How Arthritis Is Treated

Arthritis cannot be cured, but an effective arthritis treatment plan can help you manage the disease. The goals of arthritis treatment are to control pain and other symptoms, minimize joint damage and deformities, slow the progression of the disease, and preserve physical functioning.

There are several types of arthritis, and there are specific treatments for each type. Arthritis treatment options include medication, lifestyle changes, joint injections, surgeries, and more. You will likely need a combination of treatments, and your regimen may need to change over time.

It is important to discuss treatment with a healthcare provider to ensure you are getting the care appropriate for your type of arthritis.

Over-the-Counter (OTC) Therapies

Pain relief is one of the primary goals of arthritis treatment, and most healthcare providers recommend starting with OTC options for pain.

Commonly recommended treatments include:

• Tylenol (acetaminophen) has fewer side effects than some of the other OTC medications, but it doesn't help reduce inflammation. You must be careful not to take more than 3,000 milligrams (mg) per day; there isn't much leeway between a therapeutic dose and a toxic one that can permanently damage your liver.
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as Bayer (aspirin), Motrin (ibuprofen), and Aleve (naproxen) can also be used for pain relief. If you are taking large amounts of these or using them for a long period of time, you should talk to your healthcare provider and be monitored for side effects.

OTC treatments that are not taken by mouth:

• Topical skin creams are another option. Some creams contain NSAIDs, such as diclofenac, or Voltaren gel. Zostrix (capsaicin/menthol) skin cream contains capsaicin, the natural ingredient that makes peppers hot.
• Transcutaneous electrical nerve stimulation (TENS) may also help with pain relief. While some units are available OTC, others may require a prescription to obtain them and/or to have them covered by insurance.

Prescriptions

Different types of arthritis are treated with different medications. The severity of your symptoms may also influence whether prescription medication is needed. Talk to a healthcare provider about what medications are appropriate for your type of arthritis and its severity.

Drug classes used to treat arthritis include the following.

NSAIDs/COX-2 Inhibitors

Prescription-strength NSAIDs are among the most commonly prescribed and widely used arthritis drugs. They work to relieve inflammation and pain. The three types include salicylates, NSAIDs, and COX-2 selective inhibitors.

NSAIDs work by blocking the activity of the enzyme cyclooxygenase, also known as COX. COX-1 is involved in maintaining healthy tissue, while COX-2 is involved in the inflammatory pathway. NSAIDs affect both forms. Celebrex (celecoxib) is a selective inhibitor and is the only one currently available in the United States.

Common prescription NSAIDs used to treat arthritis symptoms:

• Feldene (piroxicam)
• Indocin (indomethacin)
• Mobic (meloxicam)
• Clinoril (sulindac)
• Dolobid (diflunisal)
• Relafen (nabumetone)

Side Effects

NSAIDs can have side effects such as indigestion, nausea, and ulcers. With the exception of aspirin, NSAIDs and COX-2 selective inhibitors can also significantly increase the risk of heart attack and stroke. Many of the COX-2 selective inhibitors were removed from the marketplace due to this concern. And all NSAIDs can result in kidney damage.

Analgesics (Pain Medications)

Analgesics are pain-relieving drugs that do not relieve inflammation. Acetaminophen is the most commonly used analgesic, and it may be found in some prescription medications.

Cymbalta (duloxetine HCl), a drug originally approved by the Food and Drug Administration (FDA) for the treatment of fibromyalgia, is also approved for the treatment of chronic musculoskeletal pain stemming from osteoarthritis and other causes.

According to the Arthritis Foundation, 20% to 30% of people with rheumatoid arthritis also develop fibromyalgia. In these situations, Cymbalta or another fibromyalgia drug—like Lyrica (pregabalin) and Savella (milnacipran HCl)—may be prescribed along with arthritis medication.

Narcotic analgesic drugs may also be prescribed for severe pain. They can cause drowsiness, nausea, constipation, abnormally shallow breathing, and euphoria. Older adults are more prone to these effects. There is also a risk of drug tolerance, dependence, addiction, and withdrawal.

Narcotics include Tylenol #3 (acetaminophen/codeine), OxyContin (oxycodone), Percodan (oxycodone/aspirin), Vicodin (hydrocodone/acetaminophen), and several others.

Corticosteroids

Corticosteroids reduce swelling and inflammation quickly. Joint pain is sometimes the result of inflammation. Potent antiinflammatory agents may be needed as a chronic therapy.

Corticosteroids are commonly prescribed for inflammatory types of arthritis such as lupus, rheumatoid arthritis, polymyalgia rheumatica, and vasculitis. They have the potential for serious side effects when taken at high doses or over a long period. Healthcare providers may prescribe short-term, high-dose intravenous steroids in some situations.

Examples of corticosteroids used for treating inflammatory arthritis include Deltasone (prednisone) and methylprednisolone (Medrol).

Local steroid injections can be used for managing inflammation in a specific, painful joint.

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

DMARDs are slow-acting anti-rheumatic drugs that help stop disease progression and joint damage in certain forms of arthritis. They often take weeks or months to work. DMARDs are used for treating rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.

