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<meta name="description" content="Based on high-quality evidence this review confirms that paracetamol provides only minimal improvements in pain and function for people with hip or knee osteoarthritis, with no increased risk of adverse events overall. Subgroup analysis indicates that the effects on pain and function do not differ a …"><meta name="keywords" content="pmid:30801133, PMC6388567, doi:10.1002/14651858.CD013273, Meta-Analysis, Systematic Review, Amanda O Leopoldino, Gustavo C Machado, Manuela L Ferreira, Acetaminophen / administration &amp; dosage, Acetaminophen / adverse effects, Acetaminophen / therapeutic use*, Aged, Analgesics, Non-Narcotic / administration &amp; dosage, Analgesics, Non-Narcotic / adverse effects, Analgesics, Non-Narcotic / therapeutic use*, Arthralgia / drug therapy*, Arthralgia / etiology, Humans, Liver / drug effects, Middle Aged, Osteoarthritis, Hip / drug therapy*, Osteoarthritis, Knee / drug therapy*, Pain Measurement, Randomized Controlled Trials as Topic, PubMed Abstract, NIH, NLM, NCBI, National Institutes of Health, National Center for Biotechnology Information, National Library of Medicine, MEDLINE"><meta name="robots" content="index,nofollow,noarchive"><meta property="og:title" content="Paracetamol versus placebo for knee and hip osteoarthritis - PubMed"><meta property="og:url" content="https://pubmed.ncbi.nlm.nih.gov/30801133/"><meta property="og:description" content="Based on high-quality evidence this review confirms that paracetamol provides only minimal improvements in pain and function for people with hip or knee osteoarthritis, with no increased risk of adverse events overall. Subgroup analysis indicates that the effects on pain and function do not differ a …"><meta property="og:image" content="https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image-v2.jpg"><meta property="og:image:secure_url" content="https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image-v2.jpg"><meta property="og:type" content="website"><meta property="og:site_name" content="PubMed"><meta name="twitter:domain" content="pubmed.ncbi.nlm.nih.gov"><meta name="twitter:card" content="summary_large_image"><meta name="twitter:title" content="Paracetamol versus placebo for knee and hip osteoarthritis - PubMed"><meta name="twitter:url" content="https://pubmed.ncbi.nlm.nih.gov/30801133/"><meta name="twitter:description" content="Based on high-quality evidence this review confirms that paracetamol provides only minimal improvements in pain and function for people with hip or knee osteoarthritis, with no increased risk of adverse events overall. Subgroup analysis indicates that the effects on pain and function do not differ a …"><meta name="twitter:image" content="https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image-v2.jpg">
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<select id="email-citation-format" name="citation-format" class="action-panel-selector email-citation-format">
<option selected="selected" value="summary">Summary</option>
<option value="summary-text">Summary (text)</option>
<option value="abstract">Abstract</option>
<option value="abstract-text">Abstract (text)</option>
</select>
</div>
<div class="include-supplemental-container">
<input type="checkbox" aria-label="Include MeSH and other data" name="include-supplemental" id="email-include-supplemental" class="email-include-supplemental">
<label for="email-include-supplemental" class="email-include-supplemental-label">MeSH and other data</label>
</div>
<div class="form-field recaptcha ">
<div class="g-recaptcha" id="id-recaptcha" data-sitekey="6LfsWHMdAAAAAClKbtOpjQ2pMjgsGxvv7NdZW9uI"></div>
</div>
<div id="captcha-error-message" class="usa-input-error-message captcha-validation-message" role="alert"></div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Sending..."
