The leading symptom of arthrosis and arthritis is pain. As in the case of pharmacotherapy fortumor pain, a stepped approach is also recommended for rheumatic complaints. Mild-to-moderate pain in noninflammatory arthrosis can be ameliorated by paracetamol or low-dose ibuprofen. If inflammation is present, nonsteroidal anti-inflammatory drugs (NSAIDs) must be employed. If this treatment does not suffice to manage systemic arthritis, oral short-acting corticosteroids are applied. Intra-articular corticosteroid injections can be used to individual inflamed active joints. For chronic pain, opioids may be necessary in addition to NSAID treatment. The use of NSAIDs is limited by gastrointestinal side effects. In the case of risk patients, therefore, preventive measures must be taken, and PPI or, instead of NSAIDs, coxibs employed in addition.