Saturday, 19 March 2016

Paracetamol is not effective at any dose as a treatment for osteoarthritis

(please note that this post is intended for information and is not medical advice, for medical advice on the issue raised see your doctor)
Paracetamol is not effective at any dose as a treatment for osteoarthritis

This is according to a large scale analysis of 58.5 thousand patients by Dr Sven Trelle at the University of Berne and published in the Lancet.

He found that paracetamol was only marginally better than a placebo for osteoarthritis and degenerative joint disease.

Osteoarthritis is the most common form of arthritis with about 8.5 million sufferers in the UK.

Diclofenac was found to be the most effective treatment.

All medications used had some effect but paracetamol did not meet the minimum clinical standards to be classed as effective.

Diclofenac performed better than all other NSAIDS (non steroidal anti-inflammatories pronounced n-sayds). Diclofenac out performed Naproxen.

However there are problems with diclofenac. It should only be taken in a short term course of treatment and never with a patient with heart disease.

Dr Anne-Marie Olsen at Copenhagen University looked into the effects of NSAIDS and death from heart attacks.

Heart attack survivors are 45% more likely to die of a second heart attack within a week if they are taking diclofenac and 55% more likely to die within three months. Diclofenac was to worst of the NSAIDS but all but one, including ibuprofen, increase the risk of heart attack and sudden cardiac death.

Naproxen was not associated with an increase in death in patients with heart disease and was not found to cause sudden cardiac death.

New(ish) international guidelines discourage the prescribing of NSAIDS to patients with established heart disease. In practise few if any doctors will prescribe diclofenac to people over 55.

Some research is also casting doubt as to the safety of long term use of paracetamol.

Because NSAIDs are effective and because they have been used for a long time they have become the normal treatment. Other non narcotic analgesics have more or less been ignored.

It might be that in the future more doctors will try drugs such as dipyrone. At this time it is not known how dipyrone works. It is thought that it might at least partially work through the cannabinoid receptors in the brain.