What is the best painkiller for osteoarthritis?

For knee osteoarthritis, guidelines suggest starting with a topical NSAID gel like diclofenac, since it relieves pain with less risk than pills. Oral NSAIDs like ibuprofen or naproxen work for many joints but should be used at the lowest dose for the shortest time. Acetaminophen helps less but is an option if you cannot take NSAIDs. There is no single best choice: it depends on the joint and your other health conditions.

Does exercise make osteoarthritis worse?

No. Appropriate exercise is one of the most strongly recommended osteoarthritis treatments. It strengthens the muscles that support the joint and reduces pain, and it does not wear out the cartilage. Walking, cycling, swimming, tai chi, and gentle strength training are all reasonable. Some soreness when starting is normal, but sharp or worsening joint pain means you should adjust the activity.

Do gel or hyaluronic acid injections work for knee arthritis?

The evidence is weak. In the highest-quality trials, hyaluronic acid gel injections perform about the same as a saline placebo, so the ACR and Arthritis Foundation recommend against them for knee and hip osteoarthritis. Steroid injections, by contrast, are recommended for short-term flare relief.

Should I take glucosamine and chondroitin?

Major guidelines recommend against them for osteoarthritis pain, and NIH's NCCIH says it is still uncertain whether they help. A 2018 analysis found no benefit from the combination versus placebo. They are generally considered safe but unlikely to relieve pain, so money is often better spent on exercise or physical therapy. Check with your clinician or pharmacist about interactions, such as with blood thinners.

How much weight do I need to lose to help my knees?

Even modest loss helps. For people who are overweight or obese with knee or hip osteoarthritis, guidelines strongly recommend weight loss, and roughly a 5% reduction in body weight produces a noticeable drop in pain. Each pound off reduces the multiplied load across the knee.

When should I see a doctor about joint pain?

See a clinician for joint pain, swelling, or stiffness lasting three or more days, or several episodes in a month. Seek urgent or emergency care if a joint becomes suddenly and intensely swollen, red, warm, and painful, especially with fever or chills, because that can signal a joint infection rather than ordinary osteoarthritis.

Rheumatology

Osteoarthritis Joint Pain: What Helps, What Doesn't

A rheumatologist's plain-language guide to osteoarthritis: which treatments the evidence supports, what to skip, and when joint pain needs urgent care.

Shante Hinson, MD, Rheumatology

Osteoarthritis in plain language

Osteoarthritis (OA) is the "wear-and-repair" form of arthritis, where the cushioning cartilage in a joint gradually breaks down, most often in the knees, hips, and hands. The good news is that the treatments with the strongest evidence are things you can start on: moving more, losing a little weight, and using the right pain medicine for the right joint. This guide sorts what actually helps from what the research does not support, drawing on the 2019 American College of Rheumatology and Arthritis Foundation osteoarthritis guideline.

Osteoarthritis is the most common form of arthritis in U.S. adults, about 49.6% of all diagnosed arthritis, or roughly 33.2 million people, so if you have it, you are far from alone. It is a different disease from osteoporosis (thinning bones) and from rheumatoid arthritis (an autoimmune disease).

Key takeaways

Exercise is one of the strongest evidence-based treatments and does not wear the joint out; walking, cycling, strength work, and water exercise all count.
Losing even about 5% of body weight meaningfully reduces knee and hip pain, because the load on your knee is a multiple of your body weight.
For knee OA, a topical NSAID gel is first-line and safer than pills; oral NSAIDs work but carry stomach, heart, and kidney risks.
Steroid injections help short-term, but hyaluronic acid ("gel") injections are not recommended for knee or hip OA.
Glucosamine and chondroitin supplements are not supported for OA pain.

What helps

Move the joint, don't rest it

Many people worry that exercise will grind the joint down faster. It does the opposite. The guideline gives exercise a strong recommendation for hand, hip, and knee OA, the same strength it gives to oral NSAIDs. No single type wins: walking, cycling, strength training, and aquatic exercise all qualify, so pick what you enjoy and can do safely. Exercise strengthens the muscles that support the joint and reduces pain over time. Some soreness when you start is normal; sharp or worsening joint pain is a sign to ease off and adjust.

Lose a little weight

For people who are overweight or obese with knee or hip OA, weight loss earns a strong recommendation. Because each step sends several times your body weight through the knee, even a modest loss pays off: roughly 5% of your body weight produces a noticeable drop in pain. Pairing weight loss with an anti-inflammatory eating pattern can make the effort easier to sustain.

Use the right pain medicine for the joint

For knee OA, topical NSAIDs like diclofenac gel are first-line. Because the medicine is absorbed through the skin rather than swallowed, far less reaches the rest of your body, which makes it safer, especially if you are 75 or older or have stomach, heart, or kidney concerns.

Oral NSAIDs (ibuprofen, naproxen) also get a strong recommendation and are the main oral option, but use the lowest effective dose for the shortest time because of bleeding, heart, and kidney risks. Acetaminophen (Tylenol) is only conditionally recommended, with modest benefit, and is mainly for people who cannot take NSAIDs.

Injections that work, and the ones to think twice about

Steroid (corticosteroid) injections get a strong recommendation for short-term knee relief, which makes them useful during a bad flare. They are not for unlimited repeat use, so talk with your clinician about how often is safe. Hyaluronic acid "gel" injections are a different story, covered below.

Helpful add-ons that are core, not "alternative"

Several non-drug options carry a strong recommendation: tai chi for knee and hip OA, self-management education programs, using a cane if you have lower-limb OA, a thumb-base brace for hand OA, and a knee brace for the right kind of knee OA. These are part of good care, not fringe extras.

What doesn't help (or isn't worth the money)

Hyaluronic acid ("gel") injections

For knee and hip OA, hyaluronic acid injections are conditionally recommended against. In the highest-quality trials, the effect versus a saline placebo approaches zero. Steroid injections remain a better bet for short-term relief.

Glucosamine and chondroitin supplements

The guideline strongly recommends against glucosamine (and against chondroitin for knee and hip OA) because the evidence shows no important benefit over placebo. NIH's National Center for Complementary and Integrative Health (NCCIH) agrees it is uncertain whether they help knee osteoarthritis, with a 2018 analysis finding no benefit from the combination. They are generally safe, but the money is usually better spent on exercise or physical therapy. Ask your clinician or pharmacist about interactions, such as with blood thinners.

When to seek urgent care

A hot, swollen joint is not always an OA flare. A joint infection, called septic arthritis, is a medical emergency that can destroy cartilage within days. Seek same-day or emergency care if a single joint becomes suddenly and severely swollen, red, warm, and painful, especially with fever or chills. This is the most important red flag to tell apart from ordinary osteoarthritis.

For less dramatic symptoms, see a clinician for joint pain, swelling, or stiffness lasting three or more days, or several episodes in a month. A joint that locks, gives way, or will not bear weight also needs evaluation rather than self-diagnosis. Our rheumatology team can confirm what is going on and build a plan around the treatments that actually work.

Medical disclaimer

This article is for general information and is not a substitute for professional medical advice. Talk to your clinician about your specific situation.

Ready to get ahead of your joint pain?

You do not have to guess which treatments are worth your time. Our rheumatology team can pinpoint what is driving your osteoarthritis and match you with the options the evidence supports. Book an appointment with Morningside Medical today.