The Most Effective Treatment for Knee Osteoarthritis
A team of researchers have found that an injection of hyaluronic acid or corticosteroids may be the most effective treatment for pain associated with knee osteoarthritis (OA).
In a network meta-analysis of 137 trials involving 33,243 participants, investigators sought to examine the efficacy of treatments of primary knee OA. The authors selected randomized trials of adults with knee OA comparing 2 or more of the following: acetaminophen, diclofenac, ibuprofen, naproxen, celecoxib, intra-articular (IA) corticosteroids, IA hyaluronic acid, oral placebo, and IA placebo.
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For pain, all interventions significantly outperformed oral placebo, with effect sizes from 0.63 for the most efficacious treatment (hyaluronic acid) to 0.18 for the least efficacious treatment (acetaminophen), according to the authors, who note that all interventions except IA corticosteroids were significantly superior to oral placebo in terms of function. For stiffness, most of the treatments did not significantly differ from one another.
Acetaminophen is “still a reasonable option with which to begin treatment” for knee OA-related pain,” said Raveendhara Bannuru, MD, PhD, researcher at the Center for Arthritis and Rheumatic Diseases at Tufts Medical Center, and lead author of the study.
But, he added, “one should quickly move on to other options” if acetaminophen is not effective.
“Based on the findings of this study, injected therapies—whether hyaluronic acid or corticosteroids—are worth a try, not only for their efficacy, but also to avoid the systemic adverse events associated with oral NSAIDs,” said Bannuru, “especially considering the health risks typical among individuals with OA.”
While Bannuru and his colleagues did not test the non-drug treatments in this study, “it is important for people with knee OA to understand that there are several non-drug treatments, such as exercise and physical therapy, which are recommended universally by OA clinical practice guidelines,” he said, noting that “it is certainly advisable” for physicians to discuss these options with their patients to see which are an appropriate fit for them—either alone or in conjunction with drug treatments.
Ultimately, “our study helps the decision-making process for both patients and doctors,” said Bannuru. “Individuals are encouraged to consult their doctors to discuss the harms and benefits of different treatments and chose the treatments that are right for their individual circumstances and health profiles.”
—Mark McGraw
Reference:
Bannuru R, Schmid C, et al. Pharmacologic Interventions for Knee OA. Ann Intern Med. 2015.