Medications to treat symptoms
Arthritis medications that help manage the symptoms of arthritis, such as pain, stiffness, and inflammation, do not cure arthritis but can significantly improve quality of life by reducing discomfort and allowing for better mobility. Medications used to treat symptoms include: Non-steroidal anti-inflammatories (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs) are medications used to treat many forms of arthritis – both osteoarthritis and inflammatory types of the disease. These medications can help to reduce joint inflammation and pain, but do not work to supress the underlying disease process or prevent joint damage. Often, NSAIDs can be stopped once disease-modifying anti-rheumatic drugs (or “DMARDs”) take effect and disease activity is significantly reduced.
Examples of NSAIDs available without a prescription include ibuprofen (Motrin® or Advil®). Some more powerful NSAIDs require a prescription. These include naproxen (Naprosyn®). Some different NSAIDs are more commonly used than others to treat specific types of arthritis; for example, it is thought that one of the most powerful and effective NSAIDs for gout is indomethacin (Indocid®).
Cox-2 inhibitors are a separate class of NSAID, which work to reduce inflammation but do not carry the same risk of gastrointestinal side effects. Celecoxib is an example of a cox-2 inhibitor. It is important to note that while cox-2 inhibitors cause fewer gastrointestinal side effects, research has shown that they have the same or higher risk of cardiovascular (heart) side effects compared to traditional NSAIDs.
Over-the-counter NSAIDs (non-prescription) include:
How they work
NSAIDs block enzymes in the body called cyclooxygenase (COX) enzymes. These enzymes help produce substances called prostaglandins, which are involved in inflammation, pain, and fever. By reducing the production of prostaglandins, NSAIDs help decrease inflammation and relieve pain.
Benefits
In some people, NSAIDs can be effective in reducing joint swelling, stiffness and resulting pain which can improve daily function and quality of life. They are particularly beneficial for those with osteoarthritis and some types of inflammatory arthritis like rheumatoid arthritis.
Side effects and risks
While NSAIDs can be effective for some, they can also cause side effects, especially when used for longer periods (months or years) or in higher doses. NSAIDs raise the risk of serious cardiovascular, kidney or gastro-intestinal side effects, like heart attack or stroke and stomach ulcers. For this reason, your doctor should carefully consider specific risk factors for these types of side effects before adding an NSAID to any treatment plan.
Safe use
To minimize side effects, it is recommended to use NSAIDs at the lowest effective dose for the shortest possible time. People with a history of stomach, heart, or kidney problems should use these medications with caution and under a doctor’s supervision. Sometimes, doctors may prescribe medications to protect the stomach lining if NSAIDs are necessary for long-term use.
Pain relievers
Acetaminophen, also known as paracetamol and commonly branded as Tylenol®, is a popular pain reliever. It is often recommended for mild to moderate arthritis pain.
How it works
The exact way acetaminophen works is not fully understood, but it is believed to act in the brain to reduce the sensation of pain and lower fever. Unlike NSAIDs, acetaminophen does not have anti-inflammatory properties.
Benefits
Acetaminophen is useful for managing pain without the gastrointestinal, renal and cardiovascular side effects associated with NSAIDs. It is often recommended for osteoarthritis and can be used alone or with other medications to help control pain.
Side effects and risks
Acetaminophen is generally safe when used correctly. However, taking too much can cause severe liver damage. It is important to follow dosing instructions and be aware of acetaminophen in combination with other medications such as cold pills and other pain medications that contain acetaminophen, to avoid accidental overdose.
Safe use
Do not exceed the maximum daily dose of acetaminophen. Acetaminophen is found in a few other over-the-counter medications, such as cough and cold products and prescription medications for pain relief. Carefully look at the ingredients of all the over-the-counter medications and prescription medications you are taking to ensure you are not taking too much acetaminophen.
Avoid regular consumption of alcohol while taking acetaminophen as it can increase the risk of liver toxicity. Consuming more than three alcoholic drinks per day may increase the risk of liver damage.
