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Comparative efficacy of exercise therapy and oral non-steroidal anti-inflammatory drugs and paracetamol for knee or hip osteoarthritis: a network meta-analysis of randomised controlled trials

Weng Q 1 , Goh SL 2 , Wu J 3 , Persson MSM 4 , Wei J 3 , Sarmanova A 4 Show all authors , Li X 3 , Hall M 5 , Doherty M 4 , Jiang T 1 , Zeng C 6 , Lei G 6 , Zhang W 7

Affiliations 

  • 1 Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
  • 2 Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia
  • 3 Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
  • 4 Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
  • 5 Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
  • 6 Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China [email protected] [email protected] [email protected]
  • 7 Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK [email protected] [email protected] [email protected]
Br J Sports Med, 2023 Aug;57(15):990-996.
PMID: 36593092 DOI: 10.1136/bjsports-2022-105898

Abstract

OBJECTIVE: Clinical guidelines recommend exercise as a core treatment for knee or hip osteoarthritis (OA). However, how its analgesic effect compares to analgesics, for example, oral non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol-the most commonly used analgesics for OA, remains unknown.

DESIGN: Network meta-analysis.

DATA SOURCES: PubMed, Embase, Scopus, Cochrane Library and Web of Science from database inception to January 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials (RCTs) comparing exercise therapy with oral NSAIDs and paracetamol directly or indirectly in knee or hip OA.

RESULTS: A total of n=152 RCTs (17 431 participants) were included. For pain relief, there was no difference between exercise and oral NSAIDs and paracetamol at or nearest to 4 (standardised mean difference (SMD)=-0.12, 95% credibility interval (CrI) -1.74 to 1.50; n=47 RCTs), 8 (SMD=0.22, 95% CrI -0.05 to 0.49; n=2 RCTs) and 24 weeks (SMD=0.17, 95% CrI -0.77 to 1.12; n=9 RCTs). Similarly, there was no difference between exercise and oral NSAIDs and paracetamol in functional improvement at or nearest to 4 (SMD=0.09, 95% CrI -1.69 to 1.85; n=40 RCTs), 8 (SMD=0.06, 95% CrI -0.20 to 0.33; n=2 RCTs) and 24 weeks (SMD=0.05, 95% CrI -1.15 to 1.24; n=9 RCTs).

CONCLUSIONS: Exercise has similar effects on pain and function to that of oral NSAIDs and paracetamol. Given its excellent safety profile, exercise should be given more prominence in clinical care, especially in older people with comorbidity or at higher risk of adverse events related to NSAIDs and paracetamol.CRD42019135166.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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