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NSAID ger begränsad smärtlindring vid artros

25 oktober 2010.

En norsk studie visar att NSAID bara är marginellt bättre än placebo när det gäller att reducera smärta vid knäartros på kort sikt.

Slutsatsen baseras på en metaanalys av 23 studier på sammanlagt 10 845 patienter. Forskarna hänvisar till att användning av oralt NSAID i dagens riktlinjer rekommenderas som andrahandsval efter paracetamol. NSAID används emellertid regelbundet av hälften av alla patienter med knäartros.
Deras analys visar att NSAID var 15,6 procent bättre än placebo efter två till 13 veckor. Enligt tidigare forskning behöver smärtan vid knäartros reduceras med 17 till 22 procent för att anses meningsfull.
Forskarna menar att NSAID bara bör användas i begränsad utsträckning vid knäartros med tanke på biverkningsrisken.


Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: meta-analysis of randomised placebo controlled trials (BMJ)

Abstract

Objective To estimate the analgesic efficacy of non-steroidal anti-inflammatory drugs (NSAIDs), including selective cyclo-oxygenase-2 inhibitors (coxibs), in patients with osteoarthritis of the knee.

Design Systematic review and meta-analysis of randomised placebo controlled trials.

Studies reviewed 23 trials including 10 845 patients, median age of 62.5 years. 7807 patients received adequate doses of NSAIDs and 3038 received placebo. The mean weighted baseline pain score was 64.2 mm on 100 mm visual analogue scale (VAS), and average duration of symptoms was 8.2 years.

Main outcome measure Change in overall intensity of pain.

Results Methodological quality of trials was acceptable, but 13 trials excluded patients before randomisation if they did not respond to NSAIDs. One trial provided long term data for pain that showed no significant effect of NSAIDs compared with placebo at one to four years. The pooled difference for pain on visual analogue scale in all included trials was 10.1 mm (95% confidence interval 7.4 to 12.8) or 15.6% better than placebo after 2-13 weeks. The results were heterogeneous, and the effect size for pain reduction was 0.32 (0.24 to 0.39) in a random effects model. In 10 trials that did not exclude non-responders to NSAID treatment the results were homogeneous, with an effect size for pain reduction of 0.23 (0.15 to 0.31).

Conclusion NSAIDs can reduce short term pain in osteoarthritis of the knee slightly better than placebo, but the current analysis does not support long term use of NSAIDs for this condition. As serious adverse effects are associated with oral NSAIDs, only limited use can be recommended.

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