Osteoarthritis in primary care: 8 effective, 3 ineffective treatments pinpointed

  • Ton J & al.
  • Can Fam Physician
  • 01/03/2020

  • Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • For osteoarthritis in primary care, 8 effective treatments include exercise and intra-articular corticosteroids, whereas 3 ineffective treatments are glucosamine, chondroitin, and viscosupplementation.
  • Findings are results of an umbrella systematic review and meta-analysis.

Why this matters

  • Osteoarthritis is common in primary care.
  • Results will be used to develop a clinical decision aid.

Study design

  • Systematic reviews of 155 randomized controlled trials (RCTs) with a meta-analysis of responder outcomes (clinically meaningful outcomes) for 15 treatments.
  • Funding: Alberta Health.

Key results

  • Clinically meaningful pain relief compared with control (risk ratios; 95% CIs) included:
    • Exercise: 2.36 (1.79-3.12).
    • Intra-articular corticosteroids: 1.74 (1.15-2.62).
    • Serotonin-norepinephrine reuptake inhibitors: 1.53 (1.25-1.87).
    • Oral NSAIDs: 1.44 (1.36 -1.52).
    • Glucosamine: 1.33 (1.02-1.74).
    • Topical NSAIDs: 1.27 (1.16-1.38).
    • Chondroitin: 1.26 (1.13-1.41).
    • Viscosupplementation: 1.22 (1.12-1.33).
    • Opioids: 1.16 (1.02-1.32), but not in trials longer than 4 weeks.
  • No effect was found for glucosamine, chondroitin, and viscosupplementation.

Limitations

  • Funding of studies and length of treatment should be considered when interpreting the data.
  • Some RCTs possibly overlooked.