Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee
JD Bradley, KD Brandt, BP Katz, LA Kalasinski, and SI Ryan
BACKGROUND. The optimal short-term, symptomatic therapy for osteoarthritis of the knee has not been fully determined. Accordingly, we compared the efficacy of a nonsteroidal antiinflammatory drug, ibuprofen, given in either an antiinflammatory dose (high dose) or an analgesic dose (low dose), with that of acetaminophen, a pure analgesic. METHODS. In a randomized, double-blind trial, 184 patients with chronic knee pain due to osteoarthritis were given either 2400 or 1200 mg of ibuprofen per day or 4000 mg of acetaminophen per day. They were evaluated after a washout period of three to seven days before the beginning of the study, and again after four weeks of treatment. The major measures of outcome included scores on the pain and disability scales of the Stanford Health Assessment Questionnaire (range of possible scores, 0 to 3), scores on the visual-analogue scales for pain at rest and pain while walking, the time needed to walk 50 ft (15 m), and the physician's global assessment of the patient's arthritis. RESULTS. Seventy-eight percent of the patients completed four weeks of therapy. No significant differences were noted among the three treatment groups with respect to failure to complete the trial because of noncompliance or adverse events. All three groups had improvement in all major outcome variables, and the groups did not differ significantly in the magnitude of improvement in most variables. The mean improvement (change) in the scores on the pain scale of the Health Assessment Questionnaire was 0.33 with acetaminophen (95 percent confidence interval, 0.14 to 0.52), 0.30 with the low dose of ibuprofen (95 percent confidence interval, 0.09 to 0.51), and 0.35 with the high dose of ibuprofen (95 percent confidence interval, 0.13 to 0.57). Side effects were minor and similar in all three groups. CONCLUSIONS. In short-term, symptomatic treatment of osteoarthritis of the knee, the efficacy of acetaminophen was similar to that of ibuprofen, whether the latter was administered in an analgesic or an antiinflammatory dose.
Source Information
Rheumatology Division, Indiana University School of Medicine, Indianapolis 46202-5103.
This article has been cited by other articles:
Epstein, B. J., Taylor, J. R.
(2009). Osteoarthritis: An Update on Data Currently Reshaping Practice. Journal of Pharmacy Practice
22: 75-85
[Abstract]
Cavalieri, T. A.
(2007). Managing Pain in Geriatric Patients. JAOA: Journal of the American Osteopathic Association
107: ES10-ES16
[Abstract][Full Text]
Ong, C.K.S., Lirk, P., Tan, C.H., Seymour, R.A.
(2007). An Evidence-Based Update on Nonsteroidal Anti-Inflammatory Drugs. Clin Med Res
5: 19-34
[Abstract][Full Text]
Hix, M. D.
(2007). Pain Management in Elderly Patients. Journal of Pharmacy Practice
20: 49-63
[Abstract]
Brandt, K. D., Mazzuca, S. A., Buckwalter, K. A.
(2006). Acetaminophen, like conventional NSAIDs, may reduce synovitis in osteoarthritic knees. Rheumatology (Oxford)
45: 1389-1394
[Abstract][Full Text]
Lippi, G, Franchini, M, Guidi, G C, Kean, W F
(2006). Non-steroidal anti-inflammatory drugs in athletes * Commentary. Br. J. Sports. Med.
40: 661-663
[Full Text]
Watkins, P. B., Kaplowitz, N., Slattery, J. T., Colonese, C. R., Colucci, S. V., Stewart, P. W., Harris, S. C.
(2006). Aminotransferase elevations in healthy adults receiving 4 grams of acetaminophen daily: a randomized controlled trial.. JAMA
296: 87-93
[Abstract][Full Text]
Clegg, D. O., Reda, D. J., Harris, C. L., Klein, M. A., O'Dell, J. R., Hooper, M. M., Bradley, J. D., Bingham, C. O. III, Weisman, M. H., Jackson, C. G., Lane, N. E., Cush, J. J., Moreland, L. W., Schumacher, H. R. Jr., Oddis, C. V., Wolfe, F., Molitor, J. A., Yocum, D. E., Schnitzer, T. J., Furst, D. E., Sawitzke, A. D., Shi, H., Brandt, K. D., Moskowitz, R. W., Williams, H. J.
