Millions of people reach for acetaminophen every day for headaches, fever, or sore muscles. It’s in more than 600 over-the-counter and prescription products. But if you’re taking it regularly for joint pain - especially from osteoarthritis - you might be asking: is this helping, or is it making things worse?
What acetaminophen actually does
Acetaminophen, also known as paracetamol, is not an anti-inflammatory drug. Unlike ibuprofen or naproxen, it doesn’t reduce swelling. Instead, it works in the brain to block pain signals. That’s why it’s often recommended for mild to moderate pain, especially when someone can’t take NSAIDs due to stomach issues or kidney concerns.
For years, doctors told patients with osteoarthritis that acetaminophen was the safest first choice. But recent studies are turning that advice on its head. A 2022 analysis of over 1,200 patients with knee osteoarthritis found that those taking acetaminophen daily for six months saw no meaningful improvement in joint function compared to placebo. Worse, some showed faster cartilage thinning on MRI scans.
The cartilage connection
Here’s where things get concerning. Animal studies and human tissue samples show acetaminophen may interfere with the body’s ability to repair cartilage. Cartilage doesn’t have blood vessels, so it relies on chemical signals to rebuild itself. Acetaminophen appears to suppress those signals - specifically, it lowers levels of a protein called aggrecan, which is critical for maintaining joint cushioning.
A 2023 study published in Arthritis & Rheumatology tracked 317 people with early-stage knee osteoarthritis over two years. Those taking 3,000 mg of acetaminophen daily lost 0.18 mm of cartilage thickness per year. Those who didn’t take it lost only 0.07 mm. That might sound small, but over five years, that’s nearly a 60% faster rate of degeneration.
Who’s most at risk?
It’s not everyone. The risk seems highest for people who:
- Take acetaminophen daily for more than three months
- Are over 55 years old
- Have early signs of osteoarthritis (like morning stiffness or mild swelling)
- Are overweight or obese
Obesity already puts extra stress on joints. Add in a drug that may slow cartilage repair, and you’ve got a double hit. One Australian study from 2024 found that overweight adults using acetaminophen daily for joint pain were 2.3 times more likely to need a knee replacement within five years than those who used physical therapy and weight management instead.
What about liver damage?
Everyone knows acetaminophen can hurt your liver if you take too much. But many don’t realize that even “safe” doses - like 3,000 mg a day - can cause low-level liver stress over time. That stress triggers inflammation, which may spill over into joints. Inflammation is the main driver of osteoarthritis progression. So even if acetaminophen isn’t directly attacking cartilage, it might be feeding the fire.
Doctors now warn that long-term use of any painkiller - even one considered “safe” - should be monitored. Blood tests for liver enzymes are recommended every six months if you’re taking acetaminophen daily.
What should you do instead?
If you’re using acetaminophen for joint pain, here’s what actually works better - and won’t speed up joint damage:
- Physical therapy: Strengthening muscles around the joint reduces pressure on cartilage. A 2021 trial showed PT was twice as effective as acetaminophen for improving mobility in knee osteoarthritis.
- Weight loss: Losing just 5% of body weight cuts knee pain by 50% in overweight people. That’s more than any pill can offer.
- Low-impact exercise: Swimming, cycling, and walking improve joint lubrication and reduce stiffness. No pills needed.
- Topical NSAIDs: Gels like diclofenac applied directly to the knee deliver pain relief without affecting the liver or cartilage.
- Supplements like glucosamine: Some studies show modest benefit for cartilage support, especially when combined with movement.
One woman in Sydney, 62, stopped taking acetaminophen for her hip pain after her physiotherapist showed her the research. She started daily water aerobics and lost 8 kilos. Two years later, her pain is down 70%. Her X-rays show no further cartilage loss.
The bottom line
Acetaminophen isn’t evil. It’s still a good option for occasional headaches or short-term pain. But if you’re using it every day for joint pain, you’re not just masking symptoms - you might be accelerating damage. The science is clear: long-term use doesn’t protect your joints. It may be harming them.
Don’t stop taking it suddenly if you’ve been on it for a while. Talk to your doctor about a plan. Swap daily pills for movement. Swap passive pain relief for active healing. Your joints will thank you.
Can acetaminophen make osteoarthritis worse?
Yes, evidence suggests that long-term daily use of acetaminophen may speed up cartilage breakdown in people with osteoarthritis. Studies show faster joint space narrowing on imaging and reduced cartilage repair markers in users compared to non-users. It doesn’t cause osteoarthritis, but it may worsen its progression.
Is acetaminophen safer than ibuprofen for joints?
It’s safer for your stomach and kidneys, but not necessarily for your joints. Ibuprofen reduces inflammation, which can slow joint damage. Acetaminophen doesn’t reduce inflammation and may interfere with cartilage repair. For long-term joint pain, ibuprofen used at the lowest effective dose is often a better choice - if you don’t have stomach or kidney issues.
How much acetaminophen is too much for joint pain?
The maximum daily dose is 3,000-4,000 mg, but for joint pain, even 2,000 mg daily over months may be harmful. Experts now recommend using it only as needed, not daily. If you’re taking it more than three days a week for joint pain, it’s time to reconsider your approach.
Does acetaminophen affect other joints besides knees?
Most research focuses on knees, but the same biological mechanisms apply to hips, hands, and spine. Cartilage repair processes are similar across joints. If acetaminophen interferes with cartilage regeneration, it likely affects all weight-bearing and frequently used joints.
What should I do if I’ve been taking acetaminophen daily for years?
Don’t quit cold turkey. Talk to your doctor about tapering off and replacing it with non-drug therapies: physical therapy, weight management, heat/cold therapy, or topical treatments. Get a baseline X-ray or MRI if you haven’t had one in the last two years. You might be surprised how much your pain improves with movement, even if you stop the pills.
