SynthesisAnnals of the rheumatic diseases2004
Does paracetamol (acetaminophen) reduce the pain of osteoarthritis? A meta-analysis of randomised controlled trials.
Synthesis in Annals of the rheumatic diseases, 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 93 papers, 14 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
93 citing papers in PubMed, 14 syntheses or guidelines pooled it, 314 citations in OpenAlex.
- Guideline for Medication Management of Distressing Symptoms in Older Patients Receiving End-of-Life Palliative Care.Journal of evidence-based medicine · 2026Guideline
- Conditional Recommendations for Specific Dietary Ingredients as an Approach to Chronic Musculoskeletal Pain: Evidence-Based Decision Aid for Health Care Providers, Participants, and Policy Makers.Pain medicine (Malden, Mass.) · 2019Guideline
- Tramadol for osteoarthritis.The Cochrane database of systematic reviews · 2019Pooled it
- Paracetamol versus placebo for knee and hip osteoarthritis.The Cochrane database of systematic reviews · 2019Pooled it
- Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials.BMJ (Clinical research ed.) · 2015Pooled it
- Relative benefit-risk comparing diclofenac to other traditional non-steroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors in patients with osteoarthritis or rheumatoid arthritis: a network meta-analysis.Arthritis research & therapy · 2015Pooled it
- The efficacy of duloxetine, non-steroidal anti-inflammatory drugs, and opioids in osteoarthritis: a systematic literature review and meta-analysis.BMC musculoskeletal disorders · 2014Pooled it
- A systematic review of the effect of paracetamol on blood pressure in hypertensive and non-hypertensive subjects.British journal of clinical pharmacology · 2013Pooled it
- The Hip and Knee Book: developing an active management booklet for hip and knee osteoarthritis.The British journal of general practice : the journal of the Royal College of General Practitioners · 2010Pooled it
- EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT).Annals of the rheumatic diseases · 2007Guideline
- ASAS/EULAR recommendations for the management of ankylosing spondylitis.Annals of the rheumatic diseases · 2006Guideline
- Acetaminophen for osteoarthritis.The Cochrane database of systematic reviews · 2006Pooled it
- EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT).Annals of the rheumatic diseases · 2005Guideline
- Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: meta-analysis of randomised placebo controlled trials.BMJ (Clinical research ed.) · 2004Pooled it
- Comparison of Single and Combined Treatment with Exercise Therapy and Collagen Supplementation on Early Knee Arthritis among Athletes-A Quasi-Randomized Trial.International journal of environmental research and public health · 2023Trial
- From painkiller to empathy killer: acetaminophen (paracetamol) reduces empathy for pain.Social cognitive and affective neuroscience · 2016Trial
- Treatment satisfaction after switching to another therapy in Spanish orthopaedic clinic outpatients with knee or hip osteoarthritis previously refractory to paracetamol.Clinical drug investigation · 2012Trial
- Efficacy of balneotherapy on pain, function and quality of life in patients with osteoarthritis of the knee.International journal of biometeorology · 2012Trial
- The efficacy of tramadol/acetaminophen combination tablets (Ultracet®) as add-on and maintenance therapy in knee osteoarthritis pain inadequately controlled by nonsteroidal anti-inflammatory drug (NSAID).Clinical rheumatology · 2012Trial
- Treatment of osteoarthritis of the knee with a topical diclofenac solution: a randomised controlled, 6-week trial [ISRCTN53366886].BMC musculoskeletal disorders · 2005Trial
33 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess the best available evidence for efficacy of paracetamol (acetaminophen) in the treatment of osteoarthritis (OA).
designSystematic review and meta-analysis of randomised controlled trials (RCTs). DATA SOURCES: Medline, Embase, Scientific Citation Index, CINAHL, Cochrane Library, and conference abstracts in the past 2 years from the British Society for Rheumatology, the European League Against Rheumatism, the American College of Rheumatology, and the Osteoarthritis Research Society International. SUBJECTS: 10 RCTs including 1712 patients with either symptomatic OA of the knee (6 trials) or hip/knee (3 trials) or multiple joints (1 trial).
main outcome measures(a). effect size (ES) for pain, stiffness, and functional scores from baseline to end point; (b). rate ratio (RR) and number needed to treat for clinical response rate and patient preference for treatment.
resultsParacetamol was effective in relieving pain due to OA (ES = 0.21, 95% confidence interval (CI) 0.02 to 0.41). Non-steroidal anti-inflammatory drugs (NSAIDs) were better than paracetamol for pain relief (ES = 0.20, 95% CI 0.10 to 0.30). Clinical response rate was higher with NSAIDs than with paracetamol (RR = 1.24, 95% CI 1.08 to 1.41), and the number of patients who preferred NSAIDs was more than twice the number of those preferring paracetamol (RR = 2.46, 95% CI 1.51 to 4.12). NSAIDs were associated with more frequent gastrointestinal discomfort than paracetamol (RR = 1.35, 95% CI 1.05 to 1.75).
conclusionParacetamol is an effective agent for pain relief due to OA. Although safer, it is less effective than NSAIDs. For safety reasons paracetamol should be the first line treatment, with NSAIDs reserved for those who do not respond.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.