data-ga-category="save_share"
data-ga-action="email"
data-ga-label="send">
Send email
</button>
<button class="action-panel-cancel"
aria-label="Close 'Email citations' panel"
ref="linksrc=close_email_panel"
aria-controls="email-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="email"
data-ga-label="cancel">
Cancel
</button>
</div>
<input type="hidden" name="email-search-details" value="" />
<input type="hidden" name="email-search-details-hash" value="0e42663a6c3bd85498fcb88798998fed7bfdc45d457db35281e41afe13cc0524" />
</form>
</div>
</div>
<div id="collections-action-panel"
class="collections-action-panel action-panel in-progress-dots-panel"
aria-hidden="true"
data-collections-open-panel-enabled="false"
data-collections-open-panel-url-hash="#open-collections-panel">
<div class="inner-wrap">
<h3 class="action-panel-heading">
Add to Collections
</h3>
<form id="collections-action-panel-form"
class="collections-action-panel-form action-panel-content action-form action-panel-smaller-selectors"
data-existing-collections-url="/list-existing-collections/"
data-add-to-existing-collection-url="/add-to-existing-collection/"
data-create-and-add-to-new-collection-url="/create-and-add-to-new-collection/"
data-get-article-ids-by-search-url="/get-article-ids-by-search/"
data-myncbi-max-collection-name-length="100"
data-add-to-collection-max-amount="1000"
data-collections-root-url="https://www.ncbi.nlm.nih.gov/myncbi/collections/">
<input type="hidden" name="csrfmiddlewaretoken" value="DqW5iuhCWCemqhY893KAfqzkOPEmjdo7UdGaVkKYwd1QkI4YMmnCJy5YmTmycOWr">
<div class="choice-group" role="radiogroup">
<ul class="radio-group-items">
<li>
<input type="radio"
id="collections-action-panel-new"
class="collections-new"
name="collections"
value="new"
data-ga-category="save_share"
data-ga-action="collections"
data-ga-label="collections_radio_new">
<label for="collections-action-panel-new">Create a new collection</label>
</li>
<li>
<input type="radio"
id="collections-action-panel-existing"
class="collections-existing"
name="collections"
value="existing"
checked="true"
data-ga-category="save_share"
data-ga-action="collections"
data-ga-label="collections_radio_existing">
<label for="collections-action-panel-existing">Add to an existing collection</label>
</li>
</ul>
</div>
<div class="controls-wrapper">
<div class="action-panel-control-wrap new-collections-controls">
<label for="collections-action-panel-add-to-new" class="action-panel-label required-field-asterisk">
Name your collection:
</label>
<input
type="text"
name="add-to-new-collection"
id="collections-action-panel-add-to-new"
class="collections-action-add-to-new"
pattern="[^&quot;&amp;=&lt;&gt;\/]*" title="The following characters are not allowed in the Name field: &quot;&amp;=&lt;&gt;/"
maxlength="100"
data-ga-category="save_share"
data-ga-action="create_collection"
data-ga-label="non_favorties_collection">
<div class="collections-new-name-too-long usa-input-error-message selection-validation-message">
Name must be less than 100 characters
</div>
</div>
<div class="action-panel-control-wrap existing-collections-controls">
<label for="collections-action-panel-add-to-existing" class="action-panel-label">
Choose a collection:
</label>
<select id="collections-action-panel-add-to-existing"
class="action-panel-selector collections-action-add-to-existing"
data-ga-category="save_share"
data-ga-action="select_collection"
data-ga-label="($('#collections-action-add-to-existing').val() === 'Favorites') ? 'Favorites' : 'non_favorites_collection'">
</select>
<div class="collections-retry-load-on-error usa-input-error-message selection-validation-message">
Unable to load your collection due to an error<br>
<a href="#">Please try again</a>
</div>
</div>
</div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Adding..."
