Expert-recommended strategies for managing osteoarthritis symptoms. First-line recommendations from the 2019 ACR guidelines emphasize exercise, weight loss, topical NSAIDs like diclofenac gel, and oral NSAIDs for severe pain. Second-line options include acetaminophen, capsaicin cream, and advanced interventions like intra-articular corticosteroids or duloxetine for chronic pain.
January 9, 2025

Osteoarthritis: Arthritis Foundation Guidelines

Evidence-Based Over-The-Counter Guide

William Shen

William Shen

Co-founder & CPO

See all guides. Have more questions?

Osteoarthritis is a degenerative joint disease characterized by cartilage breakdown, joint inflammation, and associated pain and stiffness. Treatment focuses on symptom management and improving joint function. 

First-line recommendations according to the 2019 American College of Rheumatology (ACR) management guidelines include exercise, weight loss, physical therapy, as well as pharmacotherapy topical and oral NSAIDs (nonsteroidal anti-inflammatory drugs). 

First-line recommendations:

  • Topical NSAIDs: Effective for localized pain relief, particularly in hand and knee OA. Apply diclofenac gel 1% (FDA NDA 22122/S-014) topically 2-4 times daily.

  • Oral NSAIDs: Used for more severe pain when topical agents are insufficient. Examples include ibuprofen 200-400 mg every 6-8 hours as needed, or naproxen 220 mg twice daily. Use with caution if gastrointestinal or cardiovascular risks are present. Naproxen sodium 220mg (FDA ANDA 204872).

Second-line recommendations: 

  • Acetaminophen: Considered for mild-to-moderate pain relief. Dose: 500-1000 mg every 6-8 hours as needed, not exceeding 3000 mg/day. Acetaminophen 650 mg (FDA M013).

  • Capsaicin cream: Capsaicin is a potential alternative for osteoarthritis (OA) pain not relieved with acetaminophen or for people who cannot tolerate or are reluctant to use oral medications, Apply topically to the affected joint 3-4 times daily for pain relief. Capsaicin 0.025% with menthol gel (FDA M017).

Interventions:

  • Intra-articular corticosteroids: Effective for reducing joint inflammation and pain in patients with acute flares. Administered by a healthcare professional.

  • Duloxetine: FDA-approved for chronic musculoskeletal pain, including OA. Dose: 30-60 mg orally once daily.

  • Joint replacement if refractory pain and loss of function in large joint

Citations:

Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken). 2020; 72(2): p.149-162. doi: 10.1002/acr.24131

Kielly, J & Low, A. (2021). Capaicin. Canadian Arthritis Society.

What OTC evidence is reviewed?

  • For each condition, we performed a literature review to find a recent widely cited expert group guideline published in the leading specialty-specific peer-reviewed journal or top general medical journal.

  • Based on the recommendations in the publication, we identify recommended active ingredients and devices that are available over-the-counter per FDA regulations.

What evidence is prioritized?

Levels of evidence considered:

  • Tier 1 (Safe and Definitely Effective): Professional field consensus or multiple randomized controlled clinical trials showing the same conclusion. Wherever possible, we use Tier 1 evidence for "first-line" recommendations.

  • Tier 2 (Safe and Probably Effective): Individual clinical trials which may be discordant or large-scale observational experience. Tier 2 evidence may inform "first-line", "second-line", or "supplement" recommendations.

  • Tier 3 (Safe and Maybe Effective): Mechanistic plausibility without high-quality clinical evidence of efficacy but high-quality evidence of safety. Tier 3 evidence may inform "second-line" or "supplement" recommendations.

How does MDandMe select recommended products?

  • Based on the top clinical recommendation, we evaluate products containing the recommended active agent with FDA-approved dosage based on price, average customer reviews, how often it is purchased, and how quickly it will ship to home. 

  • We provide public documentation of the active ingredients in our recommendations, using all 32 FDA monographs, Prescription-to-Nonprescription (Rx-to-OTC) Switches, as well as New Drug Application (NDA) approvals.

How does MDandMe select recommended devices?

  • Based on the top clinical recommendation, we evaluate devices that are FDA-cleared or comply with other medical guidelines (if not a FDA-regulated category) by reputability, price, and average customer reviews.

  • We provide public documentation of supporting evidence for each device.  

Where do I view other OTC guides?

Browse topic list here:

You can view all of our published OTC guides here.