Opioids
Opioids are powerful pain relievers and are sparingly prescribed for people with long standing damage and moderate to severe arthritis pain when other treatments are not effective. Common opioids include morphine, oxycodone (OxyContin®), and hydrocodone.
How they work
Opioids work by binding to opioid receptors in the brain and spinal cord, blocking pain signals. This not only reduces the perception of pain but also changes the emotional response to pain.
Benefits
Opioids can provide significant short-term relief for severe pain, helping people with arthritis perform daily activities more comfortably. They are often used when other pain medications do not provide sufficient relief. Opioids should not be used to treat a person’s underlying disease.
Side effects and risks
Opioids carry a high risk of side effects and potential for addiction and dependence. Common side effects include drowsiness, constipation, nausea, and dizziness. Long-term use can lead to tolerance, requiring higher doses to achieve the same effect, and withdrawal symptoms if the medication is stopped abruptly.
Safe use
Due to the risk of addiction, opioids should be used under strict medical supervision. Doctors usually recommend the lowest effective dose for the shortest possible time. Patients should be regularly evaluated for signs of misuse, and alternative pain management strategies should be considered whenever possible.
Steroids
Steroids, also known as corticosteroids or glucocorticoids, are medications that help control inflammation and immune responses in the body. They are commonly used to treat various forms of inflammatory arthritis, including rheumatoid arthritis (RA), systemic lupus erythematosus (lupus), vasculitis and similar serious inflammatory conditions.
Steroids are natural chemicals produced by the adrenal glands, which are located above the kidneys. The body produces more of these chemicals, specifically glucocorticoids, during the day when people are active. These glucocorticoids include cortisone and hydrocortisone, which play a crucial role in controlling metabolism. Metabolism is the process that allows the body to grow, function, repair tissues, and produce energy.
It's important to separate between the steroids used to treat arthritis and anabolic steroids. Anabolic steroids are variations of the male hormone testosterone and were first created in the 1950s. They are not the same as the prescription steroids used to manage arthritis.
How they work
Low-dose steroids can be used as a “bridge” therapy in early inflammatory arthritis or for disease flare management. The lowest effective dose for the shortest time should be used, and tapering should occur as soon as symptoms are under control. Steroids can be taken as tablets, injections, or through an intravenous (IV) drip.
When reducing a steroid dose, doctors recommend a gradual reduction to allow the body to adjust to producing steroids naturally again. If you are advised to stop, your rheumatologist will ask you to let them know if you feel more tired, dizzy or sick when you are not taking the steroid medication. These symptoms may mean you have adrenal insufficiency, so your rheumatologist will ask you to start taking your steroid medication again while they plan extra checks for you.
Benefits
Steroids can be very useful in three important ways:
Possible side effects
Steroids are used sparingly for inflammatory arthritis due to their potential side effects. Short-term use or injections of steroids can cause mild effects such as temporary red flushing of the face, a metallic taste in the mouth, hyperactivity, tiredness, mood changes, and blurred vision. When steroids are administered through an infusion into a vein, hypertension (raised blood pressure) may occur but usually settles by slowing the infusion rate.
Joint injections of steroids also carry some risks, though they are rare with good technique. These can include the risk of joint infection, temporary red flushing of the face, slight swelling of the face, increased calcium deposits around the injected joint, a temporary increase in insulin dose for diabetics, small skin depressions or color changes near the injection site, and pain following the injection.
Long-term use or higher doses of steroids can lead to significant side effects, including immune system suppression, which increases the risk of infections. Steroids can also suppress the signs of infection. It is essential to seek medical advice at the first sign of an infection. Other potential side effects of prolonged steroid use include the development of diabetes, thinning of the bones (osteoporosis), and weight gain, particularly in the face.
Safe use
Regular monitoring and medical supervision are crucial to managing the possible side effects and risks listed above effectively.
Arthritis medications that help manage the symptoms of arthritis, such as pain, stiffness, and inflammation, do not cure arthritis but can significantly improve quality of life by reducing discomfort and allowing for better mobility. Medications used to treat symptoms include: Non-steroidal anti-inflammatories (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs) are medications used to treat many forms of arthritis – both osteoarthritis and inflammatory types of the disease. These medications can help to reduce joint inflammation and pain, but do not work to supress the underlying disease process or prevent joint damage. Often, NSAIDs can be stopped once disease-modifying anti-rheumatic drugs (or “DMARDs”) take effect and disease activity is significantly reduced.
