REVIEW: MOST EFFECTIVE TREATMENTS FOR KNEE OA
Bannuru RR, Schmid CH, Kent DM, Vet al. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med. 2015;162(1):46-54. doi: 10.7326/M14-1231.
Intra-articular hyaluronic acid offers the best relief for pain in patients with knee osteoarthritis (OA), a meta-analysis of 137 studies with 33,243 subjects reports.
Researchers reviewed randomized trials of adults with knee OA that compared two or more treatments, including acetaminophen, diclofenac, ibuprofen, naproxen, celecoxib, intra-articular (IA) corticosteroids, IA hyaluronic acid, oral placebo, and IA placebo. They found for pain, stiffness, and function all treatments fared better than oral placebo.
• For pain, IA hyaluronic acid was most effective (0.63); acetaminophen was least effective (0.18).
• For function, all of the treatments were superior to oral placebo except IA corticosteroids.
• For stiffness, there was no significant difference among the different treatments.
COMMENTARY
The decision about which medicine to use to treat a patient with osteoarthritis is made on an individual basis, based on effectiveness for pain, as well as safety and cost considerations. Acetaminophen, which is the least effective pain agent studied, probably deserves its place as the most commonly used analgesic for OA based on safety and cost. IA treatments were in general more effective than oral treatments, though it is important to recognize that these studies looked at months, not years, of treatment of OA, and most of our patients are treated over a course of years. —NS