A network meta-analysis was done to determine the clinically relevant effectiveness of nonsteroidal anti-inflammatory drugs, acetaminophen, intra-articular (IA) corticosteroids, IA platelet-rich plasma, and IA hyaluronic acid compared with each other as well as with oral and IA placebos. Using the best available evidence, researchers from the Dartmouth-Hitchcock Clinic analyzed the available studies.
For pain, all active treatments showed significant improvement over oral placebo, with IA corticosteroids (steroid shot) having the largest magnitude of effect and significant difference only over IA placebo. For function, no IA treatments showed significance compared with either placebo, and naproxen was the only treatment showing clinical significance compared with oral placebo. When combination treatments were considered naproxen was found to be the most effective individual treatment, and when combined with IA corticosteroids, it is the most likely to improve pain and function.
Naproxen ranked as the most effective among conservative, non surgical treatments of knee OA and should be considered when treating pain and function because of its relative safety and low cost5.