data-pinger-ignore
data-ga-category="save_share"
data-ga-action="collections"
data-ga-label="add">
Add
</button>
<button class="action-panel-cancel"
aria-label="Close 'Add to Collections' panel"
ref="linksrc=close_collections_panel"
aria-controls="collections-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="collections"
data-ga-label="cancel">
Cancel
</button>
</div>
</form>
</div>
</div>
<div id="bibliography-action-panel"
class="bibliography-action-panel action-panel in-progress-dots-panel"
aria-hidden="true"
data-bibliography-open-panel-enabled="false"
data-bibliography-open-panel-url-hash="#open-bibliography-panel">
<div class="inner-wrap">
<h3 class="action-panel-heading">
Add to My Bibliography
</h3>
<form id="bibliography-action-panel-form"
class="bibliography-action-panel-form action-panel-content action-form action-panel-smaller-selectors"
data-add-to-bibliography-max-amount="100"
data-add-to-bibliography-batch-size="10"
data-bibliography-delegates-url="/list-bibliography-delegates/"
data-add-to-bibliography-url="/add-to-bibliography/"
data-get-article-ids-by-search-url="/get-article-ids-by-search/"
data-mybib-root-url="https://www.ncbi.nlm.nih.gov/myncbi/collections/mybibliography/">
<input type="hidden" name="csrfmiddlewaretoken" value="DqW5iuhCWCemqhY893KAfqzkOPEmjdo7UdGaVkKYwd1QkI4YMmnCJy5YmTmycOWr">
<div class="action-panel-control-wrap bibliographies-controls">
<div class="choice-group">
<ul class="bibliographies-action-add radio-group-items">
<li>
<input name="bibliography" id="my-bibliography" class="my-bibliography" type="radio" checked/>
<label for="my-bibliography">My Bibliography</label>
</li>
</ul>
</div>
</div>
<div class="bibliographies-retry-load-on-error usa-input-error-message selection-validation-message">
Unable to load your delegates due to an error<br>
<a href="#">Please try again</a>
</div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Adding..."
data-pinger-ignore>
Add
</button>
<button class="action-panel-cancel"
aria-label="Close 'Add to bibliography' panel"
ref="linksrc=close_bibliography_panel"
aria-controls="bibliography-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="mybib"
data-ga-label="cancel">
Cancel
</button>
</div>
</form>
</div>
</div>
<div id="saved-search-action-panel" class="saved-search-action-panel action-panel " aria-hidden="true"
data-saved-search-open-panel-enabled="false"
data-saved-search-open-panel-url-hash="#open-saved-search-panel">
<div class="inner-wrap">
<h2 class="action-panel-heading">
Your saved search
</h2>
<form id="saved-search-action-panel-form"
class="saved-search-action-panel-form action-panel-content action-form"
data-create-saved-search-url="/create-saved-search/"
data-try-search-terms-url="/try-search-term/"
data-saved-search-root-url="https://www.ncbi.nlm.nih.gov/myncbi/searches/">
<input type="hidden" name="csrfmiddlewaretoken" value="DqW5iuhCWCemqhY893KAfqzkOPEmjdo7UdGaVkKYwd1QkI4YMmnCJy5YmTmycOWr">
<div class="action-panel-control-wrap">
<label for="saved-search-name" class="action-panel-label saved-search-name-label required-field-asterisk">
Name of saved search:
</label>
<input maxlength="200"
type="text"
name="saved-search-name"
id="saved-search-name"
class="saved-search-name"
value=""
required
pattern="[^&quot;&amp;=&lt;&gt;\/]*" title="The following characters are not allowed in the Name field: &quot;&amp;=&lt;&gt;/">
</div>
<div class="action-panel-control-wrap">
<label for="saved-search-term" class="action-panel-label required-field-asterisk">
Search terms:
</label>
<textarea name="saved-search-term" id="saved-search-term" class="saved-search-term" required></textarea>
</div>
<div class="test-search-term-wrap">
<a href="#" class="try-search-term">Test search terms</a>
</div>
<div class="choice-group action-panel-extra-margin-top">
<span class="action-panel-label" id="fieldset-label">
Would you like email updates of new search results?
