Arthritis can be a debilitating condition that causes joint inflammation, pain, stiffness, or degeneration.
Pain management for arthritis typically involves exercise and taking oral pain relief medication. Another option is to try one of the many over-the-counter (OTC) topical creams available to seek relief.
In this article, we look at how arthritis creams work and the different types available. We also discuss the safety and potential side effects of using these products, and when to see a doctor.
There is a variety of arthritis creams to choose from. Some are available to buy OTC, while others require a prescription.
There is a wide range of OTC arthritis creams available to buy at pharmacies and natural health stores. They tend to contain the same or similar active ingredients or a mix of ingredients, but they may differ in strength, formula, or how a person applies them.
Topical arthritis medications are also available in other formulations and application modes, including:
- patches that stick to the skin
Choosing the best formulation depends on a person’s needs. There are a few things to consider when deciding what type to buy:
- Creams, ointments, and rubs can be messy, greasy, take longer to penetrate the skin, and potentially discolor fabrics, but they might be cheaper to buy.
- Gels, sprays, and rub-ons tend to contain less messy formulas, absorb easily, and evaporate relatively quickly. However, these may be more expensive.
- Patches are helpful for use on large parts of the body or areas that are difficult to reach. They contain formulas that soak in over longer periods to offer hours of relief.
Only a few topical arthritis pain relief products are available by prescription in the United States. They all contain the active ingredient diclofenac, an NSAID medication that reduces inflammation.
Diclofenac products may come in gel or liquid form or as patches that stick to the skin. They also contain different strengths depending on their purpose.
Prescription products include:
- Diclofenac sodium 1% gel (Voltaren but also available in generic form): People can use this on any joint in the body, but it is most effective on smaller joints.
- Diclofenac epolamine 1.3% patch (Flector): Apply twice daily to the most severely impacted area.
- Diclofenac sodium 1.5% liquid (Pennsaid): People often use this for osteoarthritis knee pain.
- Diclofenac sodium 2% liquid (Pennsaid): People commonly use this for osteoarthritis knee pain.
Because arthritis creams only act at the point where a person applies them and do not impact the entire body, they are often a safer alternative to oral medications. This is especially the case for people who:
- are over the age of 65
- have arthritis in smaller joints
- have a sensitive stomach or stomach conditions
- have cardiovascular risks
For some people, they are also safer because they reduce:
- digestive risks since the stomach does not process them
- cardiovascular risks because their ingredients tend not to enter the bloodstream
- risk of becoming drowsy and falling, unlike some oral pain medications
- risk of addiction, unlike oral narcotics
Although arthritis creams are relatively safe to use, it is still important to follow a few safety rules and tips:
- Read all product information before use, especially the sections on safety precautions, usage, and overdose information.
- Follow all application, dosage, and safety directions included and never use more of the product than indicated.
- Wash hands before applying the product and especially after applying.
- Avoid touching other parts of the body after using the product. Do not touch the eyes, mouth, genitals, and nose while the cream is still on the hands.
- Wear clean rubber or latex gloves to apply strong products or those with irritants that can linger on the skin, such as capsaicin, camphor, and menthol.
- Keep track of the frequency, length of time, and total amount of product applied. This will reduce the risk of using too little or too much medication.
- Do not apply products to broken or irritated skin.
- Do not cover topicals with bandages, gauzes, or other dressings.
- Do not apply heat or cold to treated areas (in most cases).
- Stop using the product if irritation occurs beyond temporary minor warming, cooling, burning, numbness, or tingling.
- Talk to a doctor before use if taking oral NSAIDs and other blood-thinning medications.
- Avoid using products that contain salicylates if allergic or sensitive to aspirin, ibuprofen, or naproxen.
- Avoid using the product on large portions of the body or in too many places at once.
Arthritis creams contain different compounds that can penetrate through the skin to temporarily reduce pain or inflammation by changing nerve signaling or blood flow. A person should apply the cream directly to the skin above the painful joint or surrounding areas.
Arthritis creams tend to work best on smaller joints that are closer to the surface of the skin, such as the hands, elbows, ankles, and knees.
The main ingredients in arthritis creams include:
- Salicylates: These increase blood flow and block body chemicals to reduce pain and inflammation. The active ingredients in salicylates are very similar to the active ingredients found in aspirin and other non-steroidal anti-inflammatory medications (NSAIDs).
- Counterirritants: These cause a warming or cooling sensation and increase or decrease blood flow to distract the mind from pain or change its perception of pain. Examples include camphor, menthol, and compounds found in extracts from stinging nettle, aloe vera, and eucalyptus.
- Anesthetics or analgesics: These cause a numbing sensation that reduces pain signals but not inflammation. Examples include lidocaine.
- Capsaicin: This reduces the number of pain signals sent to the brain. It is the active ingredient found in many kinds of hot or spicy peppers.
- NSAIDs: These penetrate the skin and underlying tissues to block inflammatory signals.
Arthritis creams may also contain antioxidants and other anti-inflammatory compounds found in some herbs, spices, and other plants or foods, such as:
- methylsulfonylmethane (MSM)
- glucosamine sulfate
- chondroitin sulfate
- gamma-linolenic acid (GLA)
- active ingredients in nettle, frankincense, arnica, comfrey, lavender, salvia, borage, and pine extracts
Many arthritis creams contain ingredients that work immediately or within seconds to produce temporary effects. Other types contain compounds that must build up in the body over weeks to months to provide relief, though they may offer longer lasting relief when a person uses them continuously.
Side effects of using arthritis creams include:
- Irritation or numbing of the skin: This can arise from using products that contain counterirritants and analgesic ingredients.
- Other skin sensations: These are often temporary and may include a burning, stinging, warming, cooling, or numbing feeling.
- Risk of an allergic reaction: This is more likely from products containing salicylates.
- Negatively interacting with blood-thinning medications: These include topical NSAIDs and many cardiovascular medications.
- Minor skin irritation to toxic overdose: This may occur from overuse.
Severe burns: Burns may occur if a person uses products that contain high doses of menthol (greater than 3%), or menthol and methyl salicylates (greater than 3% and 10%).
People with severe or chronic pain, inflammation, or discomfort of any kind should talk to a doctor.
They should also consult a doctor if they experience severe or persistent skin irritation when using arthritis creams. It is also important to seek medical advice if OTC medications do not work or become less effective over time.
Before using an arthritis cream, a person should talk to a doctor or pharmacist if they have any of the following:
- another medical condition
- an allergy to topical ingredients (such as salicylates)
- sensitive skin
- they are pregnant or breastfeeding
Many OTC arthritis pain relief creams, and a handful of prescription products are available to help reduce symptoms.
It can take time and trial and error before a person can determine which ingredients or products work best for them.
People should always talk to a doctor or pharmacist if they have any particular concerns or questions.