What Is the Most Effective Medication for Arthritis? A Doctor Reveals the Safest Options That Work
Find out which prescription option has significantly lower risk of GI issues than over-the-counter meds
If your joints are extra achy at this time of year, you’re in good company. Wintery and wet weather can trigger flare-ups for the 53 million American adults dealing with arthritis, a condition that can cause pain and swelling in virtually any body part that bends. It gets bad enough that many of us reach for over-the-counter meds or go to our doctors for a prescription. But are we taking the option most likely to offer relief? And how do we minimize the risk of scary side effects? Once you know the answers, you can manage arthritis confidently and safely, says Nora Singer, MD, a Case Western Reserve University rheumatology expert.
Osteoarthritis vs. rheumatoid arthritis: What’s the difference?
Osteoarthritis, a.k.a. ‘ordinary’ arthritis symptoms
There are actually over a dozen types of arthritis, from rare forms that affect the spine to gout in our toes, but up to 70 percent of us have the same kind. “Osteoarthritis is the most common type of arthritis, in which the cartilage in your joints slowly wears away from years of wear and tear,” says Blen Tesfu, MD, a women’s health advocate and medical advisor for Welzo. Risk increases with age, injury, excess weight and repetitive use of joints (for example, jogging, playing the piano or knitting). “There is frequently an inflammatory component that is often under-recognized,” says Dr. Singer. Which means inflammatory compounds linked to stress and processed food can make osteoarthritis worse.
Key symptoms:
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- Joint pain with activity
- Morning stiffness that improves within 30 minutes
- Grinding or clicking sensation in affected joints
(If you have different symptoms like warm/tender joints and morning stiffness that lasts over an hour, keep scrolling to the rheumatoid arthritis section for tips that can dramatically reduce your suffering.)
Autoimmune, a.k.a. rheumatoid arthritis symptoms
Symptoms of autoimmune or rheumatoid arthritis include:
- Swollen, warm, tender joints (rather than the “creaky” joints of osteoarthritis)
- Morning stiffness lasting over an hour
- Fatigue
Best medications for osteoarthritis
From what you eat to your sleep position, there are lots of drug-free ways to ease the ache of this type of arthritis. Staying active, avoiding ultra-processed food (which tends to worsen inflammation) and keeping your weight down (since added weight means added pressure, plus fat cells secrete inflammatory compounds) can also have a big impact, says Dr. Singer. Try natural options first, since they often work well and typically have no side effects. But if you do need something stronger, here’s where to start.
The standard treatment: NSAIDs
That’s short for non-steroidal anti-inflammatory drugs, says Dr. Singer. This category includes over-the-counter ibuprofen (Advil) and naproxen (Aleve) plus prescription-only options like diclofenac (Voltaren, Pennsaid) and celecoxib (Celebrex). They all work by partially blocking the production of chemicals that make joints sore and swollen.
How to avoid NSAID side effects
If you take too much or take them for a long time, NSAIDs can cause stomach ulcers or bleeding, increased blood pressure, a higher risk of heart attack or stroke and kidney problems.
“However, many of these risks are often preventable by taking NSAIDs in the lowest dose that will still be effective and for as short a time as possible,” says Dr. Tesfu. Listen to your body and only take the minimum amount you need.
Another great tip: Ask your doctor about diclofenac gel, which you rub on affected areas. “Topical treatments can lower the amount of drug absorbed into the bloodstream,” adds Dr. Tesfu.
Also key: While it may seem more convenient to take over-the-counter meds, a Harvard-led study found osteoarthritis patients on prescription celecoxib/Celebrex showed a 32% lower risk of gastrointestinal events compared to ibuprofen. And findings in the New England Journal of Medicine show celecoxib has similar or better cardiovascular safety compared to ibuprofen.
If you need something stronger
For some of us, osteoarthritis has a stronger inflammatory component, and in those cases, “there is some evidence that methotrexate at lower doses may help,” says Dr. Singer. Often sold as Rheumatrex, this drug is most commonly used to treat autoimmune arthritis. Dr. Singer notes that this is an “off-label” use of the drug, which does have potential side effects (more on that below). But at low doses and with proper precautions, you may avoid them. So if your pain is not well-managed with NSAIDs, you can speak to your doctor about this possibility.
Best medications for rheumatoid arthritis
Among postmenopausal women with painful joints, anywhere from 12 percent to 15 percent have rheumatoid arthritis, “a chronic inflammatory autoimmune disease, in which the body’s immune system attacks its own tissue,” notes Dr. Tesfu. Scientists aren’t entirely sure what causes rheumatoid arthritis or RA to develop, but being a woman and having a family history make you more likely to get it.
As with all meds, you can limit the risk of side effects by trying natural approaches to reduce symptoms and severity. “Smoking and periodontal disease both predispose women to RA, and patients who have those risk factors tend to have worse arthritis than non-smokers and those with good oral health,” says Dr. Singer. “So, stopping smoking and visiting the dentist regularly are both important.” There’s also evidence that the famous Mediterranean Diet may help.
That said, “the earlier we treat RA, the more effective the treatment appears to be,” says Dr. Singer. So if you have or suspect RA, see a doctor as soon as you can.
The gold-standard treatment: methotrexate
“Methotrexate is commonly used as a first-line option in RA treatment,” says Dr. Tesfu. The drug works by suppressing the immune system, which helps keep it from attacking joints.
How to avoid methotrexate side effects
Suppressing the immune system increases the risk of infections; methotrexate can also lower levels of folic acid, which can lead to blood clots, says Dr. Singer. And the drug can be tough on the liver. First steps to protect yourself? Wash your hands often and take a folic acid supplement as directed by your doctor. It’s also smart to go easy on your liver by limiting sugary and processed foods and steering clear of alcohol.
If you need something stronger
“Biologics can be added,” says Dr. Tesfu. The American College of Rheumatology guidelines suggest starting with one a TNF-a inhibitor (like Humira). If that fails, there are also more potent/risky drugs (like IL-6 inhibitors and B-cell and T-cell modulators). “Biologics can help stop or delay the progression of RA rather than simply treating the symptoms.” Some call the effect life-changing. But they block specific parts of the immune system and come with a higher risk of serious infections than methotrexate, so use the same precautions as with the less risky drugs, stay up to date on vaccines and follow your doctor’s instructions closely.
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