Associate Director, Centre for Orthopaedics, BLK-Max Super Speciality Hospital, New Delhi
Part 7 of 11 in Diagnosis and Management of Arthritis in Joints
Medicines and Joint Injections for Arthritis: What Works and What Doesn't
September 6, 2026
Once non-pharmacological measures alone are not enough, Dr. Mannu Bhatia moves to medicines and injections, though he is candid in his Jivo Masterclass session about which of these he actually trusts.
Painkillers treat the symptom, not the disease
Standard pharmacological treatment includes anti-inflammatory painkillers such as paracetamol or diclofenac, occasionally steroids, disease-modifying anti-rheumatoid drugs for patients with rheumatoid arthritis, and topical gels, ointments and sprays. Dr. Bhatia was clear that this entire category manages symptoms; it does not treat the underlying joint disease. He also cautioned against continuous NSAID use, since it can harm the kidneys over time, favouring short-term use for pain relief rather than ongoing daily use.
Steroid and hyaluronic acid injections, used selectively
Intra-articular injections, steroids and hyaluronic acid, have a genuine role in Dr. Bhatia's practice, specifically in cases where the joint space is still maintained, meaning the disease has not progressed too far. The goal of these injections is to get the patient off regular oral painkillers while they continue with exercise, rather than to replace exercise altogether.
Where PRP falls short, in Dr. Bhatia's view
Platelet-rich plasma is where Dr. Bhatia parts ways with some of his peers. He said plainly that he is not an advocate for PRP, describing it as a treatment that does not reliably deliver a result once the joint surface and cartilage are already gone. His reasoning is that PRP cannot regenerate cartilage that has already broken down, and he prefers to base treatment decisions on the patient's actual X-rays and, if needed, an MRI, rather than default to PRP.
This article is based on a Jivo Masterclass session conducted by Dr. Mannu Bhatia, Associate Director, Centre for Orthopaedics, BLK-Max Super Speciality Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Mannu Bhatia taught doctors across Africa on February 2, 2025.
FROM THE LIVE Q&A
Dr. Sunday
What is the definitive treatment for osteoarthritis?
Dr. Mannu Bhatia
The definitive treatment is that the patient should be visiting the doctor regularly. If the condition is detected and treated at an early stage, that is the definitive treatment. A patient who ignores an ACL injury, skips the recommended MRI, skips the recommended surgery and skips the medicines is the one who progresses to osteoarthritis and eventually needs a knee replacement. Patients with a problem in one knee who don't get it treated often go on to develop the same problem in the other knee, then the hips, then the spine. The definitive treatment is listening to the doctor and following through, whether that means physiotherapy or treatment for rheumatoid arthritis.
Frequently Asked Questions
I have a patient with intermittent elbow pain, treated with oral and topical NSAIDs followed by PRP injections. What is the outcome of PRP for this patient in Ethiopia?▼
I am not a strong advocate for PRP. Once the joint surface and the cartilage are already gone, PRP cannot regenerate them, so I don't believe it delivers a real result. I would want to see the patient's X-rays, and an MRI if needed, before deciding what should actually be done.
What are the absolute contraindications for joint replacement?▼
As surgical techniques progress, more countries are attempting these surgeries, but two things need to be in place regardless: a genuinely sterile operating theatre, and excellent post-operative facilities, since that is what actually gets the patient the benefit of the surgery. There are no absolute contraindications beyond the patient having a poor overall medical condition, for example a cardiac condition that would make operating on them risky.
Is it possible to do a bilateral hip replacement in a patient with a slipped hip joint?▼
Bilateral hip replacement can always be done, either in the same sitting or with a gap between the two sides, depending on the patient's condition. If the body can tolerate it, both sides can be done together. If the body, or the finances, don't allow that, there can be a gap in between, but rehabilitation and the expected result need to be planned accordingly.
What is the best NSAID to use for osteoarthritis?▼
I would not advise continuous use of NSAIDs, since they can have a harmful effect on the kidneys over time. Short-term use for pain relief is fine.
How affordable are these surgeries at your facility?▼
They are very affordable in India, around half the cost of the same surgery in Nigeria, and much less than the cost in Europe or the US, with better results.
Do arthritis medicines treat the underlying disease?▼
No. Dr. Bhatia is clear that painkillers, anti-inflammatories and topical treatments manage symptoms; they do not reverse the underlying joint damage.
When does Dr. Bhatia use steroid or hyaluronic acid injections?▼
In cases where the joint space is still maintained, with the goal of reducing the patient's dependence on daily oral painkillers while they continue with physiotherapy.
What is Dr. Bhatia's view on PRP injections for arthritis?▼
He does not recommend them. In his view, once the joint surface and cartilage are already damaged, PRP cannot regenerate them, and he prefers to base further treatment on X-rays and, if needed, an MRI.
In This Series: Diagnosis and Management of Arthritis in Joints
- 1.Diagnosis and Management of Arthritis in Joints
- 2.What Is Arthritis? Understanding Its Main Types and Causes
- 3.Who Is at Risk of Osteoarthritis: Age, Weight, Occupation and Injury
- 4.Recognising Joint Arthritis: Pain, Swelling, Crepitus and Instability
- 5.Diagnosing Joint Arthritis: Why X-Rays Come Before an MRI
- 6.Non-Surgical Management of Arthritis: Weight, Physiotherapy and Mobility Aids
- 7.Medicines and Joint Injections for Arthritis: What Works and What Doesn't
- 8.When Arthritis Needs Surgery: Hip, Knee, Shoulder and Elbow Replacement
- 9.Recovery After Joint Replacement: Rehabilitation and Activity Limits
- 10.Joint Replacement Case Studies: Patients Who Travelled From Africa for Surgery
- 11.The Cost of Joint Replacement Surgery in India for International Patients