Treatments for knee osteoarthritis are ranked for impact on pain and function

The effectiveness of non-surgical treatments for knee osteoarthritis have been ranked in the US and naproxen comes out top.

Data from multiple trials was analysed and treatments compared and ranked. These included acetaminophen, ibuprofen, intra-articular or joint injections of cortisone, platelet-rich plasma, hyaluronic acid, several NSAIDs (such as naproxen, celecoxib and diclofenac) and oral and intra-articular placebo.

Key findings

• For pain reduction, cortisone injections provided the greatest short-term (4 to 6 weeks) pain relief, followed by ibuprofen, platelet-rich plasma injections, naproxen and celecoxib;
• For improving function, naproxen ranked the highest for improving function, followed by diclofenac, celecoxib, ibuprofen and platelet-rich plasma injections;
• For improving both pain and function, naproxen was ranked the most effective, followed by cortisone injections, platelet-rich plasma injections, ibuprofen and celecoxib;
• Hyaluronic acid injections did not achieve a rank in the top five treatments for pain, function, or combined pain and function.

We know that NSAIDs have potential risks, including heart attack and stroke, but the evidence suggests that naproxen has less potential for adverse cardiovascular events.

“This is the first comprehensive mixed-comparison analysis comparing best-evidence scientific research and excluding lower quality studies that can bias the outcomes,” explains lead author Dr David Jevsevar. “Using a statistical ranking technique, we worked to provide evidence regarding which of the most common NSAIDs are most likely to decrease pain and improve function, and we attempted to fill in the gaps in evidence for more inconclusive treatments such as hyaluronic acid, platelet rich plasma and corticosteroids.”

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