</span>
<fieldset id="saved-search-alert" aria-describedby="fieldset-label">
<legend class="usa-sr-only">Saved Search Alert Radio Buttons</legend>
<ul class="radio-group-items">
<li>
<input type="radio" id="saved-search-alert-yes" class="saved-search-alert-yes" name="saved-search-alert" value="yes" checked>
<label for="saved-search-alert-yes" class="action-panel-label">Yes</label>
</li>
<li>
<input aria-label="No radio input" type="radio" id="saved-search-alert-no" class="saved-search-alert-no" name="saved-search-alert" value="no">
<label for="saved-search-alert-no" class="action-panel-label">No</label>
</li>
</ul>
</fieldset>
</div>
<div class="alert-schedule-wrap">
<div class="action-panel-control-wrap">
<label class="action-panel-label">
Email:
</label>
<span aria-label="Email address" id="saved-search-email" class="action-panel-label"><span class="action-panel-label-bold"></span> (<a class="myncbi-account-settings" href="https://www.ncbi.nlm.nih.gov/account/settings/">change</a>)</span>
</div>
<div class="action-panel-control-wrap action-panel-extra-margin-top">
<label for="saved-search-frequency" class="action-panel-label">
Frequency:
</label>
<select id="saved-search-frequency" class="no-border-panel-selector saved-search-frequency">
<option value="monthly">Monthly</option>
<option value="weekly">Weekly</option>
<option value="daily">Daily</option>
</select>
</div>
<div class="action-panel-control-wrap saved-search-monthly-additional">
<label for="saved-search-monthly-on-day" class="action-panel-label">
Which day?
</label>
<select id="saved-search-monthly-on-day" class="no-border-panel-selector">
<option value="Sunday">The first Sunday</option>
<option value="Monday">The first Monday</option>
<option value="Tuesday">The first Tuesday</option>
<option value="Wednesday">The first Wednesday</option>
<option value="Thursday">The first Thursday</option>
<option value="Friday">The first Friday</option>
<option value="Saturday">The first Saturday</option>
<option value="day">The first day</option>
<option value="weekday">The first weekday</option>
</select>
</div>
<div class="action-panel-control-wrap saved-search-weekly-additional">
<label for="saved-search-weekly-on-day" class="action-panel-label">
Which day?
</label>
<select id="saved-search-weekly-on-day" class="no-border-panel-selector saved-search-weekly-on-day">
<option value="Sunday">Sunday</option>
<option value="Monday">Monday</option>
<option value="Tuesday">Tuesday</option>
<option value="Wednesday">Wednesday</option>
<option value="Thursday">Thursday</option>
<option value="Friday">Friday</option>
<option value="Saturday">Saturday</option>
</select>
</div>
<div class="action-panel-control-wrap">
<label for="saved-search-report" class="action-panel-label">
Report format:
</label>
<select id="saved-search-report" class="no-border-panel-selector saved-search-report">
<option value="DocSum">Summary</option>
<option value="DocSumText">Summary (text)</option>
<option value="Abstract">Abstract</option>
<option value="AbstractText">Abstract (text)</option>
<option value="MEDLINE">PubMed</option>
</select>
</div>
<div class="action-panel-control-wrap">
<label for="saved-search-amount" class="action-panel-label">
Send at most:
</label>
<select id="saved-search-amount" class="no-border-panel-selector saved-search-amount">
<option value="1">1 item</option>
<option value="5" selected>5 items</option>
<option value="10">10 items</option>
<option value="20">20 items</option>
<option value="50">50 items</option>
<option value="100">100 items</option>
<option value="200">200 items</option>
</select>
</div>
<div>
<input type="checkbox" id="saved-search-send-if-no-result" class="saved-search-send-if-no-result" name="saved-search-send-if-no-result">
<label for="saved-search-send-if-no-result" class="action-panel-label smaller-checkbox">
Send even when there aren't any new results
</label>
</div>
<div class="action-panel-control-wrap option-text-in-email-wrap">
<label for="saved-search-email-text" class="action-panel-label">
Optional text in email:
</label>
<textarea name="saved-search-email-text"
id="saved-search-email-text"
class="saved-search-email-text"></textarea>
</div>
</div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Saving..."
