Paracetamol not effective for treatment of osteoarthritis
23 March 2016
There is "no role" for the use of paracetamol in treating osteoarthritis is the conclusion of a wide-ranging meta-analysis (a study combining data from many other studies).
The analysis of 74 trials of paracetamol and 7 different NSAID (non-steroidal anti-inflammatory drugs) painkillers with nearly 60,000 patients found diclofenac 15mg/day to be the most effective medicine for short-term pain relief.
Other treatments that scored well were etoricoxib 60mg/day and rofecoxib 25mg/day. (Etoricoxib is available as the brand name Arcoxia in Australia.)
However, paracetamol, which is widely used in osteoarthritis, performed only marginally better than placebo (dummy treatment) and did not seem to confer any clinically meaningful benefit.
The findings are in conflict with some Australian guidelines for treating osteoarthritis.
Lead author Dr Sven Trelle from the University of Bern in Switzerland says NSAIDs are usually only used to treat short-term pain episodes due to their well-known side-effects.
“Because of this, paracetamol is often prescribed to manage long-term pain in osteoarthritis instead of NSAIDs. However, our results suggest that paracetamol at any dose is not effective in managing pain in osteoarthritis, but that certain NSAIDs are effective and can be used intermittently without paracetamol.”
David Hunter, Florance and Cope Chair of Rheumatology and Professor of Medicine at the University of Sydney, agrees the latest evidence suggests paracetamol’s effect in osteoarthritis is not clinically meaningful and there are “real concerns” about its safety.
Professor Hunter says a number of drugs are in the pipeline for pain in osteoarthritis, including long-acting intra-articular preparations, nerve growth factor inhibitors and cannabinoid agents.
da Costa BR et al. Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis. DOI: http://dx.doi.org/10.1016/S0140-6736(16)30002-2