Arthritis Medicines Explained: Painkillers, NSAIDs, Steroids and Methotrexate Safety

Stiff, swollen, aching joints that are worst in the morning, hands that struggle to open a jar, knees that complain on every step. Arthritis (jodon ka dard, gathiya) is not one disease, and the medicine that helps one type can be useless, or even harmful, for another. Knowing which type you have, and what your tablets are doing, makes treatment safer and far more effective.

This guide explains osteoarthritis and rheumatoid arthritis, the groups of arthritis medicines (painkillers, anti-inflammatories, steroids, and disease-modifying drugs), the safety rules that matter, especially for methotrexate, and when to see a rheumatologist.

The two main types

Osteoarthritis (OA)

Wear and tear of the cartilage in joints, common after the age of 40 to 50, in the knees, hips, hands and spine. Pain gets worse with use and eases with rest. Morning stiffness lasts less than thirty minutes. It is more likely with age, extra weight, past injuries and family history.

Rheumatoid arthritis (RA)

An autoimmune condition in which the immune system attacks the joint lining. It often affects the small joints of both hands and feet symmetrically, causing swelling, warmth and stiffness lasting more than an hour in the morning, plus tiredness and sometimes low fever. It can start in younger adults, especially women, and damages joints if not treated early.

Gout, another cause of joint pain, is covered in our guide to gout and uric acid medicines.

Medicines for pain and swelling

Paracetamol

Paracetamol is gentle on the stomach and is the usual first choice for OA pain. It does not reduce inflammation.

Topical anti-inflammatory gels

Diclofenac gels such as Dyclo Emulgel (diclofenac) are rubbed on knee or hand joints. They give relief with much less drug entering the blood than tablets. Do not use on broken skin, and wash hands afterwards.

Anti-inflammatory tablets (NSAIDs)

Ibuprofen, naproxen, diclofenac, and the COX-2 types celecoxib and etoricoxib reduce both pain and swelling. They work, but they carry real risks:

• Stomach irritation and ulcers, with a risk of bleeding. Your doctor may add an acid-protecting medicine. See our guide to acidity medicines.
• Higher blood pressure, fluid retention and strain on the kidneys.
• A higher risk of heart attack and stroke with some, particularly at high doses or long use, and in people with heart disease.
• Not safe with some other medicines, such as blood thinners. See our guide to blood thinners.
• Do not combine two NSAIDs, and avoid them in the last months of pregnancy.

Use the lowest effective amount for the shortest time. If you need them every day, tell your doctor.

Steroids

Prednisolone tablets and steroid injections quickly reduce inflammation in flares, but long-term use causes weight gain, high sugar and blood pressure, thin bones, infections and cataracts. They should be used for the shortest possible time and never stopped suddenly after long courses. Steroid injections into a single joint are an option for a painful flare, given by a doctor.

Disease-modifying drugs for rheumatoid arthritis

These medicines (DMARDs) slow the disease and protect the joints. They take weeks to months to work, and need blood tests. They are prescribed by a rheumatologist.

• Methotrexate is the most commonly used. See the safety box below.
• Sulfasalazine is used alone or in combination. It can cause stomach upset and needs blood tests.
• Hydroxychloroquine is generally well tolerated, but needs regular eye checks with long use.
• Biologics and JAK inhibitors are newer, stronger options for people who do not respond. They raise the risk of infection, and require screening for TB and hepatitis before starting.

Important safety box: methotrexate is taken once a week

For arthritis, methotrexate tablets such as Cytotrexate 2.5 mg and Cytotrexate 10 mg are taken once a week, not every day. Taking it daily by mistake has caused serious poisoning and deaths. Always:

• Choose one fixed day of the week, and write it on the pack.
• Check the day with your pharmacist each time you collect it.
• Folic acid is often prescribed on other days, and it helps to reduce side effects. See folic acid.
• Have your blood and liver tests as scheduled.
• Avoid alcohol, and avoid pregnancy during treatment, and for a period afterwards. Tell your doctor if you are planning to conceive.
• Report a sore mouth, fever, cough, breathlessness, unusual bruising or bleeding straight away.
• Do not take it with trimethoprim-containing antibiotics, and check all new medicines with your pharmacist.

Browse the arthritis and gout category. These are prescription medicines. If you have a prescription, upload it here.

Beyond tablets

• Exercise: regular, gentle exercise strengthens the muscles around the joints, and reduces pain. Walking, cycling, swimming and stretching all help. A physiotherapist can show you what suits you.
• Weight: every kilo lost takes several kilos of load off the knees. See our guide to checking weight and BMI at home.
• Heat and cold: warmth eases stiffness, and cold packs help a swollen, hot joint. Read about joint pain in winter.
• Supports: knee and ankle supports can help with unstable joints. See our sprain guide and the supports and braces category.
• Walking aids: a stick or walker, such as a folding walker, reduces load.
• Vitamin D and calcium: keep bones strong, especially with steroids. See our guides to vitamin D deficiency and calcium deficiency.
• Supplements such as glucosamine have mixed evidence, and some people feel better.

When to see a doctor

• Joint swelling and morning stiffness lasting more than an hour, particularly in the small joints of the hands and feet. Early RA treatment protects joints.
• A hot, red, very painful joint, with fever. This may be an infection.
• Pain that wakes you at night or does not ease with rest.
• New deformity, or you cannot use the joint.
• Side effects from your medicines: black stools, severe stomach pain, mouth ulcers, fever or a new cough.

Frequently asked questions

Can arthritis be cured?

RA can be put into remission with treatment. OA cannot be reversed, but symptoms can be managed.

Is it safe to take a painkiller every day for joint pain?

Not without medical advice. Daily NSAIDs can harm the stomach, kidneys and heart.

Do I need to avoid certain foods?

For OA and RA there is no strict diet, though a balanced diet, a healthy weight and less processed food help. For gout, diet matters more.

Will cold weather damage my joints?

No. It may make pain feel worse, but it does not cause damage.

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This article is for general information and is not a substitute for advice from your doctor or rheumatologist. It does not include doses; your doctor decides the medicine and amount. Always follow the directions on the pack or from your doctor.