Date Published: Sep 08, 2023

Non-Steroidal Anti-Inflammatories (NSAIDS) – Oral

There is strong evidence from multiple randomised trials and meta-analyses of randomised trials that NSAIDs are are more effective for the treatment of osteoarthritis (OA) than placebo or paracetamol. They have better pain reduction results and unlike paracetamol also have an anti-inflammatory effect. There is no evidence that any of the available NSAIDs is more effective than any other for the treatment of knee OA.


NSAIDs work by blocking the synthesis of prostaglandins, substances in the body that are involved in inflammation and pain.

There are two groups of NSAIDs. Non-selective NSAIDs include medications such as ibuprofen (Nurofen), diclofenac (Voltaren) and naproxen (Naprosyn). COX-2 selective NSAIDs include celecoxib (Celebrex). COX-2 selective NSAIDs are as effective as non-selective NSAIDs but with reduced gastrointestinal side effects.

NSAIDs are used for patients whose pain is not relieved by paracetamol and in those who have inflammatory osteoarthritis. They can be used in addition to paracetamol. Anti-inflammatories should be used at the lowest effective dose for the shortest possible time.

Using a low dose on an as-needed basis will help reduce the risk of side effects. If this does not provide enough relief, NSAIDs can be taken more often as long as there are no negative effects and the patient has no medical conditions that makes regular use dangerous.

If a patient has inflammatory OA, NSAIDs should be taken regularly from the start. It may take up to four weeks to be effective due to the delay in settling the inflammation.

If one NSAID is not effective after two to four weeks on a maximum dose, another NSAID should be tried. Different NSAIDs can work better than others for different patients.

Be Aware

There are many different side effects that can occur from taking NSAIDs and the development of these varies enormously between patients.

Some of the more important side effects include abdominal pain and bleeding due to stomach ulcers, kidney damage, increased risk of heart disease and reduced effectiveness of medications taken for heart disease or stroke. If you develop any of these while taking NSAIDs it is important to stop the medication immediately and consult your doctor.

It can be more dangerous to take NSAIDs if you have certain medical conditions including gastric or peptic ulcer disease, cardiovascular (heart) disease or kidney disease, or are taking certain medications including aspirin, warfarin or other blood-thinning medications. Under these circumstances it may not be safe to take anti-inflammatories, including those you can buy over the counter. If you have any of these medical conditions or are taking any of these medications you should talk to your doctor.

Mahima Kalra
Sep 08, 2023

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