Paracetamol for osteoarthritis; is there a need for revision of guidelines?
Keywords:
Paracetamol, Osteoarthritis, NSAIDs, GuidelinesAbstract
Paracetamol (PCT) is the most commonly prescribed drug for pain of osteoarthritis (OA). Its advantage over non-steroidal anti-inflammatory drugs (NSAIDs) in terms of better gastrointestinal and renal safety had made this choice obvious especially in the elderly; a few years ago. Considering the current treatment guidelines (American College of Rheumatology, National Institute for Health and Care Excellence and European League against Rheumatism) which uphold PCT as the first choice drug for OA, a few studies have questioned the aforesaid advantage of PCT against its modest efficacy in patients with OA.References
Neame R, Zhang W, Doherty M. A historic issue of the Annals: three papers examine paracetamol in osteoarthritis. Ann Rheum Dis. 2004;63(8):897-900.
Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012;64(4):465-74.
Available at http://www.nice.org.uk/guidance/cg177. Accessed 19 Nov 2014 at 9 am.
Boureau F, Schneid H, Zeghari N, Wall R, Bourgeois P. The IPSO study: ibuprofen, paracetamol study in osteoarthritis. A randomised comparative clinical study comparing the efficacy and safety of ibuprofen and paracetamol analgesic treatment of osteoarthritis of the knee or hip. Ann Rheum Dis. 2004;63(9):1028-34.
Towheed TE, Maxwell L, Judd MG, Catton M, Hochberg MC, Wells G. Acetaminophen for osteoarthritis. Cochrane Database Syst Rev. 2006;(1):CD004257.
Kamath A. Paracetamol in osteoarthritis: NICE guidelines or not so nice. J Postgrad Med. 2014;60(2):212.