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Paracetamol for the management of pain in inflammatory arthritis: a systematic literature review.
J Rheumatol Suppl 2012; 90:11-6JR

Abstract

OBJECTIVE

To systematically review the literature on the efficacy and safety of paracetamol (acetaminophen) in the management of pain in inflammatory arthritis.

METHODS

A systematic search was performed in Medline, Embase, the Cochrane Library, and 2008/2009 American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) conference abstracts for clinical trials and observational studies of paracetamol in patients with inflammatory arthritis. Included trials were appraised for risk of bias, and relevant study details were abstracted. Efficacy was assessed from clinical trials using improvement in pain as the outcome measure, and safety was assessed using total adverse events and withdrawals due to adverse events as outcome measures. Safety data from observational studies were assessed separately.

RESULTS

Eleven articles containing 12 clinical trials and 1 observational study were identified, all in patients with rheumatoid arthritis. The trials were of short duration, used atypical doses of paracetamol, and all had a high risk of bias. Overall, there was weak evidence of a benefit of paracetamol over placebo and an additive benefit of paracetamol in combination with nonsteroidal antiinflammatory drugs (NSAID). The benefit of paracetamol to NSAID alone was uncertain. No significant differences in safety were seen in the limited clinical trial data. One cohort study showed an increased rate of serious gastrointestinal events with paracetamol over NSAID when used concurrently with corticosteroids and other analgesics, but had significant methodological limitations.

CONCLUSION

There is weak evidence for the efficacy of paracetamol in patients with inflammatory arthritis, and insufficient disease-specific safety data to draw conclusions.

Authors+Show Affiliations

University of Toronto, Toronto, Ontario, Canada. glen.hazlewood@utoronto.caNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

22942323

Citation

Hazlewood, Glen, et al. "Paracetamol for the Management of Pain in Inflammatory Arthritis: a Systematic Literature Review." The Journal of Rheumatology. Supplement, vol. 90, 2012, pp. 11-6.
Hazlewood G, van der Heijde DM, Bombardier C. Paracetamol for the management of pain in inflammatory arthritis: a systematic literature review. J Rheumatol Suppl. 2012;90:11-6.
Hazlewood, G., van der Heijde, D. M., & Bombardier, C. (2012). Paracetamol for the management of pain in inflammatory arthritis: a systematic literature review. The Journal of Rheumatology. Supplement, 90, pp. 11-6. doi:10.3899/jrheum.120336.
Hazlewood G, van der Heijde DM, Bombardier C. Paracetamol for the Management of Pain in Inflammatory Arthritis: a Systematic Literature Review. J Rheumatol Suppl. 2012;90:11-6. PubMed PMID: 22942323.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Paracetamol for the management of pain in inflammatory arthritis: a systematic literature review. AU - Hazlewood,Glen, AU - van der Heijde,Désirée M, AU - Bombardier,Claire, PY - 2012/9/4/entrez PY - 2012/9/4/pubmed PY - 2013/1/18/medline SP - 11 EP - 6 JF - The Journal of rheumatology. Supplement JO - J Rheumatol Suppl VL - 90 N2 - OBJECTIVE: To systematically review the literature on the efficacy and safety of paracetamol (acetaminophen) in the management of pain in inflammatory arthritis. METHODS: A systematic search was performed in Medline, Embase, the Cochrane Library, and 2008/2009 American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) conference abstracts for clinical trials and observational studies of paracetamol in patients with inflammatory arthritis. Included trials were appraised for risk of bias, and relevant study details were abstracted. Efficacy was assessed from clinical trials using improvement in pain as the outcome measure, and safety was assessed using total adverse events and withdrawals due to adverse events as outcome measures. Safety data from observational studies were assessed separately. RESULTS: Eleven articles containing 12 clinical trials and 1 observational study were identified, all in patients with rheumatoid arthritis. The trials were of short duration, used atypical doses of paracetamol, and all had a high risk of bias. Overall, there was weak evidence of a benefit of paracetamol over placebo and an additive benefit of paracetamol in combination with nonsteroidal antiinflammatory drugs (NSAID). The benefit of paracetamol to NSAID alone was uncertain. No significant differences in safety were seen in the limited clinical trial data. One cohort study showed an increased rate of serious gastrointestinal events with paracetamol over NSAID when used concurrently with corticosteroids and other analgesics, but had significant methodological limitations. CONCLUSION: There is weak evidence for the efficacy of paracetamol in patients with inflammatory arthritis, and insufficient disease-specific safety data to draw conclusions. SN - 0380-0903 UR - https://www.unboundmedicine.com/medline/citation/22942323/Paracetamol_for_the_management_of_pain_in_inflammatory_arthritis:_a_systematic_literature_review_ L2 - http://www.jrheum.org/cgi/pmidlookup?view=long&pmid=22942323 DB - PRIME DP - Unbound Medicine ER -