Several types of medicine reduce inflammation, ranging from over-the-counter pills you can pick up at any pharmacy to powerful prescription drugs that target the immune system at a molecular level. The right choice depends on whether your inflammation is a short-term flare from an injury or a chronic condition like rheumatoid arthritis. Here’s how each category works, what to expect, and what to watch out for.
NSAIDs: The Most Common Starting Point
Nonsteroidal anti-inflammatory drugs, or NSAIDs, are the go-to option for most people dealing with inflammation. Ibuprofen (Advil, Motrin) and naproxen (Aleve) are available without a prescription and work by blocking enzymes your body uses to produce chemicals that trigger swelling, pain, and redness. Naproxen lasts longer per dose, so you take it less often, while ibuprofen kicks in faster but wears off sooner. For most people with pain or mild inflammatory conditions, short- to moderate-acting NSAIDs like these are preferred.
Prescription-strength NSAIDs include diclofenac (typically 50 mg every 8 to 12 hours, up to 150 mg per day) and indomethacin (25 to 50 mg every 8 to 12 hours). These tend to be reserved for more significant inflammation, such as gout flares or inflammatory arthritis, where over-the-counter options aren’t enough. Your doctor picks among them based on how quickly you need relief, how long you need to take them, and your personal risk factors.
Topical NSAIDs: Lower Risk, Targeted Relief
If you’re treating a sore knee, sprained ankle, or other localized musculoskeletal pain, topical NSAID gels and patches offer a real advantage. Diclofenac gel, for example, delivers the drug directly to inflamed tissue while producing blood levels that are only 0.6% to 2.2% of what you’d get from swallowing the same drug as a pill. That tiny systemic exposure translates to a much better safety profile: topical NSAIDs have not been linked to the kidney failure or stomach bleeding that oral versions can cause.
For acute musculoskeletal pain (excluding low back pain), topical NSAIDs outperform placebo and cause fewer side effects than oral NSAIDs. They won’t help much with widespread inflammation like you’d see in rheumatoid arthritis, but for a single painful joint or a sports injury, they’re a smart first step.
Corticosteroids for Stronger Inflammation
When NSAIDs aren’t enough, corticosteroids like prednisone, methylprednisolone, and hydrocortisone are the next level up. These drugs work by slowing your body’s production of the chemicals that drive inflammation. They’re synthetic versions of cortisol, a hormone your adrenal glands naturally make.
Corticosteroids are effective for conditions where the immune system is in overdrive, sending inflammatory cells where they aren’t needed and causing more damage than they prevent. Doctors prescribe them for asthma flares, inflammatory bowel disease, lupus, severe allergic reactions, and many types of arthritis. They come as pills, injections, inhalers, and creams depending on where the inflammation is.
The tradeoff is side effects. Short courses of a few days to a couple weeks are generally well tolerated, but long-term use can lead to bone thinning, weight gain, elevated blood sugar, mood changes, and a weakened immune system. That’s why doctors typically prescribe the lowest effective dose for the shortest time possible, and taper you off gradually rather than stopping abruptly.
Biologic Drugs for Chronic Conditions
For people with chronic inflammatory diseases like rheumatoid arthritis, psoriatic arthritis, or inflammatory bowel disease, biologic drugs represent a more targeted approach. Instead of dampening inflammation broadly the way steroids do, biologics block specific proteins your immune system uses to generate inflammation.
The largest category targets a protein called TNF-alpha, one of the main signals your immune cells use to ramp up inflammation. Several TNF-alpha inhibitors are available, and they’ve transformed treatment for conditions that used to cause progressive joint destruction. Other biologics block different immune signals: some target interleukin-17, which plays a key role in psoriasis and psoriatic arthritis, while others go after interleukin-23 or interleukin-1. The choice depends on your specific diagnosis and which part of the immune system is most active in driving your disease.
Biologics are given as injections or infusions, typically every one to four weeks. They’re expensive and suppress parts of the immune system, increasing infection risk. But for people whose inflammation doesn’t respond to conventional drugs, they can dramatically reduce symptoms and prevent long-term damage to joints and organs.
JAK Inhibitors: A Newer Option
JAK inhibitors are oral medications that block a different step in the inflammatory signaling chain. Rather than targeting a single protein outside the cell like biologics do, they work inside the cell to interrupt signals from multiple inflammatory proteins at once. Three JAK inhibitors are approved for rheumatoid arthritis, and some have additional approvals for psoriatic arthritis and ulcerative colitis.
The appeal is convenience: they’re pills, not injections. But the FDA requires specific warnings about increased risks of serious heart events, cancer, blood clots, and death compared to TNF-alpha inhibitors. Because of this, JAK inhibitors are generally reserved for people who haven’t responded to or can’t tolerate other treatments.
Risks of Long-Term NSAID Use
NSAIDs are safe for occasional use in most people, but regular use carries real risks. The cardiovascular picture varies by drug. In a large study of patients hospitalized for serious coronary heart disease, ibuprofen users had a 67% higher rate of subsequent heart events compared to non-users, and diclofenac users had an 86% higher rate. Naproxen stood out as the exception: it showed no statistically significant increase in heart risk, which is why some doctors prefer it for patients with cardiovascular concerns.
Stomach and intestinal damage is the other major concern. NSAIDs reduce the protective mucus lining of your digestive tract, which can lead to ulcers and bleeding, especially with prolonged use. Combining an NSAID with a corticosteroid, another NSAID (including low-dose aspirin), or regular alcohol use raises this risk further.
Interactions to Be Aware Of
NSAIDs interact with several common medication categories in ways that matter. If you take a blood thinner like warfarin, adding an NSAID increases your bleeding risk. If you’re on blood pressure or heart failure medications, including ACE inhibitors, beta blockers, or diuretics, NSAIDs can blunt their effectiveness and, in combination with ACE inhibitors and diuretics specifically, raise the risk of kidney failure.
These interactions apply to over-the-counter NSAIDs too, not just prescription versions. Many people don’t think of ibuprofen as a “real” medication, but if you’re already taking pills for blood pressure or heart disease, even occasional NSAID use is worth discussing with your pharmacist or doctor.
Choosing the Right Approach
For a pulled muscle or a tweaked joint, a topical NSAID gel is often the safest and most effective starting point. For short-term pain with more widespread inflammation, like a gout flare or a bad bout of tendinitis, oral NSAIDs work well for most people. Naproxen is a reasonable first choice given its longer duration and relatively favorable cardiovascular profile.
Chronic inflammatory conditions usually require a layered strategy. Many people start with NSAIDs for symptom relief, add corticosteroids for flares, and eventually move to biologics or JAK inhibitors if the underlying disease keeps progressing. The goal with chronic inflammation isn’t just pain relief. It’s preventing the cumulative damage that unchecked immune activity causes to joints, organs, and blood vessels over time.