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Treatment of osteoarthritis with acetaminophen: Efficacy, safety, and comparison with nonsteroidal anti-inflammatory drugs

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Abstract

Osteoarthritis represents a major public health problem with limited effective treatment. Nonsteroidal antiinflammatory drugs (NSAIDs) are widely used to alleviate symptoms such as pain and stiffness. However, these drugs are associated with an increased risk for the development of adverse sequelae, including serious upper gastrointestinal side effects such as symptomatic ulcers, perforation, obstruction, and gastrointestinal bleeding. The simple analgesic acetaminophen has been found to be effective in alleviating pain in patients with osteoarthritis in a placebo-controlled trial, and several trials have evaluated its efficacy and safety compared with NSAIDs. This article reviews data regarding the efficacy and safety of acetaminophen in the treatment of osteoarthritis from randomized, controlled, clinical trials, focusing on studies that compared acetaminophen with NSAIDs. In addition, literature on physician and patient preferences in this area are examined. In summary, judicious use of analgesic agents as pharmacologic therapy in patients with osteoarthritis will achieve satisfactory pain relief in most cases. Acetaminophen merits a trial as initial terapy in patients with mild to moderate pain, based on cost-effectiveness and safety profile.

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References and Recommended Reading

  1. Lawrence RC, Helmick CG, Arnett FC, et al.: Estimates of prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998, 41:778–799.

    Article  PubMed  CAS  Google Scholar 

  2. Morales-Torres J, Reginster JC, Hochberg MC: Rheumatic and musculoskeletal disease and impaired quality of life: a challenge for rheumatologists. J Rheumatol 1996, 23:1–3.

    PubMed  CAS  Google Scholar 

  3. Creamer P, Flores R, Hochberg MC: Management of osteoarthritis in older adults. Clin Geriatr Med 1998, 14:435–454.

    PubMed  CAS  Google Scholar 

  4. Creamer P, Hochberg MC: Why does osteoarthritis of the knee hurt—sometimes? Br J Rheumatol 1997, 37:726–728.

    Article  Google Scholar 

  5. Creamer P, Lethbridge-Cejku M, Hochberg MC: Where does it hurt? Pain localization in osteoarthritis of the knee. Osteoarthritis Cartilage 1998, 6:318–323.

    Article  PubMed  CAS  Google Scholar 

  6. Creamer P, Lethbridge-Cejku M, Hochberg MC: Determinants of pain severity in knee osteoarthritis: effect of demographic and psychosocial variables using 3 pain measures. J Rheumatol 1999, 26:1785–1792.

    PubMed  CAS  Google Scholar 

  7. Gotzsche PC: Non-steroidal anti-inflammatory drugs. BMJ 2000, 320:1058–1061.

    Article  PubMed  CAS  Google Scholar 

  8. Dieppe P, Chard J, Faulker A, Lohmander S: Osteoarthritis. Clin Evidence 1999, 2:437–448. Available at: http://www.evidence.org.

    Google Scholar 

  9. Towheed TE, Hochberg MC: A systematic review of randomized controlled trials of pharmacological therapy in osteoarthritis of the knee, with an emphasis on trial methodology. Semin Arthritis Rheum 1997, 26:755–770.

    Article  PubMed  CAS  Google Scholar 

  10. Towheed T,Shea B, Wells G, Hochberg M: Analgesia and nonaspirin, non-steroidal anti-inflammatory drugs for osteoarthritis of the hip. In In Cochrane Library, Issue 1. Oxford, Update Software, 2000. Available at: http://www.cochrane.org.

  11. Scott DL: Guidelines for the diagnosis, investigation and management of osteoarthritis of the hip and knee. J R Coll Phys London 1993, 27:391–396.

    Google Scholar 

  12. Hochberg MC, Altman RD, Brandt KD, et al.: Guidelines for the medical management of osteoarthritis: part I: osteoarthritis of the hip. Arthritis Rheum 1995, 38:1535–1540.

    Article  PubMed  CAS  Google Scholar 

  13. Hochberg MC, Altman RD, Brandt KD, et al.: Guidelines for the medical management of osteoarthritis. part II: osteoarthritis of the knee. Arthritis Rheum 1995, 38:1541–1546.

