The authors recommend paracetamol as first-line treatment as well as long-term treatment for symptomatic osteoarthritis of the knee, in accordance with the analgesic/therapeutic guideline set out by EULAR. In 30 years of clinical practice, I have found paracetamol almost completely ineffective for arthritis pain. Non-steroidal anti-inflammatory drugs (NSAIDs) were notably more effective, if necessary in combination with proton pump inhibitors and for short-term combination treatment with metamizole. At low dosages, NSAIDs have a low side effect profile, even during long-term treatment. With paracetamol, there is a risk of liver damage if maximum doses are taken regularly. This is one of the reasons why paracetamol is now available on prescription only. In own my clinical practice, intra-articular injection of a steroid has always proved the best treatment for acute severe pain.
Dr. med. Alexander Weiss
Im Vogelsang 11
30989 Gehrden, Germany
Conflict of interest statement
The author declares that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
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Journal of Accounting and Economics, 201210.1016/j.jacceco.2012.05.001