An acute flare of arthritis may require rest for 12 to 24 hours with a return to normal activities as recommended by your health care provider.

Physical Therapy

Physical therapy can be useful for improving muscle strength and motion at stiff joints. Therapists have many techniques for treating osteoarthritis. Sticking to the daily exercise plan recommended by the physical therapist is key to success. A regular exercise program at home will often help to lessen osteoarthritis pain. Your physical therapist may be able to recommend appropriate exercises you can do to help keep your pain under control.

Hot and Cold Therapy

Applying heat and cold can help to control pain, stiffness, and muscle spasms that may occur with arthritic joints.

  • Heat (for pain, stiffness): Apply hot towels, heat packs, hot water bottles, or heated pads. Avoid burns and use a heating pad for no more than 20 minutes at a time.
  • Cold (for pain, spasms): Apply ice packs, coolant sprays for intermittent, short periods of time.


Splints and braces can sometimes support weakened joints. Some prevent the joint from moving, while others allow some movement. You should use a brace only when your doctor or physical therapist recommends one. The incorrect use of a brace can cause joint damage, stiffness and pain. Most braces can be purchased over-the-counter at pharmacies and save substantial costs compared to one ordered in the doctor's office.

Orthotic shoe inserts may help to lessen stress on the back joints and legs.

Assistive Devices

Devices that can assist the patient such as raised toilet seats, power-lift chairs, canes, walkers, and bathroom shower/tub bars can make it easier to perform daily tasks and may make it safer by offering physical support. A physical therapist can recommend if these devices may of value.

Weight Loss

Being overweight or obese can put added strain on all joints, especially the knees and hips. Losing weight, even a modest amount, may help to lessen pain.

Transcutaneous electrical nerve stimulation (TENS): With TENS, often applied by a physical therapist, a low voltage electrical current is applied to the skin in the area surrounding the joint pain. The current stimulates nerves in the skin that may transmit pain signals from a painful joint. TENS may not be effective for all patients.


Surgery to replace or repair damaged joints may be needed in severe, debilitating cases.

Surgical options include:

  • Arthroplasty - total or partial replacement of the deteriorated joint with an artificial joint e.g. knee arthroplasty, hip arthroplasty.
  • Arthroscopic - surgery to trim torn and damaged cartilage and wash out the joint. However, a 2017 guideline published in BMJ recommends against most arthroscopic or "keyhole" surgeries.
  • Cartilage Restoration - For some younger patients with arthritis, cartilage restoration is a surgical option to replace the damaged or missing cartilage.
  • Osteotomy - change in the alignment of a bone to relieve stress on the bone or joint.
  • Arthrodesis - surgical fusion of bones, usually in the spine.

Social Support and Education

Maintaining a network of friends or joining an arthritis support group can help to ease the burden of osteoarthritis and offer an outlet for discussion and to express concerns. Local health centers may offer arthritis education, as well.

To keep up with the latest medical news, drug approvals, and health tips consider joining the Support Group.

See Also


  1. Centers for Disease Control and Prevention (CDC). Osteoarthritis. January 2017. Accessed Sept. 11, 2020 at
  2. FDA Panel Sees No Heart-Safety Advantage With Naproxen. Feb 10, 2014.
  3. American Academy of Orthopaedic Surgeons. Osteoarthritis.
  4. Kalunian K, Tugwell P, Ramirez Curtis M. Patient education: Osteoarthritis treatment (Beyond the Basics). August 2020. Accessed Sept. 11, 2020 at
  5. McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, Ward RJ. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967-1975. doi:10.1001/jama.2017.5283. Accessed Sept. 11, 2020.
  6. Forget Steroid Shots for Long-Term Relief of Arthritic Knees. Consumer News. May 16, 2017.
  7. Steroid Injections for Arthritic Hips: More Trouble Than They're Worth? Consumer News. Nov. 29, 2017. Accessed Sept. 9, 2018.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.