HEALTHY LIVING Is Tylenol Safe for Arthritis?
It’s less effective than ibuprofen, but its side effects are milder. :: BY CHRIS ILIADES, M.D.
O
steoarthritis (oa) is the most common type of arthritis, affecting more than 30 million adults in
the United States. Caused by wear and tear of the
joints, OA is also the most common cause of long-term (chronic) pain in people over age 65. For decades, doctors have
recommended acetaminophen (Tylenol) as the over-the-counter pain medication choice for OA. The other major option for OTC
pain relief is a nonsteroidal anti- inflammatory drug like ibuprofen (Advil).
Although acetaminophen does
not relieve pain or reduce swelling as well as an NSAID, it has been recommended as a safer choice for chronic pain. NSAID use in the elderly has
been linked to an increased risk of cardiovascular disease, gastrointestinal (GI) bleeding, and kidney damage. A 2024 study, published in
Arthritis Care & Research, warns that acetaminophen may act as a milder type of NSAID with similar side effects when used regularly over six months. The study of more than 115,000
people ages 65 and older found a 20% increased risk of GI bleeding, along with a higher risk for high blood pressure and kidney failure.
SIDE EFFECTS NSAIDs relieve pain, fever, and swelling by blocking an enzyme called cyclooxygenase (COX). COX inhibition prevents production of prostaglandin, a hormone-like substance in the body that causes pain, fever, and swelling.
90 NEWSMAX MAXLIFE | JUNE 2025
When it comes to osteoarthritis, many people have more benefit from things like physical therapy than they do from any pharmaceutical medications.” — Ryan Marino, M.D.
Several studies now suggest that acetaminophen may have similar effects. “Although the way acetaminophen
reduces pain and fever has not been clear in the past, it is now recognized as having COX-inhibiting effects,” says Ryan Marino, M.D., assistant professor of emergency medicine and toxicology at Case Western Reserve University School of Medicine in Cleveland. “Acetaminophen’s COX-inhibition
effects are like NSAIDs; however, they are significantly weaker. “For this reason, acetaminophen
is not an effective anti-inflammatory agent, but may have benefits in specific conditions like headaches,” he says.
NEW GUIDELINES The U.K. National Institute for Health and Care Excellence included
acetaminophen as a first-line treatment for osteoarthritis until 2022, but after research found complications with long-term use in the elderly, it is no longer recommended as a first-line treatment. OA treatment guidelines
from the Arthritis Foundation and the American Academy of Rheumatology now strongly recommend weight loss, education, self-management, and supervised exercise or a mind-body exercise, such as tai chi, as treatment cornerstones. For OTC pain treatment they
recommend topical NSAIDs and oral NSAIDs. “When it comes to osteoarthritis,
many people have more benefit from things like physical therapy than they do from any pharmaceutical medications,” advises Marino.
BEST OPTIONS Because acetaminophen does less to relieve chronic pain than stronger NSAIDs with similar side effects, its use as a first-line painkiller for long-term conditions such as osteoarthritis in older people needs to be carefully considered. “The causes of chronic pain
vary so widely, and because every individual responds differently, there is no one-size-fits-all answer for treatment of chronic pain in any population or disease process,” says Marino. If you or a loved one is struggling
with OA pain, talk to your healthcare provider about a pain management program. It could include physical exercise, mind- body exercise, and a safer OTC pain reliever. Studies now show that an
NSAID-based topical gel or cream may work as well as an oral NSAID with fewer side effects.
SLOBO©ISTOCK / THARAKORN©ISTOCK
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