Osteoarthritis pain has a way of quietly dictating your world, so if your knees (or hands) are controlling your choices in 2026, you’re not alone. First, it affects the long walks, then the stairs, then the errands you used to do without thinking. The good news: you don’t have to jump straight to the strongest treatment option (or one that wrecks your stomach). Most osteoarthritis treatment follows a stepwise plan: start with low-risk, local treatments like topical diclofenac (Voltaren), move to oral non-steroidal anti-inflammatories (NSAIDs) like celecoxib (Celebrex) only when the benefits outweigh the gastrointestinal, kidney, and heart risks, and consider injections like a hyaluronic acid viscosupplement (sodium hyaluronate [Orthovisc]) if simpler steps aren’t enough. This guide breaks down what to try first, when to escalate, and which current guidelines generally support it, so you can get moving again—safely.
Osteoarthritis Pain in 2026: A Smarter, Stepwise Plan
Osteoarthritis (OA) isn’t just “wear and tear.” It’s a whole-joint condition that can involve cartilage changes, bone remodeling (abnormally active breakdown of old bone and formation of new bone), and low-grade inflammation that can flare. That’s why OA pain can feel inconsistent—fine one day, sharp and swollen the next.
Most evidence-based guidance starts with core non-drug treatments and then adds medication in a lowest-risk-first order. For example, the American College of Rheumatology (ACR)/Arthritis Foundation guideline strongly recommends exercise and weight loss (when a person is overweight or obese), and topical NSAIDs for knee OA and oral NSAIDs when appropriate.
The goal of a smarter osteoarthritis pain plan is better function with the lowest risk.
This means many clinicians focus on functional goals, like:
• Walk 10-20 minutes without needing to stop.
• Climb stairs with less pain.
• Get through errands without a two-day flare.
• Sleep without being woken by joint pain.
Goals based on function help you choose the least aggressive option that still gets your life back.
Always keep in mind that while OA is common, not every painful joint is OA. Your joint pain might not be osteoarthritis, and you should seek urgent medical evaluation if you have:
• A red, hot, swollen, painful joint plus a feeling of overall unwellness (malaise) and/or fever
• Sudden, severe joint pain (often in one joint) with swelling and skin colour change, especially if you feel hot/shivery or generally unwell
• Significant trauma with loss of movement, abnormal shape/deformity, marked swelling/bruising, or clearly reduced movement
• Unexplained weight loss, unremitting or increasing pain, night pain/disturbed sleep, a new mass/swelling, or a history of cancer
• Progressive or widespread neurological signs (new/worsening weakness, spreading numbness), gait disturbance, or abnormal bladder/bowel symptoms
Step 1: Topical Diclofenac (Voltaren) for Knee or Hand Osteoarthritis
For many people—especially with knee OA (and often hand OA)—topical NSAIDs like diclofenac (Pennsaid or Voltaren Emulgel), which you rub directly into your joint, are the best first medication step. They deliver anti-inflammatory medication right where it’s needed with less total body exposure (meaning fewer side effects) than pills.
Why Guidelines Often Recommend Topical NSAIDs First
Guidelines repeatedly elevate topical NSAIDs early in OA treatment—particularly for knee OA. The ACR/Arthritis Foundation guideline says topical NSAIDs are strongly recommended for knee OA and conditionally recommended for hand OA when not contraindicated.
The logic is simple: meaningful pain relief can often be achieved without immediately taking on the full systemic risk profile of oral NSAIDs. This can be particularly important when dealing with older adults.
As noted by the ACR/Arthritis Foundation, topical diclofenac tends to be most useful when:
• Pain is localized (for example, in one or two joints, not widespread pain).
• The joint is close to the skin surface (for example, knee or hand joints more than hip joints).
• You’re trying to minimize systemic side effects (such as gastrointestinal bleeding risk, kidney risk, cardiovascular risk).
How to Use Diclofenac Gel Correctly (and Why It ‘Fails’ for Some People)
Topical diclofenac can be very effective; it “fails” most often due to inconsistent use.
You can trial topical diclofenac as a treatment for osteoarthritis by following these rules:
• Use it consistently for 1-2 weeks before judging results.
• Apply to clean, dry, intact skin (avoid cuts or active rashes).
• Wash hands after application (unless treating hands—make sure to follow product instructions).
• Avoid layering of topical diclofenac with oral NSAIDs unless your clinician says it’s appropriate.
• Don’t treat huge surface areas for long periods without guidance (due to systemic absorption increases).
Topical NSAIDs Are Gentler on Your Stomach (But Still Aren’t ‘Nothing’)
Topical diclofenac results in substantially lower overall physical exposure than oral diclofenac. In a scientific study, systemic exposure from 1% diclofenac gel was approximately 5- to 17-fold lower than that of oral diclofenac. That’s a big reason it’s often a first-line choice when your goal is get moving again without upsetting your stomach.
Still, topical NSAIDs are not risk-free, especially with heavy or long-term use, use in large areas, or in people with complex medical histories. Common side effects include skin irritation, rash, dryness at the application site, and others.
Step 2: Oral NSAIDs: Celecoxib (Celebrex) vs Diclofenac Tablets
If topical options and core strategies like weight loss and self-management programs aren’t enough, clinicians may consider oral NSAIDs, which can be very effective medications for OA pain in the right people. But this is where risks versus benefits must be explicit, as oral NSAIDs can affect the gastrointestinal tract, kidneys, and cardiovascular system.
Common oral NSAIDs include celecoxib (Celebrex) and diclofenac tablets (often sold as diclofenac SR tablets or diclofenac potassium [Cataflam]).