(2006). Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis.. NEJM
354: 795-808
[Abstract][Full Text]
Cao, Y., Shi, Y., Zheng, Y., Shi, M., Lo, S. K.
(2005). Blood-nourishing and Hard-softening Capsule Costs Less in the Management of Osteoarthritic Knee Pain: A Randomized Controlled Trial. Evid Based Complement Alternat Med
2: 363-368
[Abstract][Full Text]
Ioannidis, J. P. A.
(2005). Contradicted and Initially Stronger Effects in Highly Cited Clinical Research. JAMA
294: 218-228
[Abstract][Full Text]
Rabenda, V, Burlet, N, Ethgen, O, Raeman, F, Belaiche, J, Reginster, J-Y
(2005). A naturalistic study of the determinants of health related quality of life improvement in osteoarthritic patients treated with non-specific non-steroidal anti-inflammatory drugs. Ann Rheum Dis
64: 688-693
[Abstract][Full Text]
Cavalieri, T. A.
(2005). Management of Pain in Older Adults. JAOA: Journal of the American Osteopathic Association
105: 12S-17S
[Abstract][Full Text]
Boureau, F, Schneid, H, Zeghari, N, Wall, R, Bourgeois, P
(2004). The IPSO study: ibuprofen, paracetamol study in osteoarthritis. A randomised comparative clinical study comparing the efficacy and safety of ibuprofen and paracetamol analgesic treatment of osteoarthritis of the knee or hip. Ann Rheum Dis
63: 1028-1034
[Abstract][Full Text]
Stockler, M., Vardy, J., Pillai, A., Warr, D.
(2004). Acetaminophen (Paracetamol) Improves Pain and Well-Being in People With Advanced Cancer Already Receiving a Strong Opioid Regimen: A Randomized, Double-Blind, Placebo-Controlled Cross-Over Trial. JCO
22: 3389-3394
[Abstract][Full Text]
Neame, R, Zhang, W, Doherty, M
(2004). A historic issue of the Annals: three papers examine paracetamol in osteoarthritis. Ann Rheum Dis
63: 897-900
[Full Text]
Zhang, W, Jones, A, Doherty, M
(2004). Does paracetamol (acetaminophen) reduce the pain of osteoarthritis?: a meta-analysis of randomised controlled trials. Ann Rheum Dis
63: 901-907
[Abstract][Full Text]
Pincus, T, Koch, G, Lei, H, Mangal, B, Sokka, T, Moskowitz, R, Wolfe, F, Gibofsky, A, Simon, L, Zlotnick, S, Fort, J G
(2004). Patient Preference for Placebo, Acetaminophen (paracetamol) or Celecoxib Efficacy Studies (PACES): two randomised, double blind, placebo controlled, crossover clinical trials in patients with knee or hip osteoarthritis. Ann Rheum Dis
63: 931-939
[Abstract][Full Text]
Perrott, D. A., Piira, T., Goodenough, B., Champion, G. D.
(2004). Efficacy and Safety of Acetaminophen vs Ibuprofen for Treating Children's Pain or Fever: A Meta-analysis. Arch Pediatr Adolesc Med
158: 521-526
[Abstract][Full Text]
Wegman, A C M, van der Windt, D A W M, de Haan, M, Deville, W L J M, Fo, C T C. A, de Vries, T. P G M
(2003). Switching from NSAIDs to paracetamol: a series of n of 1 trials for individual patients with osteoarthritis. Ann Rheum Dis
62: 1156-1161
[Abstract][Full Text]
Iorio, R., Healy, W. L.
(2003). Unicompartmental Arthritis of the Knee. JBJS
85: 1351-1364
[Full Text]
Lonner, J. H.
(2003). A 57-Year-Old Man With Osteoarthritis of the Knee. JAMA
289: 1016-1025
[Full Text]
Case, J. P., Baliunas, A. J., Block, J. A.
