Source: Lancet 

Key Point

• According to this meta-analysis of 76 randomized clinical trials (RCTs), paracetamol had no clinically significant effect in treating osteoarthritis pain.
  
  

   

  Key Findings

  
  

• Diclofenac 150mg/day was the most effective intervention for pain and physical function.
  
  

• Etoricoxib 60mg/day or rofecoxib 25mg/day also made a clinically relevant difference.
  
  

• All NSAIDs showed significant gastrointestinal and cardiovascular damage.
  
  

• Paracetamol had no clinically significant effect at any dose compared to placebo.
  
  

   

  Study Design

  
  

• Network meta-analysis of 76 randomized clinical trials (n = 58,451) comparing different doses of NSAIDs and a placebo or paracetamol for hip or knee osteoarthritis.
  
  

• In most cases, follow-up duration was ≤3 months.
  
  

• Most trials were of high quality.
  
  

• The primary outcome measure was pain.
  
  

• Funding: Swiss National Science Foundation; ARC Foundation, Switzerland.
  
  

   

  Why it matters

  
  

• NSAIDs are a cornerstone of osteoarthritis treatment; however, given the risks and overmedication, drug selection can be complicated.