A new analysis of 53 randomized controlled trials compares outcomes for the most common NSAID as treatments to lower pain and improve function in osteoarthritic (OA) knees.
Novel Meta-analysis Compares NSAIDs for OA Pain
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Secondary#kneeosteoarthritis#knee#naproxen#nonsteroidalantiinflammatorydrug
The study, “Mixed Treatment Comparisons for Nonsurgical Treatment of Knee Osteoarthritis: A Network Meta-analysis,” was published in the May 1, 2018 edition of the Journal of the American Academy of Orthopaedic Surgeons.
“This is the first comprehensive mixed-comparison analysis comparing best-evidence scientific research and excluding lower quality studies that can bias the outcomes,” said lead author and orthopaedic surgeon David Jevsevar, M.D., M.B.A. “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 HA [hyaluronic acid], PRP [platelet-rich plasma], and corticosteroids.”
The researchers examined knee OA treatments, ranking them on a scale of one to five, with one being the most effective. They found that naproxen was ranked the most effective individual knee OA treatment for improving both pain and function followed by cortisone injections, PRP injections, ibuprofen and celecoxib.
Dr. Jevsevar told OTW, “We were certainly surprised that one of the least expensive treatments for knee OA provided the best outcome through this analysis when evaluated by both pain and function.”
Asked about special considerations for doctors who have to counsel patients with comorbidities, he commented, “Obviously, each treatment has its own set of risks, and comorbidities can interact with those risks. While NSAIDs have documented cardiac risks, Naproxen has a better risk profile as discussed. GI and renal complications from its use are still possible. While IA [intra-articular] corticosteroids are effective as well, brittle diabetics can sometimes have poor blood glucose responses to the IA corticosteroid use. The potential interactions of PRP are less well documented.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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