Treatment of osteoarthritis with acetaminophen: efficacy, safety, and comparison with nonsteroidal anti-inflammatory drugs.

Osteoarthritis represents a major public health problem with limited effective treatment. Nonsteroidal anti- inflammatory drugs (NSAIDs) are widely used to alleviate symptoms such as pain and stiffness. However, these drugs are associated with an increased risk for the development of adverse sequelae, including serious upper gastrointestinal side effects such as symptomatic ulcers, perforation, obstruction, and gastrointestinal bleeding. The simple analgesic acetaminophen has been found to be effective in alleviating pain in patients with osteoarthritis in a placebo-controlled trial, and several trials have evaluated its efficacy and safety compared with NSAIDs. This article reviews data regarding the efficacy and safety of acetaminophen in the treatment of osteoarthritis from randomized, controlled, clinical trials, focusing on studies that compared acetaminophen with NSAIDs. In addition, literature on physician and patient preferences in this area are examined. In summary, judicious use of analgesic agents as pharmacologic therapy in patients with osteoarthritis will achieve satisfactory pain relief in most cases. Acetaminophen merits a trial as initial therapy in patients with mild to moderate pain, based on cost-effectiveness and safety profile.