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Posts Tagged ‘Acetaminophen’

Arthritis Drugs

March 26, 2014

Arthritis Drugs

Arthritis drugs are usually what doctors prescribe to treat osteoarthritis.   Since people respond differently to different types of drugs it’s not always easy to predict how the medications will work.  Potential side effects and poor reactions have to be considered.  It’s not easy to find the right combination of drugs and medications to achieve optimum pain relief for any given patient.  If you have arthritis, you should know as much as possible about your treatment options so you can talk about it with your doctor.

NSAIDs (nonsteroidal anti-inflammatory drugs) are prescribed a lot to treat OA. NSAIDs work by fighting an enzyme called cyclooxygenase (COX). COX comes in two forms: COX-1 and COX-2. NSAIDs can treat COX-1 and COX-2

DMARDs (Disease-Modifying Anti-Rheumatic Drugs) can take weeks or months to start providing pain relief.  DMARDs may be slow acting but they work.  They treat conditions like rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.   These drugs can stop the progression of the disease and limit damage to the joints.

Corticosteroids are usually called “steroids”.  These are strong drugs that quickly reduce swelling and inflammation.   Doses can be all over the place depending on what’s being treated and how agressive the treatment plan is.   Harmful side effects are more likely at high doses or with long-term use.

Analgesics relieve pain. However, unlike NSAIDs, they don’t help with inflammation. Acetaminophen is  a common analgesic.

Cox II Inhibitor

Cox II Inhibitor

This blog post is one in a series of articles about the American Academy of Orthopedic Surgeons’ (AAOS) Full Guideline for Treatment of Knee Osteoarthritis.

Recommendation 14 – The AAOS suggests that patients with symptomatic osteoarthritis of the knee and an increased gastrointestinal risk (patients older than 60), multiple medical conditions, peptic ulcer disease, GI bleeding, concurrent corticosteroid and/or concomitant (at the same time) use of anticoagulants receive one of the following for pain relief:

  • Acetaminophen
  • Topical non steroidal anti inflammatory drugs (NSAIDs)
  • nonselective oral NSAIDs plus gastro-protective agent
  • Cyclooxygenase (Cox II inhibitors)

The AAOS reports that each of these treatment options for osteoarthritis of the knee has a reduced risk of GI complications when compared to the isolated use of oral NSAIDs.  The evidence does not say that one treatment options is more advantageous than another.



This blog post if one in a series of posts about the American Academy of Orthopedic Surgeons’ (AAOS) Full Guideline for the Treatment of Knee Osteoarthritis.

Recommendation 13 – The AAOS suggests that patients with osteoarthritis of the knee receive either acetaminophen or Non-steroidal anti inflammatory drugs (NSAIDs), unless there are contraindications to these drugs.

The research team looked at evidence suggesting that acetaminophen provides pain relief without a significant risk of toxicity to the patient.  The evidence further demonstrated that NSAIDs provide more pain relief than acetaminophen but with a greater risk of gastrointestinal complications.

This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.



Recommendation XIII

Acetaminophen or paracetamol can be an effective oral pain reliever for treatment of mild to moderate hip and knee osteoarthritis.

16 out of 16 guidelines examined by the research team recommend acetaminophen as a pain reliever.  Doses up to 4 grams per day is usually a first choice for mild to moderate pain relief.  However the safety and efficacy of long-term use can be dangerous.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 92%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.

Acetaminophen (Paracetamol) is an over the counter pain reliever.  It is a primary ingredient in cold and flu remedies like Anacin-3, DayQuil, Liquiprin, Ny-Quil, Tylenol, and Xcel.  It is used to relieve minor aches and pains, as well as treat fevers and headaches. It is also used as a short term osteoarthritis treatment for knee pain.

However the pain relief comes with risks.  When used correctly side effects are rare.  Although the risk of liver damage increases with large doses, chronic use, and use with alcohol.  In fact Paracetamol Toxicity is the leading cause of acute liver failure in the United States.

Other side effects include allergic reactions, irregular heartbeat, stomach pain, fatigue and kidney failure.