Key messages from scientific research that's ready to be acted on
Got It, Hide thisBannuru RR, Schmid CH, Kent DM, et al. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med. 2015;162:46-54.
In people with knee osteoarthritis (OA), are some drugs better than others for reducing pain and stiffness and improving physical function?
OA is a disease of the joints and often occurs in knees. It develops when your joints lose the cartilage that protects the ends of your bones. There is no cure and it often gets worse over time. Symptoms of knee OA include pain, stiffness, and worsening physical function.
There are different treatments for the symptoms of knee OA. This review is about drugs given by mouth (oral method) or by injection directly into the knee joint (intra-articular [IA] method) to reduce symptoms.
The researchers did a systematic review, searching for studies that were published up to August 2014.
They included 137 randomized controlled trials with 33,243 people (average age 45 to 76 years, 3% to 100% women).
The key features of the studies were:
Compared with placebo:
Compared with acetaminophen:
IA hyaluronic acid reduced pain more than celecoxib and naproxen and improved physical functioning more than IA corticosteroids.
There was not enough information to compare the side effects of the drugs.
Trials were combined using a type of analysis that lets you compare treatments even if they were not compared directly in the individual trials.
In people with knee osteoarthritis, all drugs evaluated in the review reduce pain and most improve physical functioning. Oral NSAIDs, IA hyaluronic acid, and IA corticosteroids each reduce pain more than acetaminophen, and IA hyaluronic acid is better than some NSAIDs.
Outcomes | Number of trials (people) | Effect of treatment at 3 months* |
Pain | 129 trials (32,129 people) | Acetaminophen, NSAIDs†, IA corticosteroids, and IA hyaluronic acid reduced pain more than placebo |
|
| Diclofenac, ibuprofen, naproxen, IA corticosteroids, and IA hyaluronic acid reduced pain more than acetaminophen |
|
| IA hyaluronic acid reduced pain more than celecoxib or naproxen |
Physical functioning | 76 trials (24,059 people) | Acetaminophen, NSAIDs†, and IA hyaluronic acid improved physical functioning more than placebo |
|
| NSAIDs† improved physical functioning more than acetaminophen |
|
| IA hyaluronic acid improved physical functioning more than IA corticosteroids |
Stiffness | 55 trials (18,267 people) | NSAIDs† and IA hyaluronic acid reduced stiffness more than placebo |
|
| NSAIDs† reduced stiffness more than acetaminophen |