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Significant improvements in pain found in knee OA treatments
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A comparison of the most commonly used pharmacologic interventions for knee osteoarthritis-related pain showed that, besides acetaminophen, all treatments resulted in clinically significant improvement in pain, according to study results.
“We found that the injections are more effective, but acetaminophen is still a reasonable option to begin the treatment with as it is less risky,” Raveendhara R. Bannuru, MD, PhD, FAGE, a researcher at the Center for Arthritis and Rheumatic Diseases at Tufts Medical Center, told Orthopedics Today. “If [acetaminophen] is not effective, one should quickly move on to other options. Also, based on the findings of this study, I would say injection therapies like hyaluronic acid or steroids are what to try.”
Bannuru and colleagues included 137 randomized, controlled trials from 1980 to 2014 comprising 33,243 adults with knee osteoarthritis. All studies compared at least two or more of the following: acetaminophen, diclofenac, ibuprofen, naproxen, celecoxib, intra-articular (IA) corticosteroids, IA hyaluronic acid, oral placebo and IA placebo. The researchers extracted data on measures of pain, function and stiffness.
When it came to pain-related outcomes, results showed all interventions significantly outperformed oral placebo. The researchers found effect sizes for pain-related outcomes ranged from 0.63 for the most efficacious treatment to 0.18 for the least efficacious treatment. Except IA corticosteroids, all interventions were significantly superior to oral placebo for physical function outcomes. Most of the treatments did not significantly differ from one another for stiffness outcomes, according to the researchers.
There were higher effect sizes in studies that reported WOMAC pain scales compared with studies reporting on other pain scales. In studies reporting pain alone, the researchers found stronger effects for diclofenac, celecoxib, IA corticosteroids and acetaminophen vs. oral placebo. Compared with oral placebo and acetaminophen, oral nonselective nonsteroidal anti-inflammatory drugs led to more gastrointestinal adverse events and withdrawals due to adverse events. However, the researchers found these events were similar between acetaminophen and celecoxib. Patients undergoing oral treatments and IA therapies were more likely to withdrawal due to adverse events, according to study results.
“Since we found some surprising effects on the differential placebo effect, we are planning to explore more on the differential placebo effects,” Bannuru said. “Also, I would be interested in looking at the cost effectiveness of all these treatments because the most effective treatment may not be cost-effective.” – by Casey Tingle
Disclosures: Bannuru received grants from the Agency for Healthcare Research and Quality. Please see the full study for a list of all other authors’ relevant financial disclosures.
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