Learn more from OA experts

Stanley Dysart: There are many nonoperative treatments for osteoarthritis and as a practicing orthopaedic surgeon I use many of these methods. Our academy has recently looked at arthritis and has looked at the various treatments involved. Acetaminophen is a very common treatment for arthritis. It is readily available, its over the counter. The downside seems to be that it does have a problem with the liver in some individuals. So if you have liver disease or if you are heavily involved with alcohol, you really should not take high doses of acetaminophen and you should monitor your liver functions. But it does work, it's a pain reliever.

Jeffrey Rosen: The average person may take two extra- strength Tylenol which is a 1000 mg. You really shouldn't take more than four doses of two extra-strength Tylenol a day or 8 tablets. The maximum dose of Tylenol that people should take is 8 grams a day.

SD: The second course of over-the-counter is non-steroidal and as you know both ibuprofen and Naproxen are over-the-counter medications, they are anti-inflammatories and they can be used successfully for osteoarthritis. The problem here though is they have side effects. There are GI side effects, they can cause stomach ulcers, they can cause problems with kidney function. They can also cause problems with the liver. So you have to carefully monitor these medications if they are given at the physician prescribed level.

JR: The long term use greater than six weeks has been associated with an increase risk of ulcer disease in the small disease. The affects on the cardiovascular system have been called into question and it is thought that anyone who has a history of cardiac history of high blood pressure, cardiovascular disease, history of a coronary artery bypass surgery or a history of a stroke may not be appropriate patient to be taking anti-inflammatory medications.

SD: I have patients on these, patients as you know, will purchase many of the over-the-counter medications. They say they are effective and some studies they seem to be helpful. but what they are doing they are not so sure.

JR: because there are so many side effects associated with taking oral medications, people are much more interested in taking something that is directed where there problem is. So if you could have a topical medication that delivered an anti-inflammatory affect to the knee joint because you have a knee problem and avoid the systemic affects of taking the medicine that gets dissolved in your digestive system and is distributed throughout your body, that is a very attractive therapy. So there are increasing interest in localized therapies that we deliver topical anti-inflammatory agents to the joint of interest.