Examples of NSAIDs available without a prescription include ibuprofen (Motrin® or Advil®). Some more powerful NSAIDs require a prescription. These include naproxen (Naprosyn®). Some different NSAIDs are more commonly used than others to treat specific types of arthritis; for example, it is thought that one of the most powerful and effective NSAIDs for gout is indomethacin (Indocid®).
Cox-2 inhibitors are a separate class of NSAID, which work to reduce inflammation but do not carry the same risk of gastrointestinal side effects. Celecoxib is an example of a cox-2 inhibitor. It is important to note that while cox-2 inhibitors cause fewer gastrointestinal side effects, research has shown that they have the same or higher risk of cardiovascular (heart) side effects compared to traditional NSAIDs.
Over-the-counter NSAIDs (non-prescription) include:
- Aspirin (Bayer®)
- Ibuprofen (Advil®, Motrin®)
- Naproxen (Aleve®)
- Celecoxib (Celebrex®)
- Diclofenac sodium (Voltaren®)
- Indomethacin (Indocin®)
- Meloxicam (Mobicox®)
- Nabumetone (Relafen®)
How they work
NSAIDs block enzymes in the body called cyclooxygenase (COX) enzymes. These enzymes help produce substances called prostaglandins, which are involved in inflammation, pain, and fever. By reducing the production of prostaglandins, NSAIDs help decrease inflammation and relieve pain.
Benefits
In some people, NSAIDs can be effective in reducing joint swelling, stiffness and resulting pain which can improve daily function and quality of life. They are particularly beneficial for those with osteoarthritis and some types of inflammatory arthritis like rheumatoid arthritis.
Side effects and risks
While NSAIDs can be effective for some, they can also cause side effects, especially when used for longer periods (months or years) or in higher doses. NSAIDs raise the risk of serious cardiovascular, kidney or gastro-intestinal side effects, like heart attack or stroke and stomach ulcers. For this reason, your doctor should carefully consider specific risk factors for these types of side effects before adding an NSAID to any treatment plan.
Safe use
To minimize side effects, it is recommended to use NSAIDs at the lowest effective dose for the shortest possible time. People with a history of stomach, heart, or kidney problems should use these medications with caution and under a doctor’s supervision. Sometimes, doctors may prescribe medications to protect the stomach lining if NSAIDs are necessary for long-term use.
Pain relievers
Acetaminophen, also known as paracetamol and commonly branded as Tylenol®, is a popular pain reliever. It is often recommended for mild to moderate arthritis pain.
How it works
The exact way acetaminophen works is not fully understood, but it is believed to act in the brain to reduce the sensation of pain and lower fever. Unlike NSAIDs, acetaminophen does not have anti-inflammatory properties.
Benefits
Acetaminophen is useful for managing pain without the gastrointestinal, renal and cardiovascular side effects associated with NSAIDs. It is often recommended for osteoarthritis and can be used alone or with other medications to help control pain.
Side effects and risks
Acetaminophen is generally safe when used correctly. However, taking too much can cause severe liver damage. It is important to follow dosing instructions and be aware of acetaminophen in combination with other medications such as cold pills and other pain medications that contain acetaminophen, to avoid accidental overdose.
Safe use
Do not exceed the maximum daily dose of acetaminophen. Acetaminophen is found in a few other over-the-counter medications, such as cough and cold products and prescription medications for pain relief. Carefully look at the ingredients of all the over-the-counter medications and prescription medications you are taking to ensure you are not taking too much acetaminophen.
Avoid regular consumption of alcohol while taking acetaminophen as it can increase the risk of liver toxicity. Consuming more than three alcoholic drinks per day may increase the risk of liver damage.
Opioids
Opioids are powerful pain relievers and are sparingly prescribed for people with long standing damage and moderate to severe arthritis pain when other treatments are not effective. Common opioids include morphine, oxycodone (OxyContin®), and hydrocodone.
