| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
|
|
|
|
|||||||||||||
|
|
|||||||||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
REVIEW |
1 Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK
2 Rheumatology Unit, Nottingham City Hospital, Nottingham NG5 1PB, UK
Correspondence to:
Correspondence to:
Dr W Zhang
Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK; weiya.zhang{at}nottingham.ac.uk
ABSTRACT
Objective: To assess the best available evidence for efficacy of paracetamol (acetaminophen) in the treatment of osteoarthritis (OA).
Design: Systematic review and meta-analysis of randomised controlled trials (RCTs).
Data sources: Medline, Embase, Scientific Citation Index, CINAHL, Cochrane Library, and conference abstracts in the past 2 years from the British Society for Rheumatology, the European League Against Rheumatism, the American College of Rheumatology, and the Osteoarthritis Research Society International.
Subjects: 10 RCTs including 1712 patients with either symptomatic OA of the knee (6 trials) or hip/knee (3 trials) or multiple joints (1 trial).
Main outcome measures: (a) effect size (ES) for pain, stiffness, and functional scores from baseline to end point; (b) rate ratio (RR) and number needed to treat for clinical response rate and patient preference for treatment.
Results: Paracetamol was effective in relieving pain due to OA (ES = 0.21, 95% confidence interval (CI) 0.02 to 0.41). Non-steroidal anti-inflammatory drugs (NSAIDs) were better than paracetamol for pain relief (ES = 0.20, 95% CI 0.10 to 0.30). Clinical response rate was higher with NSAIDs than with paracetamol (RR = 1.24, 95% CI 1.08 to 1.41), and the number of patients who preferred NSAIDs was more than twice the number of those preferring paracetamol (RR = 2.46, 95% CI 1.51 to 4.12). NSAIDs were associated with more frequent gastrointestinal discomfort than paracetamol (RR = 1.35, 95% CI 1.05 to 1.75).
Conclusion: Paracetamol is an effective agent for pain relief due to OA. Although safer, it is less effective than NSAIDs. For safety reasons paracetamol should be the first line treatment, with NSAIDs reserved for those who do not respond.
Abbreviations: ACR, American College of Rheumatology; CI, confidence interval; ES, effect size; EULAR, European League Against Rheumatism; GI, gastrointestinal; MeSH, medical subject heading; NNT, number needed to treat; NSAIDs, non-steroidal anti-inflammatory drugs; OA, osteoarthritis; RCT, randomised controlled trial; RR, rate ratio; WOMAC, Western Ontario and McMaster Universities OA Index
Keywords: paracetamol; osteoarthritis; meta-analysis; randomised controlled trials
This article has been cited by other articles:
|
|
 |
|
  R. Chou, A. Qaseem, V. Snow, D. Casey, J. T. Cross Jr, P. Shekelle, D. K. Owens, and for the Clinical Efficacy Assessment Subcommittee Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society Ann Intern Med, October 2, 2007; 147(7): 478 - 491. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Chou and L. H. Huffman Medications for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline Ann Intern Med, October 2, 2007; 147(7): 505 - 514. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C.K.S. Ong, P. Lirk, C.H. Tan, and R.A. Seymour An Evidence-Based Update on Nonsteroidal Anti-Inflammatory Drugs Clin. Med. Res., March 1, 2007; 5(1): 19 - 34. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W Zhang, M Doherty, B F Leeb, L Alekseeva, N K Arden, J W Bijlsma, F Dincer, K Dziedzic, H J Hauselmann, G Herrero-Beaumont, et al. EULAR evidence based recommendations for the management of hand osteoarthritis: Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT) Ann Rheum Dis, March 1, 2007; 66(3): 377 - 388. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J Bjordal and P G Conaghan NSAIDs in osteoarthritis: irreplaceable or troublesome guidelines? Br. J. Sports Med., April 1, 2006; 40(4): 285 - 286. [Full Text] [PDF]
|
|
|
|
|
|
J Zochling, D van der Heijde, R Burgos-Vargas, E Collantes, J C Davis Jr, B Dijkmans, M Dougados, P Geher, R D Inman, M A Khan, et al. ASAS/EULAR recommendations for the management of ankylosing spondylitis Ann Rheum Dis, April 1, 2006; 65(4): 442 - 452. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W Zhang, M Doherty, N Arden, B Bannwarth, J Bijlsma, K-P Gunther, H J Hauselmann, G Herrero-Beaumont, K Jordan, P Kaklamanis, et al. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT) Ann Rheum Dis, May 1, 2005; 64(5): 669 - 681. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Lehman Evidently... Evid. Based Med., February 1, 2005; 10(1): 8 - 8. [Full Text] [PDF]
|
|
|
|
|
|
Other articles noted Evid. Based Med., February 1, 2005; 10(1): 31 - 32. [Full Text] [PDF]
|
|
|
|
 |
|
 C. R Kessenich Review: paracetamol reduces pain in osteoarthritis but is less effective than NSAIDs Evid. Based Nurs., January 1, 2005; 8(1): 21 - 21. [Full Text] [PDF]
|
|
|
|
|
|
L Denoeud, B Mazieres, C Payen-Champenois, and P Ravaud First line treatment of knee osteoarthritis in outpatients in France: adherence to the EULAR 2000 recommendations and factors influencing adherence Ann Rheum Dis, January 1, 2005; 64(1): 70 - 74. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. MacAuley Managing osteoarthritis of the knee BMJ, December 4, 2004; 329(7478): 1300 - 1301. [Full Text] [PDF]
|
|
|
|
|
|
J. M. Bjordal, A. E. Ljunggren, A. Klovning, and L. Slordal Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: meta-analysis of randomised placebo controlled trials BMJ, December 4, 2004; 329(7478): 1317. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R Neame, W Zhang, and M Doherty A historic issue of the Annals: three papers examine paracetamol in osteoarthritis Ann Rheum Dis, August 1, 2004; 63(8): 897 - 900. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
