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Effectiveness of nonsurgical treatments for knee osteoarthritis

By Nicole MacKee
A comparison of nonsurgical treatments for knee osteoarthritis (OA) has found naproxen to be the treatment of choice, but an Australian expert says core therapy options, such as exercise and weight management, have been overlooked in the study.

In a network meta-analysis of 56 randomised controlled trials, published in the Journal of the American Academy of Orthopaedic Surgeons, researchers investigated the effectiveness of NSAIDs, paracetamol, intra-articular (IA) corticosteroids, IA platelet-rich plasma and IA hyaluronic acid for reliev- ing pain and improving function in patients with knee OA. Treatments were compared with each other and with oral and IA placebos, and then ranked in terms of effectiveness.

The researchers found naproxen to be the most effective individual treatment for both pain relief and improved function. The low-cost treatment also had a favourable cardiac risk profile, they reported. The next most effective therapy for both pain reduction and functional improvement was IA corticosteroids, followed by IA platelet-rich plasma, celecoxib and ibuprofen.

‘The combined greatest effect based on this NMA [network meta-analysis] would be a combination of an IA corticosteroid and naproxen,’ the researchers wrote.

Professor David Hunter, Florance and Cope Chair of Rheumatology and Professor of Medicine at The University of Sydney, said the authors had selected several treatments that may be of interest, but had overlooked important therapies.

‘They have ignored the core treatment options that everybody with osteoarthritis should be offered or receive including exercise, weight loss and other nonoperative interventions,’ Professor Hunter told Pain Management Today.

‘I have no question that the findings have internal validity. The big concern is the fact that they have cherry picked a few interventions, there is not complete coverage of the ones that they have chosen because many trials are not included, and as such the conclusions that can be reached are very limited.’ Professor Hunter said the findings should not be relied upon in the management of knee OA.
J Am Acad Orthop Surg 2018; 26: 325-336.