Osteoarthritis: Management, Medications, and Treatment Options

If you’re living with osteoarthritis (OA) , your doctor will create a treatment plan to help you manage your joint pain and swelling. Unfortunately, there’s currently no cure for osteoarthritis, but there are several treatment options to help control inflammation, alleviate pain, and improve your mobility.

While there aren’t any therapies specifically for treating osteoarthritis, your doctor may prescribe a combination of oral and topical medications, exercise, surgery, and/or home remedies.

Anti-Inflammatory Medications for Osteoarthritis

One of the most common treatments for osteoarthritis is oral treatment with nonsteroidal anti-inflammatory drugs (NSAIDs).1 They work by blocking cyclooxygenase (COX) enzymes that contribute to inflammation, pain, and swelling. Examples of over-the-counter (OTC) NSAIDs include ibuprofen (Advil®, Motrin®) and naproxen sodium (Aleve®). Your doctor may also write a prescription for celecoxib (Celebrex®), an NSAID that specifically blocks the COX-2 enzyme.2

NSAIDs are generally safe medications, but they are associated with some unwanted side effects, including:3

  • Nausea and vomiting
  • Heartburn
  • Bloating and gas
  • Stomach pain
  • Diarrhea or constipation

There’s also an increased risk of stomach or gastrointestinal bleeding when taking NSAIDs. Do not take an NSAID when taking a blood thinner or if you have a history of stomach ulcers or bleeding. Studies show that NSAIDs raise the risk of heart attack or stroke, especially in people with other underlying health conditions like diabetes, high blood pressure, or high cholesterol. It’s best to avoid taking NSAIDs for an extended period of time to avoid these side effects.

Your doctor may prescribe acetaminophen (Tylenol®) if it’s unsafe for you to take NSAIDs. It’s important to note that acetaminophen isn’t an NSAID, and it can’t help treat inflammation or swelling, but it can relieve joint pain.4

Duloxetine for Osteoarthritis

If your osteoarthritis doesn’t improve with NSAIDs or pain relievers or if you can’t tolerate them, your doctor may prescribe the antidepressant medication duloxetine (Cymbalta®). It was approved by the U.S. Food and Drug Administration in 2010 to treat chronic back and knee pain from osteoarthritis.5

Duloxetine is a selective norepinephrine reuptake inhibitor (SNRI). It works by influencing levels of the neurotransmitter norepinephrine, a chemical in the brain thought to play a role in pain signaling. For this reason, duloxetine is also used to treat fibromyalgia and diabetic nerve pain.6

Common side effects of duloxetine include:

  • Nausea
  • Dry mouth
  • Constipation
  • Drowsiness or fatigue
  • Dizziness

Topical Treatments for Osteoarthritis

NSAID medications are also available in topical sprays, creams, ointments, or patches applied to the skin over an affected joint. Studies show that ibuprofen and diclofenac (Voltaren) are the most effective topical NSAIDs. Other ingredients that may provide pain relief include:7

  • Capsaicin — Creates a mild burning or tingling sensation and blocks pain signals; works best for knee osteoarthritis pain
  • Lidocaine — Creates a cool, numbing sensation and blocks pain signals but can’t treat inflammation
  • Menthol or camphor — Known as counterirritants, they create a soothing, cooling sensation but don’t address inflammation or pain

Topical treatments are typically associated with mild side effects like skin redness, irritation, or itching. It’s best to avoid using heating pads or tight bandages when using counterirritants.

Corticosteroid Injections for Osteoarthritis

Corticosteroids are synthetic or laboratory-made hormones that mimic the effects of cortisol, an anti-inflammatory hormone found in the body. Your doctor may perform a corticosteroid injection directly into an affected joint like the knee, spine, or hip to help relieve pain, swelling, and inflammation.8

Injections are typically performed in your doctor’s or rheumatologist’s office. They’ll numb the area with an anesthetic cream or spray, then use an X-ray or ultrasound to guide the needle into the affected joint. The corticosteroid may be mixed with an anesthetic drug to offer pain relief immediately. The effects can last anywhere from a few weeks to up to 6 months.9

Repeated injections into joints can further damage the cartilage and make symptoms worse. Most people receive a maximum of three to four injections per year. If your symptoms don’t improve after corticosteroid injections, you’ll likely need surgery.

Surgery for Osteoarthritis

In severe cases of osteoarthritis with widespread joint or bone damage, your doctor or rheumatologist may recommend surgery.10 They’ll take into consideration how severe your pain is and the affected joints along with your age, occupation, and how much your osteoarthritis interferes with your daily life. Two types of surgery for osteoarthritis include a partial or total joint replacement and an osteotomy.

Joint replacement surgery involves removing the damaged joint and replacing it with a metal, ceramic, or plastic prosthetic device.11 Joint replacements are most common for the knees and hips, but they can also be done to treat the elbows, shoulders, wrists, or ankles.

Osteotomy is a procedure that reshapes bones in affected joints to treat pain and help patients regain function. An osteotomy is performed in the early stages of knee or hip osteoarthritis before lasting joint and bone damage can occur.12,13 During the procedure, your surgeon will remove or replace damaged portions of the joint and reinforce it with a plate and screws.

As with any surgery, there’s an increased risk of infection and blood clots in deep veins in the body (known as deep vein thrombosis or DVT). Your doctor and surgeon will discuss the risks and benefits with you to help you make the best decision for your health.

At-Home Remedies for Osteoarthritis

In addition to your medications, topical therapies, or surgery, your doctor will likely recommend at-home remedies you can try for added relief from pain and swelling. Examples include:5,10

  • Heat or cold therapy: Taking a warm bath or using a heating pad or a cold pack can help temporarily alleviate pain and stiffness
  • Exercise: Regular exercise can help improve muscle strength, stabilize your joints, and enhance flexibility; gentle, low-impact exercises like swimming or riding a stationary bike are best
  • Eating a healthy diet: A healthy diet can help you better manage your weight and take extra pressure off of your knee and hip joints; losing weight may also help reduce inflammation associated with obesity

The Future of Osteoarthritis Treatments

Doctors and researchers continue to research and develop new ways to treat osteoarthritis through clinical trials. Clinical trials are large, controlled studies that help investigators study their new treatment in people with osteoarthritis to learn more about its safety and efficacy. They also help investigators learn how patients use new tools and technologies to live better with osteoarthritis.