The right arthritis treatment depends on the type you have and how severe your symptoms are, but most people start with over-the-counter pain relievers, topical creams, or lifestyle changes before moving to prescription options. Osteoarthritis and rheumatoid arthritis are the two most common forms, and they call for different approaches. Here’s what works, what doesn’t, and what to weigh before choosing.
Over-the-Counter Pain Relievers
For most people with osteoarthritis, oral anti-inflammatory drugs like ibuprofen and naproxen are the go-to starting point. These reduce both pain and swelling, and shorter-acting versions of these drugs are preferred for most patients. The general principle is to use the lowest dose that controls your pain for the shortest time you need it. If one type doesn’t help after about two weeks of consistent use, switching to a different anti-inflammatory in another chemical class is reasonable, since people respond differently.
Acetaminophen (Tylenol) is another option, though it only addresses pain without touching inflammation. It’s gentler on the stomach and kidneys, which makes it a better fit for people who can’t tolerate anti-inflammatories. But for the joint swelling that drives much of arthritis pain, anti-inflammatories tend to do more.
The tradeoff with anti-inflammatories is real: they can increase the risk of heart attack and stroke, and this applies whether or not you already have heart disease. Serious side effects can show up as early as the first few weeks of daily use, and the risk climbs the longer you take them. They can also damage the stomach lining and strain the kidneys. For older adults or anyone with cardiovascular, gastrointestinal, or kidney problems, these drugs need to be used cautiously, at lower doses, or avoided entirely.
Topical Creams and Gels
If your arthritis is in your hands or knees, topical anti-inflammatory gels are worth trying before oral versions. Diclofenac gel and ketoprofen gel are the best-studied options, and UK clinical guidelines actually recommend them ahead of oral anti-inflammatories for hand and knee osteoarthritis. They work by delivering the drug directly through the skin to the inflamed joint underneath.
The pain relief is real but modest. About 1 in 5 to 1 in 10 people get their pain cut by at least half over 6 to 12 weeks. That sounds underwhelming, but the safety profile is significantly better than swallowing the same drugs. Upper gastrointestinal bleeding rates are low with topical anti-inflammatories, and the heart and kidney risks associated with oral versions are less of a concern. For arthritis in joints close to the skin surface, topicals give you a meaningful shot at pain relief with fewer systemic side effects.
Capsaicin cream, made from chili peppers, is another topical option. It works by desensitizing pain nerve endings in the skin over time. It requires consistent application (usually three to four times daily) and causes a burning sensation for the first week or two before that fades. It’s not as well-supported by evidence as topical anti-inflammatories, but some people find it helpful as an add-on.
Cortisone Injections
When a single joint is flaring badly, a cortisone shot delivered directly into the joint can provide fast relief lasting weeks to months. These are especially common for knee, hip, and shoulder arthritis. The injection reduces inflammation at the source, and many people notice improvement within a few days.
The catch is that these can’t be repeated frequently. There’s concern that repeated cortisone shots damage cartilage over time, which would accelerate the very problem you’re treating. The number of shots you can safely get per year depends on the joint and the situation, but clinicians generally limit them. Side effects from repeated use include weakening of nearby tendons, thinning of surrounding bone, temporary blood sugar spikes, and short-term pain flares at the injection site. Cortisone shots work best as an occasional tool for bad flares rather than a long-term management strategy.
Prescription Drugs for Rheumatoid Arthritis
Rheumatoid arthritis is a different disease from osteoarthritis. It’s driven by an overactive immune system attacking your joint lining, and it requires medications that calm that immune response. These are called disease-modifying drugs, and they don’t just manage pain. They slow or stop the joint damage itself.
Traditional options work by broadly dialing down immune activity. Methotrexate is the most commonly used and is typically the first one prescribed. Others include hydroxychloroquine, leflunomide, and sulfasalazine. These take weeks to reach full effect, and they require regular blood monitoring since they suppress immune function.
Biologic drugs are a newer class that target specific parts of the immune system rather than suppressing it broadly. Some block a protein called TNF that drives inflammation. Others target different immune signaling molecules or specific immune cell types. Because they’re more targeted, they can be effective when traditional options fail, though they still carry infection risks from immune suppression.
JAK Inhibitors and Safety Concerns
A newer group of targeted drugs called JAK inhibitors works similarly to biologics but comes in pill form, which is more convenient than the injections biologics require. However, the FDA now requires its strongest warning label on these drugs. A large safety trial found that compared to TNF-blocking biologics, JAK inhibitors carried a higher risk of serious heart events, cancer (about 48% higher rate), blood clots, and death. The FDA now limits these drugs to patients who haven’t responded to or can’t tolerate TNF blockers. These remain an option, but they sit further down the treatment ladder than they once did.
Supplements: Glucosamine, Chondroitin, and Turmeric
Glucosamine and chondroitin are among the most popular joint supplements, but the evidence behind them is disappointing. A 2022 analysis pooling eight studies with nearly 4,000 people with knee osteoarthritis found no convincing evidence of major benefit. An earlier 2018 review found that these supplements produced small improvements on a pain scale, but it wasn’t clear the relief was meaningful in everyday terms. There’s also no strong evidence they protect cartilage or slow arthritis progression.
Perhaps most striking: a 2016 study of 164 people with knee osteoarthritis was stopped early because participants taking glucosamine and chondroitin actually reported worse symptoms than those taking a placebo. That doesn’t mean the supplements caused harm, but it underscores how weak the case for them is. Some people swear by them, and they’re generally safe, but you shouldn’t expect much based on what clinical research shows.
Turmeric (specifically its active compound curcumin) has anti-inflammatory properties in lab settings, but human evidence for arthritis relief remains limited and inconsistent. It’s not harmful in normal dietary amounts, but supplement doses can interact with blood thinners and other medications.
Weight Loss and Exercise
Losing weight is one of the most effective things you can do for arthritis in weight-bearing joints, and the math is striking. Every pound you lose removes 3 to 4 pounds of pressure from your knees and hips. Lose 10 pounds, and that’s 40 pounds of force your joints no longer absorb with every step. For people who are overweight, this alone can meaningfully reduce pain and slow cartilage breakdown.
Exercise helps through a different mechanism. Strengthening the muscles around a joint stabilizes it and absorbs shock that would otherwise hit the cartilage directly. Low-impact activities like swimming, cycling, and walking are joint-friendly options. Stiffness often feels worse when you first start moving, which makes the idea of exercise unappealing, but regular activity consistently reduces arthritis pain over time. Physical therapy can help you build a routine that strengthens the right muscle groups without aggravating inflamed joints.
Heat and cold therapy, while simple, can also help. Ice reduces swelling during flares, and heat loosens stiff joints before activity. Neither changes the underlying disease, but both can make daily movement more comfortable.