data-ga-category="save_share"
data-ga-action="alert"
data-ga-label="save">
Save
</button>
<button class="action-panel-cancel"
aria-label="Close 'Your saved search' panel"
ref="linksrc=close_saved_search_panel"
aria-controls="saved-search-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="alert"
data-ga-label="cancel">
Cancel
</button>
</div>
</form>
</div>
</div>
<div id="citation-manager-action-panel" class="citation-manager-action-panel action-panel" aria-hidden="true">
<div class="inner-wrap">
<h2 class="action-panel-heading">
Create a file for external citation management software
</h2>
<form id="citation-manager-action-panel-form"
class="action-panel-content action-form"
action="/results-export-ids/"
data-by-search-action="/results-export-search-data/"
data-by-ids-action="/results-export-ids/"
method="post"
data-by-search-method="post"
data-by-ids-method="post">
<input type="hidden" name="csrfmiddlewaretoken" value="DqW5iuhCWCemqhY893KAfqzkOPEmjdo7UdGaVkKYwd1QkI4YMmnCJy5YmTmycOWr">
<input name="results-format" type="hidden" value="pubmed"/>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Sending..."
data-ga-category="save_share"
data-ga-action="citation_manager"
data-ga-label="save">
Create file
</button>
<button class="action-panel-cancel"
aria-label="Close 'Send citations to citation manager' panel"
ref="linksrc=close_citation_manager_panel"
aria-controls="citation-manager-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="citation_manager"
data-ga-label="cancel">
Cancel
</button>
</div>
</form>
</div>
</div>
<div id="rss-action-panel" class="rss-action-panel action-panel " aria-hidden="true">
<div class="inner-wrap">
<h2 class="action-panel-heading">
Your RSS Feed
</h2>
<form id="rss-action-panel-form"
class="rss-action-panel-form action-panel-content action-form"
data-create-rss-feed-url="/create-rss-feed-url/"
data-search-form-term-value="">
<input type="hidden" name="csrfmiddlewaretoken" value="DqW5iuhCWCemqhY893KAfqzkOPEmjdo7UdGaVkKYwd1QkI4YMmnCJy5YmTmycOWr">
<div class="action-panel-control-wrap">
<label for="rss-name" class="action-panel-label required-field-asterisk">
Name of RSS Feed:
</label>
<input maxlength="200"
placeholder="Name"
type="text"
name="rss-name"
id="rss-name"
class="rss-name"
value=''
required
pattern="[^&quot;&amp;=&lt;&gt;\/]*" title="The following characters are not allowed in the Name field: &quot;&amp;=&lt;&gt;/">
</div>
<div class="rss-limit-wrap">
<div class="action-panel-control-wrap action-panel-extra-margin-top">
<label for="rss-limit" class="action-panel-label">
Number of items displayed:
</label>
<select id="rss-limit" class="no-border-panel-selector rss-limit">
<option value="5">5</option>
<option value="10">10</option>
<option value="15" selected="selected">15</option>
<option value="20">20</option>
<option value="50">50</option>
<option value="100">100</option>
</select>
</div>
</div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Creating..."
data-ga-category="save_share"
data-ga-action="alert"
data-ga-label="save">
Create RSS
</button>
<button class="action-panel-cancel"
aria-label="Close 'Your RSS' panel"
ref="linksrc=close_rss_panel"
aria-controls="rss-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="alert"
data-ga-label="cancel">
Cancel
</button>
</div>
<div class="action-panel-control-wrap rss-link-copy-wrap">
<label for="rss-link" class="usa-sr-only">RSS Link</label>
<input placeholder="Your RSS Feed Link" type="text" name="rss-link" id="rss-link" class="rss-link" title="RSS Link">
<button
type="button"
disabled
class="rss-link-copy-button disabled"
data-ga-category="save_share"
data-ga-action="rss"
data-ga-label="copy">
Copy
</button>
</div>
</form>
</div>
</div>
</div>
</div>
<div class="article-page" id="article-page" data-article-pmid="30801133">
<aside class="page-sidebar">
<div class="inner-wrap">
<div class="full-text-links">
<div class="full-view">
<h3 class="title">
Full text links
</h3>
<div class="full-text-links-list">
<a class="link-item
dialog-focus"
href="https://doi.org/10.1002/14651858.CD013273"
target="_blank"
rel="noopener"
ref="linksrc=fulltextorjournal_fulltext&amp;is_pmc=False&amp;PrId=3058&amp;itool=Abstract-def&amp;log$=linkouticon&amp;uid=30801133&amp;db=pubmed&amp;nlmid=100909747"
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Wiley
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pmc
"
href="https://pmc.ncbi.nlm.nih.gov/articles/pmid/30801133/"
target="_blank"
rel="noopener"
ref="linksrc=fulltextorjournal_fulltext&amp;is_pmc=True&amp;PrId=3494&amp;itool=Abstract-def&amp;log$=linkouticon&amp;uid=30801133&amp;db=pubmed&amp;nlmid=100909747"
title="Free full text at PubMed Central"
