Symptomatic treatment of osteoarthritis: paracetamol or non-steroidal anti-inflammatorydrugs?

Overview

The author discusses relative advantage of paracetamol or non-steroidal anti-inflammatory drugs(NSAIDs) application in the symptomatic treatment of osteoarthritis. While older studies demonstrateda similar efficacy of paracetamol and NSAIDs, latest cross-over trials revealed superiorityof NSAIDs, particularly in patients with initially higher level of pain. About 60% of patients preferNSAIDs, but nearly 40% of them describe quite a similar efficacy of paracetamol. Paracetamol hasbeen considered to be a safe drug. Two epidemiological studies showed comparable frequencies ofgastrointestinal adverse events between higher doses of paracetamol and NSAIDs. Nevertheless,there is no evidence for increased risk of gastric ulcer after paracetamol use. Considering thecost/benefit ratio, the most advisable approach is to initiate analgesic treatment with paracetamoland to continue with it over long termtreatment, if satisfactory. The use of NSAIDs is recommendedwhen paracetamol is insufficient in pain control. The concept of phasic treatment - short term useof NSAIDs during pain exacerbation and long termadministration of paracetamol afterwards is alsorecommended.

Key words:
osteoarthritis, paracetamol, non-steroidal anti-inflammatory drugs