Nov 13, 2018

Non-surgical management options for osteoarthritis are limited. Self directed exercise programs are the most effective.

Posted By: Richard Iorio, MD

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.


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  2. Projected state-specific increases in self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitations: United States, 2005–2030. MMWR Morb Mortal Wkly Rep 2007;56:423–425.
  3. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation: United States, 2010–2012. MMWR Morb Mortal Wkly Rep 2013;62:869–873
  4. Skou ST, Roos EM, Laursen MB, et al: A randomized, controlled trial of total knee replacement. N Engl J Med 2015;373:1597–1606.
  5. Jevsevar, David, S., MD, MBA; Shores, Peter, B., MPH; Mullen, Kyle, MPH; Schulte, Danielle, M., MS; Brown, Gregory, A., MD, PhD; Cummins, Deborah, S., PhD. Mixed Treatment Comparisons for Nonsurgical Treatment of Knee References Osteoarthritis: A Network Meta-analysis. JAAOS - Journal of the American Academy of Orthopaedic Surgeons: May 1, 2018 - Volume 26 - Issue 9 - p325–336
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