Non-Steroidal Anti-Inflammatories (NSAIDS) – Oral

There is strong evidence from multiple clinical trials and reviews that NSAIDs are more effective for relieving osteoarthritis (OA) pain than paracetamol or a placebo. Unlike paracetamol, NSAIDs also reduce inflammation, which can be a significant contributor to pain in OA.

Importantly, no single NSAID has been shown to be more effective than another in treating knee osteoarthritis — meaning different options may work better for different people.

How NSAIDs Work

NSAIDs reduce pain and inflammation by blocking the production of prostaglandins, natural substances in the body that promote inflammation, pain, and fever.

There are two main types of NSAIDs:

• Non-selective NSAIDs, such as Ibuprofen (Nurofen), Diclofenac (Voltaren) and Naproxen (Naprosyn)

• COX-2 selective NSAIDs, such as Celecoxib (Celebrex). These work similarly but tend to have fewer stomach-related side effects compared to non-selective NSAIDs.

NSAIDs are commonly used for people who:

• Have not found enough relief from paracetamol
• Have inflammatory symptoms as part of their osteoarthritis (e.g. warmth, swelling)

They can be used on their own or alongside paracetamol.

To reduce the risk of side effects, NSAIDs should be taken at the lowest effective dose for the shortest possible time.

Considerations

NSAIDs can cause a range of side effects, and how each person reacts can vary.

Common and serious risks include:

• Stomach issues (e.g. ulcers, bleeding, abdominal pain)
• Kidney damage
• Increased risk of heart disease or stroke
• Interactions with medications used for heart disease, high blood pressure, or blood thinning (e.g. aspirin, warfarin)

Talk to your doctor before using NSAIDs if you:

• Have a history of stomach ulcers
• Have heart or kidney disease
• Take medications such as aspirin, warfarin, or other blood thinners