Paracetamol is ineffective against osteoarthritis, says new study

A major new study published in the Lancet, has found that paracetamol does not meet the minimum standard of clinical effectiveness in reducing pain or improving physical function in patients with knee or hip osteoarthritis.

Scientists in the study have warned that paracetamol is ineffective no mater how high the dose and does little to improve movement or ease pain in people suffering from the debilitating condition.

Paracetamol has traditionally been the main treatment for the condition, because it has fewer side effects that stronger drugs, even though they are more effective. However, it has been found that while higher doses of the painkiller does little to improve conditions, it can have side effects if taken in high doses over long periods.

In 2013, the National Institute for Health and Care Excellence (NICE), advised doctors to stop prescribing pills for long-term treatment of osteoarthritis, with warnings of possible long-term impacts including heart, kidney and intestinal problems.

However, Arthritis Research UK still advises patients that paracetamol can be taken for “mild to moderate” pain caused by osteoarthritis.

For this study a team of Swiss researchers from the University of Bern, pooled data from 74 randomised trials involving 58,500 patients and found that although paracetamol was slightly better than a placebo pill, it “has no role” in the treatment of patients with osteoarthritis, irrespective of dose.

The team also found that the nonsteroidal anti-inflammatory drug (NSAID) diclofenac was a more effective treatment and should be considered for intermittent and not long term use.

Study leader Dr Sven Trelle, says, “NSAIDs are usually only used to treat short-term episodes of pain in osteoarthritis, because the side-effects are thought to outweigh the benefits when used longer term.

“Because of this, paracetamol is often prescribed to manage long-term pain instead of NSAIDs.

“However, our results suggest that paracetamol at any dose is not effective in managing pain in osteoarthritis, but that certain NSAIDs are effective and can be used intermittently without paracetamol.”

In the Daily Mail, Britain’s most senior GP said patients who take paracetamol shouldn’t panic, but called for more research into better treatments for the condition.

Dr Maureen Baker, chair of the Royal College of GPs, says, “The majority of evidence still suggests that paracetamol is a safe drug for most patients, but a number of recent studies – today’s included – do cast doubt on its effectiveness at treating osteoarthritis.

“What the study doesn’t suggest is a suitable – and safe – alternative for pain management in patients with osteoarthritis. We know that alternatives, such as NSAIDs, can be effective but they can have nasty side-effects for patients if they are taken over a long period of time.

“And whilst GPs understand and advocate lifestyle changes to patients, that can help ease their pain, there is a limit to how viable these are, particularly in serious cases.

“We would welcome more research into safe and effective alternatives to paracetamol, so that we can help our patients with osteoarthritis manage their condition and live as comfortable a life as possible.”

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