(2003). Lack of Efficacy of Acetaminophen in Treating Symptomatic Knee Osteoarthritis: A Randomized, Double-blind, Placebo-Controlled Comparison Trial With Diclofenac Sodium. Arch Intern Med
163: 169-178
[Abstract][Full Text]
SHEEN, C.L., DILLON, J.F., BATEMAN, D.N., SIMPSON, K.J., MACDONALD, T.M.
(2002). Paracetamol toxicity: epidemiology, prevention and costs to the health-care system. QJM
95: 609-619
[Abstract][Full Text]
Skelly, M M, Hawkey, C J
(2002). Potential alternatives to COX 2 inhibitors. BMJ
324: 1289-1290
[Full Text]
Petrella, R. J., DiSilvestro, M. D., Hildebrand, C.
(2002). Effects of Hyaluronate Sodium on Pain and Physical Functioning in Osteoarthritis of the Knee: A Randomized, Double-blind, Placebo-Controlled Clinical Trial. Arch Intern Med
162: 292-298
[Abstract][Full Text]
Geba, G. P., Weaver, A. L., Polis, A. B., Dixon, M. E., Schnitzer, T. J., for the VACT Group,
(2002). Efficacy of Rofecoxib, Celecoxib, and Acetaminophen in Osteoarthritis of the Knee: A Randomized Trial. JAMA
287: 64-71
[Abstract][Full Text]
MacLean, C. H.
(2001). Quality Indicators for the Management of Osteoarthritis in Vulnerable Elders. ANN INTERN MED
135: 711-721
[Full Text]
Trappe, T. A., Fluckey, J. D., White, F., Lambert, C. P., Evans, W. J.
(2001). Skeletal Muscle PGF2{alpha}and PGE2 in Response to Eccentric Resisitance Exercise: Influence of Ibuprofen Acetaminophen. J. Clin. Endocrinol. Metab.
86: 5067-5070
[Abstract][Full Text]
Felson, D. T., Lawrence, R. C., Hochberg, M. C., McAlindon, T., Dieppe, P. A., Minor, M. A., Blair, S. N., Berman, B. M., Fries, J. F., Weinberger, M., Lorig, K. R., Jacobs, J. J., Goldberg, V.
(2000). Osteoarthritis: New Insights. Part 2: Treatment Approaches. ANN INTERN MED
133: 726-737
[Abstract][Full Text]
Scott, D. L., Berry, H., Capell, H., Coppock, J., Daymond, T., Doyle, D. V., Fernandes, L., Hazleman, B., Hunter, J., Huskisson, E. C., Jawad, A., Jubb, R., Kennedy, T., McGill, P., Nichol, F., Palit, J., Webley, M., Woolf, A., Wotjulewski, J.
(2000). The long-term effects of non-steroidal anti-inflammatory drugs in osteoarthritis of the knee: a randomized placebo-controlled trial. Rheumatology (Oxford)
39: 1095-1101
[Abstract][Full Text]
Williams, R. J. III, Wickiewicz, T. L., Warren, R. F.
(2000). Management of Unicompartmental Arthritis in the Anterior Cruciate Ligament-Deficient Knee. Am J Sports Med
28: 749-760
[Abstract][Full Text]
KIRKLEY, A., WEBSTER-BOGAERT, S., LITCHFIELD, R., AMENDOLA, A., MACDONALD, S., MCCALDEN, R., FOWLER, P.
(1999). The Effect of Bracing on Varus Gonarthrosis. JBJS
81: 539-48
[Abstract][Full Text]
Mamlin, L. A., Melfi, C. A., Parchman, M. L., Gutierrez, B., Allen, D. I., Katz, B. P., Dittus, R. S., Heck, D. A., Freund, D. A.
(1998). Management of Osteoarthritis of the Knee by Primary Care Physicians. Arch Fam Med
7: 563-567
[Abstract][Full Text]
Rochon, P. A, Gurwitz, J. H
(1997). Optimising drug treatment for elderly people: the prescribing cascade. BMJ
315: 1096-1099
[Full Text]
Trinkhaus, J., Nathan, J., Beane, L., Meltzer, B.
(1997). Acetaminophen (Tylenol): Johnson & Johnson and Consumer Safety. J Law Med Ethics
25: 49-57
Callaghan, J. J.
