Zhang W, Jones A, Doherty M.
Annals of the Rheumatic Diseases 2004;63:901-907.

A systematic review and meta-analysis of randomised controlled trials included 1712 patients with either symptomatic osteoarthritis (OA) of the knee (six trials) or hip/knee (three trials) or multiple joints (one trial). The trial assessed the available evidence for efficacy of paracetamol (acetaminophen) in the treatment of OA and found that paracetamol was more effective in relieving pain due to OA. Non-steroidal anti-inflammatory drugs (NSAIDs) were better than paracetamol for pain relief. Clinical response rate was found to be higher with NSAIDs than with paracetamol, with twice the number of patients preferring NSAIDs over paracetamol. However, NSAIDs were associated with more frequent gastrointestinal discomfort than paracetamol. Overall, paracetamol was found to be an effective agent for pain relief due to OA. Although safer, the study found it less effective than NSAIDs. Therefore, the authors concluded that paracetamol should be the first-line treatment, with NSAIDs reserved for non-responders, due to safety concerns.