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Study ranks effectiveness of non-surgical treatments for knee OA

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The non-steroidal anti-inflammatory drug (NSAID) naproxen is the most effective non-surgical treatment for knee osteoarthritis (OA), according to a new analysis.

The drug — which is considered a relatively safe and low-cost treatment method — was ranked as most effective in individual knee OA treatment for improving both pain and function, the American Academy of Orthopaedic Surgeons reports.

Researchers analysed data from 53 randomised controlled trials to determine the relative effectiveness of various non-surgical treatments for knee OA. The treatments that were compared and ranked included acetaminophen; ibuprofen; intra-articular (IA) or joint injections of cortisone; platelet-rich plasma (PRP); hyaluronic acid (HA); several NSAIDs, including naproxen, celecoxib and diclofenac; and both oral and IA placebo.

“This is the first comprehensive mixed-comparison analysis comparing best-evidence scientific research and excluding lower quality studies that can bias the outcomes,” said lead author and orthopaedic surgeon Dr David Jevsevar. “Using a statistical ranking technique, we worked to provide evidence regarding which of the most common NSAIDs are most likely to decrease pain and improve function, and we attempted to fill in the gaps in evidence for more inconclusive treatments such as HA, PRP and corticosteroids.”

The network meta-analysis showed that cortisone injections provided the greatest short-term (4 to 6 weeks) pain relief, followed by ibuprofen, PRP injections, naproxen and celecoxib.

Naproxen ranked the highest for probability for improving function, followed by diclofenac, celecoxib, ibuprofen and PRP injections.

Overall, naproxen was ranked the most effective individual knee OA treatment for improving both pain and function, followed by cortisone injections, PRP injections, ibuprofen and celecoxib.

The authors also noted that HA injections did not achieve a rank in the top five treatments for pain, function, or combined pain and function.

They added that, although the use of NSAIDs for conditions such as knee OA has potential risks, including heart attack and stroke, existing evidence indicates that naproxen has less potential for adverse cardiovascular events.

The findings have been published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).