Question In patients with osteoarthritis (OA) of the knee or hip, do nonsteroidal antiinflammatory drugs (NSAIDs) or acetaminophen reduce joint pain? Review scope Included studies compared NSAIDs and acetaminophen with each other or with placebo in patients with pain due to OA of the knee or hip. Primary outcome was pain; secondary outcome was physical function. Review methods MEDLINE and EMBASE/Excerpta Medica (2009 to Feb 2015), Cochrane Central Register of Controlled Trials (1980 to Feb 2015), reference lists, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) that included, on average, ≥100 patients/group. RCTs that included patients with diseases other than knee or hip OA had to report results separately for different patient populations or include ≥80% of patients with knee or hip OA. NSAIDs that were previously determined to have insufficient data for inclusion in a related safety assessment were excluded. 74 RCTs (n =58556, mean age 58 to 71 y, 49% to 90% women) met the selection criteria. Trials assessed 7 NSAIDs (celecoxib, naproxen, ibuprofen, rofecoxib, lumiracoxib, etoricoxib, and diclofenac) and acetaminophen at various doses. Outcomes for rofecoxib and lumiracoxib are not reported here because they have been largely or entirely removed from the market. Follow-up ranged from 1 to 52 weeks (median 12 wk). Data from direct and indirect treatment comparisons were combined using Bayesian network meta-analysis. For both outcomes, the prespecified minimal clinically important difference (MCID) between treatments was-0.37 standard deviation units (equivalent to a difference of 9 mm on a 100 mm visual analogue scale). Main results The main results of the network meta-analysis are in the Table. Conclusions Some nonsteroidal antiinflammatory drugs result in clinically relevant improvement in joint pain and physical function in patients with osteoarthritis pain of the knee or hip. Only diclofenac, 150 mg, clearly exceeded the prespecified minimal clinically important difference for both pain and physical function.
