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Randomized Controlled Trial
. 2015 Aug;65(637):e530-7.
doi: 10.3399/bjgp15X686101.

Effectiveness of diclofenac versus paracetamol in knee osteoarthritis: a randomised controlled trial in primary care

Saskia P J Verkleij  1 , Pim A J Luijsterburg  1 , Sten P Willemsen  2 , Bart W Koes  1 , Arthur M Bohnen  1 , Sita M A Bierma-Zeinstra  3
Affiliations
Randomized Controlled Trial

Effectiveness of diclofenac versus paracetamol in knee osteoarthritis: a randomised controlled trial in primary care

Saskia P J Verkleij et al. Br J Gen Pract. 2015 Aug.

Abstract

Background: The effectiveness of diclofenac versus paracetamol in primary care patients with pain caused by knee osteoarthritis is unclear.

Aim: To assess the effectiveness of diclofenac compared with paracetamol over a period of 2, 4, and 12 weeks in patients with knee osteoarthritis.

Design and setting: Randomised controlled trial in general practice.

Method: There were 104 patients included in the study, they were aged ≥45 years consulting their GP with knee pain caused by knee osteoarthritis. Patients were randomly allocated to diclofenac (n = 52) or paracetamol (n = 52) for at least 2 weeks. Primary outcomes were daily knee pain severity, and knee pain and function measured with the Knee Injury and Osteoarthritis Outcome Score (KOOS).

Results: Over a period of 2- and 4-weeks follow-up, no significant difference in daily knee pain was found between the patient groups: estimated differences of 0.5 (95% CI = -0.2 to 1.3) and -0.2 (95% CI = -1.0 to 0.7), respectively. Over the 12-weeks follow-up, no significant differences were found between both groups for KOOS pain: estimated difference of -2.8 (95% CI = -10.7 to 5.1) and KOOS function of -2.7 (-10.6 to 5.0).

Conclusion: Over a period of 2- and 4-weeks follow-up no significant difference in daily measured knee pain severity was found between primary care patients with knee osteoarthritis taking paracetamol or diclofenac. Also, over a period of 12-weeks follow-up no significant differences were found regarding KOOS pain and KOOS function between both groups. Patients more frequently reported minor adverse events after taking diclofenac (64%) than paracetamol (46%).

Keywords: diclofenac; general practice; knee osteoarthritis; paracetamol; randomised controlled trial.

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Figures

Figure 1.
Figure 1.
Flowchart of the study. ACR = American College of Rheumatology. NSAIDs = non-steroidal anti-inflammatory drugs.
Figure 2.
Figure 2.
Mean daily measured knee pain severity of the paracetamol and diclofenac group over a period of 4-weeks follow-up. NRS = Numeric Rating Scale.
Figure 3.
Figure 3.
Mean medication intake of the paracetamol and diclofenac group over a period of 4-weeks follow-up. aThe daily dose of diclofenac was converted (for example, total use of 150 mg of diclofenac per day was converted to 3000 mg).
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