Should the use of pharmacological treatments still be recommended for the management of osteoarthritis?

Abstract

Pharmacological treatments including acetaminophen and non-steroidal anti-inflammatory drugs are widely recommended in national and international guidelines for the management of osteoarthritis (OA) in primary care settings. Other pharmacological modalities such as intra-articular corticosteroid or hyaluronic acid injections and symptomatic slow-acting drugs remain controversial across organisations, as there are important differences in interpretation of the evidence base. Recommendations are usually based on the results of systematic reviews and meta-analysis of randomized clinical trials. These reviews are often inconclusive for the benefits of these treatments and are limited by the heterogeneity and the quality of the included studies. Furthermore, concerns have been raised about the benefit-risk profile of these drugs, including acetaminophen. Therefore, in the light of most recent evidence, one can question if the use of pharmacological treatments should still be recommended for the management of OA, especially when the level of evidence for efficacy of non-pharmacological treatments is comparable, with less concerns about side effects. Recently, network meta-analyses have been proposed as a powerful methodological approach to compare available pharmacological treatments in OA according to their relative efficacy, safety profiles and relative costs. Their results could be helpful in formulating new evidence-based rational treatment algorithms and individualized patient care decisions, in updating current guidelines, and in deciding which place pharmacological treatments should take in physician's armamentarium.