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We use pharmacologic agents for patients with symptomatic OA who have not responded adequately to initial nonpharmacologic measures or concomitantly with these interventions for those with more severe symptoms. Pharmacologic therapy should only be used during periods when symptoms are present, since none of the interventions have been shown to be disease-modifying. The main medications used in the pharmacologic management of OA include oral and topical non steroidal anti inflammatory drugs, with topical capsaicin, duloxetine, and intra articular glucocorticoids . The choice of pharmacologic agent used is influenced by the specific joint and number of joints involved, as well as the presence of certain comorbidities. non steroidal anti inflammatory drugs and acetaminophen are generally considered first-line therapies in the treatment of OA. non steroidal anti inflammatory drugs are effective for overall pain from OA. There is no strong evidence of benefit of any particular NSAID over another. NSAIDS should be used with caution in those with gastrointestinal disease including selective cox-2 inhibitors or nonselective NSAIDs with the addition of a gastroprotective agent. Acetaminophen has been found to be effective in the treatment of OA, although modestly. They are also less effective than NSAIDs. Acetaminophen is generally safe and may be preferable when NSAIDs are contraindicated.