(1996). A 76-Year-Old Woman Considering Total Hip Replacement. JAMA
276: 486-491
[Abstract]
Henry, D., Lim, L. L-Y, Rodriguez, L. A G., Gutthann, S. P., Carson, J. L, Griffin, M., Savage, R., Logan, R., Moride, Y., Hawkey, C., Hill, S., Fries, J. T, Fries, J. T
(1996). Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. BMJ
312: 1563-1566
[Abstract][Full Text]
Jones, D. L., Kroenke, K., Landry, F. J., Tomich, D. J., Ferrel, R. J.
(1996). Cost Savings Using a Stepped-Care Prescribing Protocol for Nonsteroidal Anti-inflammatory Drugs. JAMA
275: 926-930
[Abstract]
Griffin, M. R., Brandt, K. D., Liang, M. H., Pincus, T., Ray, W. A.
(1995). Practical Management of Osteoarthritis: Integration of Pharmacologic and Nonpharmacologic Measures. Arch Fam Med
4: 1049-1055
[Abstract]
Dieppe, P.
(1995). Fortnightly Review: Management of hip osteoarthritis. BMJ
311: 853-857
[Abstract][Full Text]
Smalley, W. E., Griffin, M. R., Fought, R. L., Sullivan, L., Ray, W. A.
(1995). Effect of a Prior-Authorization Requirement on the Use of Nonsteroidal Antiinflammatory Drugs by Medicaid Patients. NEJM
332: 1612-1617
[Abstract][Full Text]
Alarcon, G. S., Straaton, K. V.
(1995). Rheumatology. JAMA
273: 1721-1723
[Abstract]
Bateman, D N, Kennedy, J G
(1995). Non-steroidal anti-inflammatory drugs and elderly patients. BMJ
310: 817-818
[Full Text]
Hawkey, C J
(1995). n of1 trials in osteoarthritis. BMJ
310: 666c-667
[Full Text]
(1994). Rational use of NSAIDs for musculoskeletal disorders. DTB
32: 91-95
[Abstract][Full Text]
Stucki, G., Johannesson, M., Liang, M. H.
(1994). Is Misoprostol Cost-effective in the Prevention of Nonsteroidal Anti-inflammatory Drug--Induced Gastropathy in Patients With Chronic Arthritis? A Review of Conflicting Economic Evaluations. Arch Intern Med
154: 2020-2025
[Abstract]
Gurwitz, J. H., Avorn, J., Bohn, R. L., Glynn, R. J., Monane, M., Mogun, H.
(1994). Initiation of Antihypertensive Treatment During Nonsteroidal Anti-inflammatory Drug Therapy. JAMA
272: 781-786
[Abstract]
Cushnaghan, J, McCarthy, C, Dieppe, P
(1994). Taping the patella medially: a new treatment for osteoarthritis of the knee joint?. BMJ
308: 753-755
[Abstract][Full Text]
Ray, W. A., Griffin, M. R, Avorn, J.
(1993). Evaluating Drugs after Their Approval for Clinical Use. NEJM
329: 2029-2032
[Full Text]
Fennerty, M. B.
(1993). Nonsteroidal Anti-inflammatory Drugs, Ulcers, and Histamine2 Blockers: The Ostrich Phenomenon!. Arch Intern Med
153: 2411-2412
[Abstract]
Greene, J. M., Winickoff, R. N.
(1992). Cost-Conscious Prescribing of Nonsteroidal Anti-inflammatory Drugs for Adults With Arthritis: A Review and Suggestions. Arch Intern Med
152: 1995-2002
[Abstract]
Hadler, N. M.
(1992). Knee Pain Is the Malady--Not Osteoarthritis. ANN INTERN MED
116: 598-599
[Abstract]
(1991). ACETAMINOPHEN VS. IBUPROFEN FOR OSTEOARTHRITIS OF THE KNEE. JWatch General
1991: 2-2
[Full Text]
Trappe, T. A., White, F., Lambert, C. P., Cesar, D., Hellerstein, M., Evans, W. J.
(2002). Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis. Am. J. Physiol. Endocrinol. Metab.
282: E551-E556
[Abstract][Full Text]