Common DMARDs include methotrexate and Plaquenil (hydroxychloroquine). Sometimes biologics are prescribed if there is an inadequate response to traditional DMARDs.

Biologic Response Modifiers (Biologics)

Biologics are most often used to treat RA when conventional DMARDs have not given a satisfactory response. They can be given by injection or infusion (via an IV). JAK inhibitors (Xeljanz, Olumiant) and Otezla are oral.

TNF blockers are one class of biologics that interfere with inflammatory activity. They include Enbrel (etanercept), Remicade (infliximab), Humira (adalimumab), Cimzia (certolizumab pegol), and Simponi (golimumab).

Another type is Orencia (abatacept), a T-cell co-stimulation modulator. Rituxan (rituximab) is used in combination with methotrexate to treat rheumatoid arthritis, targeting one type of immune cell. Actemra (tocilizumab) is a monoclonal antibody that inhibits the interleukin-6 (IL-6) receptor. Two major concerns with these drugs include the risk of serious infection or lymphoma.

Krystexxa (pegloticase) is a biologic drug that works by breaking down uric acid and is used in treating gout.

Surgeries and Specialist-Driven Procedures

Viscosupplementation is a procedure that involves the injection of gel-like substances (hyaluronates) into a joint (currently approved for the knee) to supplement the viscous properties of synovial fluid.

Joint surgery can be considered when severe joint damage and pain interfere with daily activities.

Surgical options include:

• Arthrodesis (fusion)
• Arthroscopy
• Osteotomy
• Joint replacement
• Revision joint replacement
• Resection
• Synovectomy
• Partial knee replacement

Home Remedies and Lifestyle

Regular exercise can reduce pain and improve physical function, muscle strength, and quality of life for people with arthritis, and it is strongly recommended for people who have arthritis. While it can be difficult to be motivated to exercise when you are having symptoms such as pain or fatigue, choosing the right exercise that you also enjoy can make a big difference in your quality of life.

Eating a nutritious diet is important for maintaining ideal weight and for bone health. There is no known diet that can cure arthritis, so you can start by following the basics of healthy eating; you may also benefit from incorporating anti-inflammatory foods.

Reducing stress may also help calm the pain and stiffness associated with arthritis. Being under stress can heighten your pain perception. A study also found that psychological stress was associated with flares and relapse in people with rheumatoid arthritis.

Home remedies to manage pain and stiffness can help you keep it from interfering with daily living. You can try tactics such as cryotherapy (cold packs), heat therapy or warm water therapy (especially for stiffness), or self-massage. Beware of folk remedies.

Assistive devices can help protect your joints and make it easier for you to go about your day. Look into canes, walkers, raised toilet seats, grabbers, and other helpful devices.

Complementary and Alternative Medicine (CAM)

If you prefer a natural approach to treating arthritis or would like to explore complementary options, it's imperative that you tell your healthcare provider what you want to try (or are already using). There are many alternative treatment options that, while popular, are not verified for effectiveness and safety.

The National Center for Complementary and Integrative Medicine, a division of the National Institutes of Health (NIH), reports on the effectiveness of some CAM treatments for arthritis:

• Acupuncture and acupressure: Studies have not shown clear evidence of a beneficial effect as a treatment of rheumatoid arthritis. But as practiced in the U.S., it may help some patients with knee osteoarthritis manage their pain.
• Biofeedback and relaxation techniques: Some small studies have been promising for managing symptoms of rheumatoid arthritis.
• Magnets: Static magnets have not been shown to have any effect on osteoarthritis. Electromagnetic field therapy is still being explored.
• Massage therapy: There have been studies demonstrating the benefits of massage in hand arthritis and knee osteoarthritis.
• Meditation: Some studies have found mindfulness meditation to be helpful in managing symptoms of pain and in helping patients cope with their condition.
• Tai chi: Studies have found tai chi to be beneficial for well-being in osteoarthritis patients and rheumatoid arthritis patients.
• Yoga: Yoga should be a beneficial form of exercise for people with arthritis, but modifications may be needed to minimize joint stress.
• Omega-3 fatty acids (fish oil): A 2017 review of studies found some favorable effects on pain for patients with rheumatoid arthritis.
• Glucosamine and chondroitin: After much study, it appears chondroitin doesn't help osteoarthritis pain, and it's unclear as to whether glucosamine has any effect. Neither is recommended by the American College of Rheumatology.

Can Diet Help Treat Arthritis?

Research suggests that following an anti-inflammatory diet can reduce osteoarthritis and rheumatoid arthritis symptoms. A healthy diet can also lead to weight loss, which reduces stress and strain on joints. Gout, a form of metabolic arthritis, can be relieved by avoiding purines (such as alcohol and seafood) that can trigger gout flares.

A Word From Verywell

The Arthritis Foundation recommends seeing a healthcare provider if you have joint pain, stiffness, or swelling persisting for two or more weeks, whether or not your symptoms began suddenly or gradually. Only a healthcare provider can diagnose arthritis. An accurate diagnosis is needed so that appropriate treatment can begin. A rheumatologist (arthritis specialist) will help you understand all of your options—their benefits and their risks.