For knee osteoarthritis, UK NICE guidelines recommend a topical NSAID gel (such as diclofenac or ibuprofen gel) as the first medicine to try. The knee sits close to the skin, so gel reaches the joint with far less risk to the stomach than tablets.
Options compared
| Option | Notes |
|---|---|
| Topical NSAID gel | First choice for knee arthritis. Rub in 3 to 4 times a day. |
| Oral NSAIDs (ibuprofen, naproxen) | Stronger, short courses only. Risks for stomach, kidneys, heart. |
| Paracetamol (acetaminophen) | NICE no longer recommends it routinely for osteoarthritis: little benefit. |
| Capsaicin cream | Option for some people. Burns at first. |
| Opioids | Not recommended for knee arthritis long term. |
Who should check with a doctor first
- Stomach ulcers, kidney disease, heart disease or high blood pressure
- Taking blood thinners
- Pregnant
- Asthma that gets worse with aspirin or ibuprofen
Medicines ease pain but do not change the joint. Pair them with exercise.