Topical diclofenac and acetaminophen are the best bets for osteoarthritis pain, concludes a review in Medical Letter. Hyaluronic acid scores a moderately favorable vote.
Drugs for Osteoarthritis. The Medical Letter (2014) 56(1450):80-84, September 1, 2014
After considering the American College of Rheumatology, American Academy of Orthopedic Surgeons, and Osteoarthritis Research Society International guidelines, this review gives its own take on the benefits, adverse effects and costs of drugs for osteoarthritis.
A table provides doses and costs.
A full page discusses the adverse effects of NSAIDs, which editor in chief Mark Abramowicz MD recommends against in a commentary, particularly for the elderly, because of the renal side effects. Acetaminophen is almost as effective and safer, he observes.
After some thought, the review concludes that diclofenac gel ($42 a week) and other topical preparations are modestly effective with low risk of systemic side effects, although there is further discussion about this on The Medical Letter blog.
Several randomized trials report benefits of glucosamine and chondroitin sulfate, the authors concede, remaining skeptical. They are even more skeptical of capsaicin, given the reports of severe skin burns and nerve damage.
Intra-articular injections of corticosteroids give relief for at least a month in 80% of patients, and are generally safe, they conclude. Hyaluronic acid injections have modest benefits, are non-inferior to oral NSAIDS, and safer.