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Initial options for treating patients with knee osteoarthritis include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular (IA) corticosteroids, or IA hyaluronic acid. But which agent should be tried first? Using network meta-analysis of data from 137 studies (>30,000 participants), researchers evaluated these agents (including 4 NSAIDs) both head-to-head and versus oral or IA placebos.
For pain outcomes, IA placebo was more effective than oral placebo. Acetaminophen was least effective and failed to produce a clinically significant improvement, followed by (in ascending order of effectiveness) IA placebo, celecoxib, naproxen, ibuprofen, diclofenac, and IA corticosteroids; IA hyaluronic acid was the most efficacious…