    Article  PubMed  CAS  Google Scholar 

  14. Griffin MR, Brandt KD, Liang M, et al.: Practical management of osteoarthritis: integration of pharmacologic and nonpharmacologic measures. Arch Fam Med 1995, 4:1049–1055.

    Article  PubMed  CAS  Google Scholar 

  15. Insel PA: Analgesic-antipyretic and anti-inflammatory agents and drugs employed in the treatment of gout. In In Goodman and Gilman’s The Pharmacological Basis of Therapeutics, edn 9. Edited by Hardman JG, et al. New York: McGraw Hill; 1996:631–633.

    Google Scholar 

  16. Jackson CH, MacDonald NC, Cornett JWD: Acetaminophen: a practical pharmacologic overview. Can Med Assoc J 1984, 131:25–32.

    PubMed  CAS  Google Scholar 

  17. Clissold SP: Paracetamol and phenacetin. Drugs 1986, 32:46–59.

    PubMed  Google Scholar 

  18. Warner TD, Giuliao F, Vojnovic I, et al.: Nonsteroid drug selectivities for cyclo-oxygenase-1 rather than cyclo-oxygenase-2 are associated with human gastrointestinal toxicity: a full in vitro analysis. Proc Natl Acad Sci U S A 1999, 96:7563–7568.

    Article  PubMed  CAS  Google Scholar 

  19. Abramson SR, Weissman G: The mechanisms of action of non-steroidal anti-inflammatory drugs. Arthritis Rheum 1989, 32:1–9.

    Article  PubMed  CAS  Google Scholar 

  20. Flower RJ, Vane JR: Inhibition of prostaglandin synthetase in brain explains the antipyretic activity of paracetamol. Nature 1972, 240:410–411.

    Article  PubMed  CAS  Google Scholar 

  21. Pini LA, Vitale G, Ottani A, Sandrini M: Naloxone-reversible antinociception by paracetamol in the rat. J Pharmacol Exp Ther 1991, 280:934–940.

    Google Scholar 

  22. Tjolsen A, Lund A, Hole K: Antinociceptive effect of paracetamol in rats is partly dependent on spinal serotonergic systems. Eur J Pharmacol 1991, 193:193–201.

    Article  PubMed  CAS  Google Scholar 

  23. Muth-Selbach S, Tegeder I, Brune K, Geisslinger G: Acetaminophen inhibits spinal prostaglandin E2 release after peripheral noxious stimulation. Anesthesiology 1999, 91:231–239.

    Article  PubMed  CAS  Google Scholar 

  24. Amadio PJr, Cummings DM: Evaluation of acetaminophen in the management of osteoarthritis of the knee. Curr Ther Res 1983, 34:59–66.

    Google Scholar 

  25. Bradley JD, Brandt KD, Katz BP, et al.: Comparison of an antiinflammatory dose of Ibuprofen, an analgesic dose of Ibuprofen and acetaminophen in the treatment of patients with OA of the knee. N Engl J Med 1991, 325(2):87–91.

    Article  PubMed  CAS  Google Scholar 

  26. Williams HJ, Ward JR, Egger MJ, et al.: Comparison of naproxen and acetaminophen in a two-year study of treatment of osteoarthritis of the knee. Arthritis Rheum 1993, 9:1196–206.

    Article  Google Scholar 

  27. Temple AR, Reel LJ, Fox TM, Lynch JM: Long-term use of acetaminophen in osteoarthritis pain [abstract]. Ann Rheum Dis 2000, 59:135.

    Article  Google Scholar 

  28. Eccles M, Freemantle N, Mason J, for the North of England Non-Steroidal Anti-Inflammatory Drug Guideline Development Group: North of England evidence based guideline development project: summary guideline for non-steroidal anti-inflammatory drugs versus basic analgesia in treating the pain of degenerative arthritis. BMJ 1998, 317:526–530.

