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Medically reviewed on Jun 06, 2016 by L. Anderson, PharmD

What is Osteoarthritis?

Osteoarthritis, often just called arthritis or degenerative joint disease, is the most common form of arthritis and affects over 27 million Americans.1 It’s a chronic disease of the joint cartilage and bone that worsens over time. But is this condition simply one of growing old with limited movement and creaky bones, or is it something else more serious?

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 and trouble moving the joint, and inflammation. Osteoarthritis is most frequently diagnosed in the hands, knees, hips and spine.

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 where 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 often thought to result from 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.

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).1 The most common causes of secondary osteoarthritis are metabolic conditions, such as acromegaly, anatomical problems (for example, being bow-legged), trauma or injury, or 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:2

  • 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 if your joint has 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 these 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 4

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.

In patients who do not respond to initial non-drug therapy and lifestyle changes, medication management may be used. Medication management of osteoarthritis involves simple analgesics like acetaminophen (Tylenol), oral and topical NSAIDS (non steroidal anti-inflammatory drugs) such as ibuprofen or naproxen, and intra-articular steroid injections to provide symptomatic relief. No drug treatment, to date, has shown to delay the progression or cure 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 hours or 650 milligrams (mg) every 4 to 6 hours (with a maximum of 1 gram per 4 hours and 3 to 4 grams in 24 hours from all sources) is appropriate for most patients. Acetaminophen is a safer choice for most patients due to lesser risk of cardiovascular and gastrointestinal side effects compared to NSAIDs. However, acetaminophen may not provide adequate relief in patients who have inflammation and may offer only modest benefit.

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 elderly, the choice of NSAID should be strongly influenced by the side effect profile. Topical NSAIDS or rubefacients may be useful when the pain is localized. However, topical NSAID use can also produce systemic side effects.

Medicines Used To Treat Osteoarthritis


Most people can take acetaminophen (Tylenol) without any problems as long as they do not exceed the recommended dose. It reduces mild pain but does not help with inflammation or swelling. Combinations of acetaminophen with narcotics (opioids), such as Tylenol #3 with codeine,  Vicodin, or Lorcet, are also available, although long-term treatment with opioids for osteoarthritis is not recommended. Excessive acetaminophen dosing or combining with alcohol can lead to severe liver toxicity and should be avoided. Be aware of the all of the acetaminophen you are taking from different products, especially if you combine over-the-counter and prescription pain medications. Your total acetaminophen dose should not exceed 3 to 4 grams per day, with a maximum of 1 gram per 4 hours from all sources.

Brand Name Generic Name
Tylenol, Tylenol 8 Hour, Tylenol Arthritis Pain, Tylenol Extra Strength 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 bleeding. Taking a combination of NSAIDs or NSAIDs and aspirin together increases the incidence of stomach ulcers or bleeding, too. Naproxen may be a preferred NSAID in some patients with cardiovascular risk, but that is an individual decision that should be made in conjunction with your doctor. According to the FDA, more data is needed to prove naproxen is safer for the heart.

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 that which is achieved with acetaminophen.

Also, due to an important drug interaction, regular NSAID use should be avoided in patients taking low dose aspirin for cardiovascular prevention. NSAIDs may decrease the beneficial effect of aspirin on the heart. If NSAIDs are taken on an “as needed”, short-term basis, the aspirin should be taken at least 2 hours before the NSAID.

Brand Name Generic Name
Advil, IBU, Motrin, Motrin IB ibuprofen
Aleve, Anaprox, Naprosyn, EC-Naprosyn, Naprelan naproxen, naproxen sodium
Vimovo esomeprazole/ naproxen
Ansaid (brand discontinued) flurbiprofen
Cambia, Cataflam, Voltaren, Voltaren XR, Zipsor, Zorvolex diclofenac sodium, diclofenac potassium
Arthrotec diclofenac/misoprostol
Clinoril (brand discontinued) sulindac
Daypro oxaprozin
Duexis famotidine/ibuprofen
Lodine, Lodine XL (brand discontinued) etodolac
Feldene piroxicam
Indocin, Tivorbex indomethacin
Oruvail, Orudis KT (brand discontinued) ketoprofen
Sprix, Toradol (max 5 day use only) ketorolac
Mobic, Vivlodex meloxicam
Relafen (brand discontinued) nabumetone
Nalfon fenoprofen
Tolectin (brand discontinued) tolmetin
Meclomen meclofenamate

Cyclo-oxygenase 2 Inhibitors (COX-2 inhibitors)

COX-2 Inhibitors block an enzyme that promotes inflammation called COX-2. 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 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

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 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 less 20 years. 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 (brand discontinued) choline magnesium trisalicylate


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

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 demonstrated in knee and hip joints. Intra-articular glucocorticoids may be appropriate for 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.

Relief is typically short-lived with intra-articular glucocorticoids, with peak effects within the first few weeks after injection. Pain relief effects may wane after 2 years with repeat injections.

Brand Name Generic Name
Celestone Soluspan Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension
Depo-Medrol methylprednisolone acetate injection
Brands discontinued Triamcinolone hexacetonide

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 touted as having anti-inflammatory properties for osteoarthritis. Bioflavonoids are found in the rind of green citrus fruits and in rose hips and black currants. These agents are said to lessen inflammation by inhibition of cyclooxygenase (COX) and lipoxygenase (5-LOX) pathways, and they may also possess general analgesic and antioxidant/anticytokine properties.

Bioflavonoids are often sold as an herbal supplement over-the-counter (OTC), and not all uses are FDA approved for treatment of osteoarthritis. Always ask 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 Bioflavinoids

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 (genus 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.

In September 2012, the FDA 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, and 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
Myoflex Cream, Aspercreme, Sportscreme (OTC) trolamine salicylate
Brand Name Generic Name
Capsin, Trixaicin, Zostrix (OTC, prescription) 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

Arthrotec and Prevacid contain an NSAID with a stomach protecting agent.

Brand Name Generic Name
Arthrotec diclofenac/misoprostol
Prevacid NapraPAC 500 naproxen/lansoprazole
Duexis ibuprofen/famotidine
Vimovo esomeprazole and naproxen

Non-Drug Treatment

Non-drug treatment is also important. It is important to make lifestyle changes. Exercise helps maintain joint and overall mobility. Ask your health care provider to recommend an appropriate home exercise routine. Water exercises, such as swimming, are especially helpful. You also need to balance rest with activity. Non-drug pain relief techniques may help to control pain. Heat and cold treatments, protection of the joints and the use of self-help devices are 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.

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. If physical therapy does not make you feel better after 3-6 weeks, then it is likely that it will not work at all.

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.

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 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.
  • 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.

See Also:

Recommended for you


  1. Centers for Disease Control and Prevention (CDC). Osteoarthritis. October 2015. Accessed June 6, 2016 at
  2. FDA Panel Sees No Heart-Safety Advantage With Naproxen. 10, 2014. Accessed June 6, 2016 at
  3. American Academy of Orthopaedic Surgeons. Osteoarthritis. Accessed June 6, 2016 at
  4. Kalunian K, Tugwell P, Ramirez Curtis M. Initial Pharmacotherapy of Osteoarthritis. Up To Date. Accessed June 6, 2016 at