A variety of oral and injectable treatments for knee osteoarthritis (OA) are more effective than placebo, but head-to-head comparisons are limited, according to a systematic evidence review being published in Annals of Internal Medicine.
Knee OA is progressive joint disease affecting nearly 40 percent of the U.S. population over the age of 45. Many oral nonsteroidal anti-inflammatory drugs (NSAIDs) and injectable therapies are available to treat knee OA; however, it is difficult to know which treatments work best because few head-to-head comparison studies are available.
Researchers reviewed published research to compare the relative efficacy of commonly used treatments. They selected randomized trials that compared two or more of the following: acetaminophen, diclofenac, ibuprofen, naproxen, celecoxib, corticosteroid injections, hyaluronic acid injections, oral placebo, and placebo injections.
At three months, all interventions were significantly better than oral placebo for improving OA pain. Acetaminophen, the most commonly used over-the-counter treatment for knee OA, was shown to be the least effective option for pain. Except for celecoxib, all treatments were significantly better than acetaminophen.
Injections proved to be the most effective treatment for knee OA pain. Even placebo injections were better than oral NSAIDs, suggesting a placebo effect of the delivery method.
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