data-ga-category="full_text"
data-ga-action="PMC"
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Free PMC article
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</div>
<div class="short-view">
<a href="#" class="full-text-links-button full-text-links-dialog-trigger">
Full text links
</a>
</div>
</div>
<div class="actions-buttons sidebar"><h3 class="title">Actions</h3><div class="inner-wrap"><button class="citation-button citation-dialog-trigger"
aria-label="Open dialog with citation text in different styles"
data-ga-category="save_share"
data-ga-action="cite"
data-ga-label="open"
data-all-citations-url="/30801133/citations/"
data-citation-style="nlm"
data-pubmed-format-link="/30801133/export/"><span class="button-label">Cite</span></button><link type="text/css" href="ncbi-overlay-block/src/overlay-block.css"><div class="collections-button-container" data-article-id="30801133" data-article-db="pubmed"><button class="collections-button collections-dialog-trigger"
aria-label="Save article in MyNCBI collections."
data-ga-category="collections_button"
data-ga-action="click"
data-ga-label="collections_button"
data-collections-open-dialog-enabled="false"
data-collections-open-dialog-url="https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F30801133%2F%23open-collections-dialog"
data-in-collections="false"><span class="button-label">Collections</span></button><div class="overlay" role="dialog"><div id="collections-action-dialog"
class="dialog collections-dialog"
aria-hidden="true"><div class="title">Add to Collections</div><div class="collections-action-panel action-panel"><form id="collections-action-dialog-form"
class="collections-action-panel-form action-panel-content action-form action-panel-smaller-selectors"
data-existing-collections-url="/list-existing-collections/"
data-add-to-existing-collection-url="/add-to-existing-collection/"
data-create-and-add-to-new-collection-url="/create-and-add-to-new-collection/"
data-myncbi-max-collection-name-length="100"
data-collections-root-url="https://www.ncbi.nlm.nih.gov/myncbi/collections/"><input type="hidden" name="csrfmiddlewaretoken" value="DqW5iuhCWCemqhY893KAfqzkOPEmjdo7UdGaVkKYwd1QkI4YMmnCJy5YmTmycOWr"><div class="choice-group" role="radiogroup"><ul class="radio-group-items"><li><input type="radio"
id="collections-action-dialog-new"
class="collections-new"
name="collections"
value="new"
data-ga-category="collections_button"
data-ga-action="click"
data-ga-label="collections_radio_new"><label for="collections-action-dialog-new">Create a new collection</label></li><li><input type="radio"
id="collections-action-dialog-existing"
class="collections-existing"
name="collections"
value="existing"
checked="true"
data-ga-category="collections_button"
data-ga-action="click"
data-ga-label="collections_radio_existing"><label for="collections-action-dialog-existing">Add to an existing collection</label></li></ul></div><div class="controls-wrapper"><div class="action-panel-control-wrap new-collections-controls"><label for="collections-action-dialog-add-to-new" class="action-panel-label required-field-asterisk">
Name your collection:
</label><input
type="text"
name="add-to-new-collection"
id="collections-action-dialog-add-to-new"
class="collections-action-add-to-new"
pattern="[^&quot;&amp;=&lt;&gt;\/]*" title="The following characters are not allowed in the Name field: &quot;&amp;=&lt;&gt;/"
maxlength="100"
data-ga-category="collections_button"
data-ga-action="create_collection"
data-ga-label="non_favorties_collection"><div class="collections-new-name-too-long usa-input-error-message selection-validation-message">
Name must be less than 100 characters
</div></div><div class="action-panel-control-wrap existing-collections-controls"><label for="collections-action-dialog-add-to-existing" class="action-panel-label">
Choose a collection:
</label><select id="collections-action-dialog-add-to-existing"
class="action-panel-selector collections-action-add-to-existing"
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<div class="abstract" id="abstract">
<h2 class="title">
Abstract
</h2>
<div class="abstract-content selected"
id="eng-abstract">
<p>
<strong class="sub-title">
Background:
</strong>
Paracetamol (acetaminophen) is vastly recommended as the first-line analgesic for osteoarthritis of the hip or knee. However, there has been controversy about this recommendation given recent studies have revealed small effects of paracetamol when compared with placebo. Nonetheless, past studies have not systematically reviewed and appraised the literature to investigate the effects of this drug on specific osteoarthritis sites, that is, hip or knee, or on the dose used.
