Paracetamol bij artrose in het verdomhoekje?

The network-meta-analysis by da Costa et al. reported in The Lancet shows that NSAIDs are effective for pain relief in hip and knee osteoarthritis, while paracetamol is not effective. The question, therefore, arises as to whether use of paracetamol should be abandoned for this indication. However, paracetamol has to be taken frequently because of its short T_max and T_½, a fact that was not taken into account in the network meta-analysis. NSAIDs ‘on-demand’ (a short 2-week course) might be sufficiently safe when considering that high-dose paracetamol also has risks; future alternative medications for NSAIDs might include colchicine or prednisone, also given in short 2-week courses. In conclusion: if conservative measures and/or paracetamol are not effective NSAIDs (diclofenac 150 mg daily or etoricoxib 60 mg daily) are indicated, with dose reductions in renal impairment. Hip or knee replacement might also offer a good solution.

Conflict of interest and financial support: none declared.