The Pharmaceutical Journal
Vol 270 No 7234 p142
1 February 2003

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Reconsider first-line paracetamol use for knee osteoarthritis

The recommendation that paracetamol should be used in preference to non-steroidal anti-inflammatory drugs in the initial treatment of osteoarthritis of the knee should be reconsidered, according to researchers from Rush Medical College, Chicago, Illinois.

Dr John Case and colleagues conducted a double-blind, placebo-controlled trial of diclofenac sodium (75mg twice daily) versus paracetamol (1g four times daily) in 82 patients with osteoarthritis of the knee. At two and 12 weeks, clinical improvements were seen in the group of patients treated with diclofenac (P<0.001) but not in the group treated with paracetamol.

The researchers point out that there is scant evidence for a therapeutic effect of paracetamol relative to placebo in this group of patients. They add that this is because most published studies use active comparators (ie, non-steroidal anti-inflammatory drugs).

"The advocacy of [paracetamol] use in subjects with osteoarthritis of the knee should be reconsidered pending further placebo-controlled studies," they conclude (Archives of Internal Medicine 2003;163:169).