In the comparator-controlled RCTs, acetaminophen was less effective overall than NSAIDs in terms of pain reduction and global assessments but both drugs had similar efficacy in terms of improvements in functional status.
Reviewer's conclusions: The evidence to date suggests that NSAIDs are superior to acetaminophen for improving knee and hip pain in people with OA but have not been shown to be superior in improving function. The size of the treatment effect was modest, and the mean trial duration was only six weeks, therefore, additional considerations need to be factored in when making the decision between using acetaminophen or NSAIDs.
Abstract Background: Osteoarthritis OA is the most common form of arthritis. Publication types Review Systematic Review. Diclofenac is sold by prescription in the U. Taking any NSAID long term carries risks, such as serious gastrointestinal and cardiovascular side effects, that doctors and patients need to consider carefully, the researchers warned.
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," study co-author Dr. Sven Trelle, from the University of Bern, in Switzerland, said in a statement. Trelle noted that NSAIDs are some of the most widely used drugs for patients with osteoarthritis, but patients often switch between the different options.
Arthritis expert Dr. Bashir Zikria, an assistant professor of orthopaedic surgery at the Johns Hopkins University School of Medicine, said there's been limited research comparing acetaminophen against a placebo. Doctors recommend it to patients with osteoarthritis because it's generally safe. It doesn't bother your kidneys and stomach," Zikria explained, although, in very high doses, acetaminophen can have liver side effects. The company said in a statement: "We disagree with the authors' interpretation of this meta-analysis and believe acetaminophen remains an important pain relief option for millions of consumers, particularly those with certain conditions for which nonsteroidal anti-inflammatory drugs NSAIDs may not be appropriate including cardiovascular disease, gastrointestinal bleeding, and renal disease.
The safety and efficacy profile of acetaminophen is supported by more than studies over the past 50 years and we are committed to furthering research and education to ensure consumers can make informed choices about their medications based on individual health needs. In the study by Bradley et al, APAP demonstrated equivalent efficacy to both a high "anti-inflammatory" dose and a low "analgesic" dose of ibuprofen in knee OA.
A subsequent analysis of data from that study provided some revealing context regarding analgesia. The authors examined the impact of inflammation in these patients upon relief of symptoms. They found that reduction in the signs of joint inflammation was similar among the 3 treatment groups and associated with less disability and pain at rest, but that better outcomes were not more or less prevalent in any of the 3 treatment groups. This notion is supported by several dental surgery studies, which show that APAP is equivalent to NSAIDs in the reduction of both swelling and pain, and is superior to placebo Figure 2 and.
Ultimately, the mechanism by which APAP produces analgesic effects is not well understood. It is generally accepted that the analgesic activity of APAP occurs via its effect on the central nervous system. Consequently, the major clinical treatment guidelines for OA recommend APAP as the initial treatment for those with mild-to-moderate pain, both for its efficacy and safety. Whereas the analgesic mechanism of APAP has yet to be elucidated, the assumption that APAP lacks an anti-inflammatory effect is challenged by various, albeit inconclusive, data.
These data point to the possibility that the inflammatory process in OA is more complex than previously understood. Authorship Information: Concept and design; analysis and interpretation of data; and critical revision of the manuscript for important intellectual content. E-mail: jjflood columbusrr. Osteoarthritis Cartilage. Osteoarthritis: the care and management of osteoarthritis in adults.
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