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Paracetamol appropriate pain relief for osteoarthritis, say international experts

International experts on osteoarthritis have recommended paracetamol should continue to be used for pain relief in patients with knee or multi-joint osteoarthritis, casting further doubt on NICE proposals unveiled last year advising against routine use of the drug.

The newly published guidance from the Osteoarthritis Research Society Internation (OARSI) says paracetamol can be prescribed to individuals ‘without relevant comorbidities’ as the benefits of treatment still outweigh the risks.

However, the experts say it is no longer certain whether paracetamol is appropriate for patients with relevant comorbidities.

The guidelines committee considered a large systematic review and meta-analysis, also used to inform the NICE guidance as well as a large safety review, which showed paracetamol had a small beneficial effect on osteoarthritis pain, but also indicated a potential increased risk of gastrointestinal bleeding and multi-organ failure.

The guidance – published last week in Osteoarthritis and Cartilage – states: ‘These recent findings suggest greater risk associated with acetaminophen [paracetamol] use (particularly when used for extended durations) than previously thought.

‘Thus, we recommend conservative dosing and treatment duration with approved prescribing limits.’

The final version of the updated NICE guidance on osteoarthritis is due to be published later this month


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