    PubMed  CAS  Google Scholar 

  29. March L, Irving L, Schwarz J, et al.: N of 1 trials comparing a non-steroidal anti-inflammatory drug with paracetamol in osteoarthritis. BMJ 1994, 309:1041–1046.

    PubMed  CAS  Google Scholar 

  30. Senn S, Bateshi R, Ezzet N: N of 1 trials in osteoarthritis: N of 1 trials in interpretation needed [letter]. BMJ 1995, 310:667.

    PubMed  CAS  Google Scholar 

  31. Altman RD for the IAP Study Group: Ibuprofen, acetaminophen and placebo in osteoarthritis of the knee: a six-day double-blind study [abstract]. Arthritis Rheum 1999, 42:S403.

    Google Scholar 

  32. Pincus T, Callahan LF, Wolfe F, et al.: Arthrotec compared to acetaminophen: a clinical trial in patients with osteoarthritis of the hip or knee. Arthritis Rheum 1999, 42:S404.

    Google Scholar 

  33. Geba GP, Weaver AL, Schnitzer TJ, et al.: A clinical trial comparing rofecoxib to celecoxib and acetaminophen in the treatment of osteoarthritis: early efficacy results [abstract]. Ann Rheum Dis 2000, 59:133.

    Google Scholar 

  34. Whitcomb DC, Block GD: Association of acetaminophen hepatotoxicity with fasting and ethanol use. JAMA 1994, 273:1845–1850.

    Article  Google Scholar 

  35. Schiodt FV, Rochling FA, Casey DL, Lee WM: Acetaminophen toxicity in an urban county hospital. N Engl J Med 1997, 337:1112–1117.

    Article  PubMed  CAS  Google Scholar 

  36. Perneger TV, Whelton PK, Klag MJ: Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs. N Engl J Med 1994, 331:1675–1679.

    Article  PubMed  CAS  Google Scholar 

  37. Henrich WL, Agodaoa LE, Barret B, et al.: Analgesics and the kidney: summary and recommendations to the Scientific Advisory Board of the National Kidney Foundation from an Ad Hoc Committee of the National Kidney Foundation. Am J Kidney Dis 1996, 27:162–165.

    PubMed  CAS  Google Scholar 

  38. Hylek M, Heiman H, Skates SJ, et al.: Acetaminophen and other risk factors for excessive warfarin anticoagulation. JAMA 1998, 279:657–662.

    Article  PubMed  CAS  Google Scholar 

  39. Hochberg MC, Perlmutter D, Hudson J, Altinar K: Preferences in the management of osteoarthritis of the hip and knee: results of a survey of community-based rheumatologists in the US. Arthritis Care Res 1996, 9:170–176.

    Article  PubMed  CAS  Google Scholar 

  40. Mazzuca SA, Brandt KD, Katz BP, et al.: Comparison of general internists, family physicians, and rheumatologists managing patients with symptoms of osteoarthritis of the knee. Arthritis Care Res 1997, 10:289–299.

    Article  PubMed  CAS  Google Scholar 

  41. Pincus T, Swearingen C, Cummins P, Callahan LF: Preference for nonsteroidal antiinflammatory drugs versus acetaminophen and concomitant use of both types of drugs in patients with osteoarthritis. J Rheumatol 2000, 27:1020–1027.

    PubMed  CAS  Google Scholar 

  42. Wolfe F, Zhao S, Lane N: Preference for nonsteroidal anti-inflammatory drugs over acetaminophen by rheumatic disease patients: a survey of 1,799 patients with osteoarthritis, rheumatoid arthritis, and fibromyalgia. Arthritis Rheum 2000, 43:378–385.

    Article  PubMed  CAS  Google Scholar 

  43. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines: Recommendations for the medical management of osteoarthiritis of the hip and knee: 2000 update. Arthritis Rheum 2000, 43:1905–1915.

    Article  Google Scholar 

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Shamoon, M., Hochberg, M.C. Treatment of osteoarthritis with acetaminophen: Efficacy, safety, and comparison with nonsteroidal anti-inflammatory drugs. Curr Rheumatol Rep 2, 454–458 (2000). https://doi.org/10.1007/s11926-000-0020-z

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