Oral NSAIDs may be appropriate when:
• Pain is limiting function (walking, sleep, work, daily tasks).
• You’ve trialed topical NSAIDs and non-drug treatments.
• You can use the lowest effective dose for the shortest necessary time.
Oral NSAIDs may be inappropriate, or require heightened caution/monitoring, if you have:
• Concerns regarding potential gastrointestinal, renal, liver, or cardiovascular impairment.
• Any additional risk factors, including age, pregnancy, current medication, and comorbidities.
GI Risks: Ulcers and Bleeding—Who’s at Highest Risk?
All oral NSAIDs increase the risk of gastrointestinal side effects, including ulcers and bleeding. These risks rise with older age, prior ulcer or gastrointestinal bleed, higher doses, longer duration, and certain medication combinations. For this reason, you need to tell any prescribing doctor about all health concerns you have and any medications you take before considering an oral NSAID.
Kidney Risks: What to Monitor?
Nonsteroidal anti-inflammatory drugs can reduce blood flow through the kidneys. They may cause acute kidney injury or worsen chronic kidney disease—especially at higher doses or with long-term use. This is one reason clinicians may:
• Check kidney function before longer courses.
• Re-check labs during ongoing use, especially in older adults or people on certain medications.
• Advise avoiding NSAIDs during dehydration/illness (case-dependent).
Cardiovascular Risks: Dose, Duration, and Risk Factors
The Food and Drug Administration (FDA) warns that non-aspirin NSAIDs can increase the risk of heart attack or stroke, and that risk can occur as early as the first weeks of NSAID use and may increase with more prolonged use and higher doses. This doesn’t mean you shouldn’t take NSAIDs, but it does mean that you shouldn’t treat daily NSAID use like a casual supplement.
Overall, no matter what your health concerns are, or even if you have none at all, common safety principles say to use the lowest effective dose of medication for the shortest duration possible. While NSAIDs are generally safe medications when used as directed, everything comes with risks and benefits, and these should always be discussed with your doctor.
Celecoxib vs Traditional NSAIDs: How Clinicians Choose
Celecoxib (Celebrex) is a specific type of anti-inflammatory drug known as a COX-2 selective inhibitor. This type of medication primarily blocks the COX-2 enzyme (cyclooxygenase-2) rather than the COX-1 enzyme, which other, nonselective, anti-inflammatory agents more readily block. This means that celecoxib may be associated with a lower risk of gastrointestinal side effects. Clinicians sometimes choose celecoxib when an oral NSAID is needed, and gastrointestinal risk is a major concern, while still weighing cardiovascular and kidney risks.
However, while celecoxib may reduce the risk of gastrointestinal side effects, other medications are sometimes preferred due to their different risk profiles. For example, some reviews and clinical guidance note that naproxen may have a more favorable cardiovascular risk profile than many other NSAIDs, so that this medication may be preferred for those with greater cardiovascular risk.
Of course, cost, insurance coverage, and convenience are other considerations when a doctor recommends a specific medication. Over-the-counter NSAIDs may win out here over celecoxib, which may cost more.
Step 3: Injections for Osteoarthritis: Where Orthovisc (Sodium Hyaluronate) Fits
If you’ve tried core measures like exercise, strength training, weight management (if relevant), and topical and oral NSAIDs are unsafe, not tolerated, or insufficient, then injections may be considered as an add-on.
What Orthovisc Is (Hyaluronic Acid / Viscosupplementation)?
Orthovisc is a hyaluronic acid product injected into the knee joint (viscosupplementation). It’s used for knee pain due to OA, typically after conservative treatments haven’t provided enough relief. Orthovisc is commonly administered as a series of injections one week apart, typically three or four injections, depending on the regimen and the clinician's judgment. You might not feel relief after the first shot, and many people who respond notice improvement as the series progresses.
What the Research Says About Pain Relief
Hyaluronic acid injections help some people, and don’t help others. Across studies, average benefits tend to be modest, and patient response varies, so it may or may not work for you.
Orthovisc is most commonly discussed for people who:
• Have knee OA pain that still limits function after conservative measures
• Can’t safely take oral NSAIDs (e.g., GI bleed risk, kidney disease, cardiovascular risk), or haven’t tolerated them
It may be avoided in the setting of a joint infection, a skin infection at the injection site, or known hypersensitivity. Discuss any concerns you have with your doctor.
Key takeaways: Voltaren vs Celebrex vs Orthovisc
If you want a cheat sheet for the above, remember these three steps:
1. Best starting point for most people: For knee (and often hand) OA pain, topical diclofenac (Voltaren-type gel) plus exercise/strength work is a smart, low-risk first medication step. Guidelines strongly support topical NSAIDs for knee OA.
2. Best next step if pain is still limiting: Oral NSAIDs (like celecoxib [Celebrex]) can be very effective, but require a deliberate plan because of gastrointestinal, kidney, and cardiovascular risks, some of which can occur early and increase with dose and duration.
3. When NSAIDs aren’t safe or haven’t worked: If topical isn’t enough and oral NSAIDs aren’t appropriate, or you’ve tried them, and you’re still limited, Orthovisc injections are a reasonable discussion, with the key caveat that benefits vary.
(See the individual sections above for linked information sources.)
If OA pain has been shrinking your life, let 2026 be the year you take space back safely. Start with the foundations that improve both pain and function, then use the “lowest-risk-first” medication ladder. The win isn’t finding a “perfect” treatment, it’s finding the right combination that lets you walk farther, do more, and worry less about side effects.
Sources
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