How they work
Opioids work by binding to opioid receptors in the brain and spinal cord, blocking pain signals. This not only reduces the perception of pain but also changes the emotional response to pain.
Benefits
Opioids can provide significant short-term relief for severe pain, helping people with arthritis perform daily activities more comfortably. They are often used when other pain medications do not provide sufficient relief. Opioids should not be used to treat a person’s underlying disease.
Side effects and risks
Opioids carry a high risk of side effects and potential for addiction and dependence. Common side effects include drowsiness, constipation, nausea, and dizziness. Long-term use can lead to tolerance, requiring higher doses to achieve the same effect, and withdrawal symptoms if the medication is stopped abruptly.
Safe use
Due to the risk of addiction, opioids should be used under strict medical supervision. Doctors usually recommend the lowest effective dose for the shortest possible time. Patients should be regularly evaluated for signs of misuse, and alternative pain management strategies should be considered whenever possible.
Steroids
Steroids, also known as corticosteroids or glucocorticoids, are medications that help control inflammation and immune responses in the body. They are commonly used to treat various forms of inflammatory arthritis, including rheumatoid arthritis (RA), systemic lupus erythematosus (lupus), vasculitis and similar serious inflammatory conditions.
Steroids are natural chemicals produced by the adrenal glands, which are located above the kidneys. The body produces more of these chemicals, specifically glucocorticoids, during the day when people are active. These glucocorticoids include cortisone and hydrocortisone, which play a crucial role in controlling metabolism. Metabolism is the process that allows the body to grow, function, repair tissues, and produce energy.
It's important to separate between the steroids used to treat arthritis and anabolic steroids. Anabolic steroids are variations of the male hormone testosterone and were first created in the 1950s. They are not the same as the prescription steroids used to manage arthritis.
How they work
Low-dose steroids can be used as a “bridge” therapy in early inflammatory arthritis or for disease flare management. The lowest effective dose for the shortest time should be used, and tapering should occur as soon as symptoms are under control. Steroids can be taken as tablets, injections, or through an intravenous (IV) drip.
When reducing a steroid dose, doctors recommend a gradual reduction to allow the body to adjust to producing steroids naturally again. If you are advised to stop, your rheumatologist will ask you to let them know if you feel more tired, dizzy or sick when you are not taking the steroid medication. These symptoms may mean you have adrenal insufficiency, so your rheumatologist will ask you to start taking your steroid medication again while they plan extra checks for you.
Benefits
Steroids can be very useful in three important ways:
- at disease onset to quickly suppress inflammation;
- at the early stage of medication treatment, either in pill form while DMARDs build up effectiveness;
- as a joint injection in a problematic joint(s);
- an occasional intramuscular or intravenous dose.
Possible side effects
Steroids are used sparingly for inflammatory arthritis due to their potential side effects. Short-term use or injections of steroids can cause mild effects such as temporary red flushing of the face, a metallic taste in the mouth, hyperactivity, tiredness, mood changes, and blurred vision. When steroids are administered through an infusion into a vein, hypertension (raised blood pressure) may occur but usually settles by slowing the infusion rate.
Joint injections of steroids also carry some risks, though they are rare with good technique. These can include the risk of joint infection, temporary red flushing of the face, slight swelling of the face, increased calcium deposits around the injected joint, a temporary increase in insulin dose for diabetics, small skin depressions or color changes near the injection site, and pain following the injection.
Long-term use or higher doses of steroids can lead to significant side effects, including immune system suppression, which increases the risk of infections. Steroids can also suppress the signs of infection. It is essential to seek medical advice at the first sign of an infection. Other potential side effects of prolonged steroid use include the development of diabetes, thinning of the bones (osteoporosis), and weight gain, particularly in the face.
Safe use
Regular monitoring and medical supervision are crucial to managing the possible side effects and risks listed above effectively.
Arthritis Consumer Experts
ACE thanks Arthritis Research Canada (ARC) for its scientific review of ACE and JointHealth™ information and education programs.