Nonsteroidal anti-inflammatory drugs (NSAIDs) are a large group of medications used to help reduce joint pain, swelling and inflammation. NSAIDs are available over the counter and by prescription. For patients with knee osteoarthritis who experience moderate or severe pain and signs of inflammation, the American College of Rheumatology recommends NSAIDs as an alternate initial therapy to acetaminophen. Aspirin is the most common NSAID. Other examples of NSAIDs are ibuprofen (Advil, Motrin IB), ketoprofen (Actron, Orudis KT, Oruvail), naproxen (Naprosyn, Naprelan) and naproxen sodium (Anaprox, Aleve).

NSAIDs also include the class of drugs called COX-2 inhibitors, which are much like traditional NSAIDs but formulated to be safer for the stomach. At present, the only COX-2 inhibitor available is celecoxib (Celebrex). Two others were removed from the market when they were found to increase the risk of cardiovascular events.

NSAIDs work by stopping the production of chemicals called prostaglandins that occur naturally in the body and are involved in inflammation.

Corticosteroid injections – Corticosteroids are drugs related to the naturally occurring hormone in your body called cortisone. In some cases your doctor may inject these drugs into a painful joint for fast, targeted relief. When fluid builds up in a knee with osteoarthritis, the doctor may drain fluid from the knee and then inject a corticosteroid medication. The American College of Rheumatology (ACR) recommends corticosteroid injections as an alternate initial therapy for patients who have moderate to severe knee pain and signs of inflammation and who do not get relief from acetaminophen. You can have corticosteroid injections in the same joint three to four times per year.

Hyaluronic acid therapy – Hyaluronic acid occurs naturally in joint fluid, acting as a shock absorber and lubricant, allowing joints to move smoothly over each other. However, the acid appears to break down in people with osteoarthritis. Injecting it into a joint it may lessen pain and inflammation. The injections are given weekly for three or five weeks, depending on the product (examples are Synvisc and Hyalgan). A small amount of joint fluid is removed first to make room for the hyaluronic acid.

According to ACR guidelines, Hyaluronic acid therapy may be helpful to patients who have inadequate response to NSAIDs or COX-2 drugs, or who have experienced adverse side effects from these drugs. Clinical trails have shown that the injections may provide pain relief for people with mild to moderate osteoarthritis of the knee. It is not know whether the injections are helpful for other joints.