</p>
<p>
<strong class="sub-title">
Objectives:
</strong>
To assess the benefits and harms of paracetamol compared with placebo in the treatment of osteoarthritis of the hip or knee.
</p>
<p>
<strong class="sub-title">
Search methods:
</strong>
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, AMED, CINAHL, Web of Science, LILACS, and International Pharmaceutical Abstracts to 3 October 2017, and ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (ICTRP) portal on 20 October 2017.
</p>
<p>
<strong class="sub-title">
Selection criteria:
</strong>
We included randomised controlled trials comparing paracetamol with placebo in adults with osteoarthritis of the hip or knee. Major outcomes were pain, function, quality of life, adverse events and withdrawals due to adverse events, serious adverse events, and abnormal liver function tests.
</p>
<p>
<strong class="sub-title">
Data collection and analysis:
</strong>
Two review authors used standard Cochrane methods to collect data, and assess risk of bias and quality of the evidence. For pooling purposes, we converted pain and physical function (Western Ontario and McMaster Universities Osteoarthritis Index function) scores to a common 0 (no pain or disability) to 100 (worst possible pain or disability) scale.
</p>
<p>
<strong class="sub-title">
Main results:
</strong>
We identified 10 randomised placebo-controlled trials involving 3541 participants with hip or knee osteoarthritis. The paracetamol dose varied from 1.95 g/day to 4 g/day, and the majority of trials followed participants for three months only. Most trials did not clearly report randomisation and concealment methods and were at unclear risk of selection bias. Trials were at low risk of performance, detection, and reporting bias.At 3 weeks' to 3 months' follow-up, there was high-quality evidence that paracetamol provided no clinically important improvements in pain and physical function. Mean reduction in pain was 23 points (0 to 100 scale, lower scores indicated less pain) with placebo and 3.23 points better (5.43 better to 1.02 better) with paracetamol, an absolute reduction of 3% (1% better to 5% better, minimal clinical important difference 9%) and relative reduction of 5% (2% better to 8% better) (seven trials, 2355 participants). Physical function improved by 12 points on a 0 to 100 scale (lower scores indicated better function) with placebo and was 2.9 points better (0.95 better to 4.89 better) with paracetamol, an absolute improvement of 3% (1% better to 5% better, minimal clinical important difference 10%) and relative improvement of 5% (2% better to 9% better) (7 trials, 2354 participants).High-quality evidence from eight trials indicated that the incidence of adverse events was similar between groups: 515/1586 (325 per 1000) in the placebo group versus 537/1666 (328 per 1000, range 299 to 360) in the paracetamol group (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.92 to 1.11). There was less certainty (moderate-quality evidence) around the risk of serious adverse events, withdrawals due to adverse events, and the rate of abnormal liver function tests, due to wide CIs or small event rates, indicating imprecision. Seventeen of 1480 (11 per 1000) people treated with placebo and 28/1729 (16 per 1000, range 8 to 29) people treated with paracetamol experienced serious adverse events (RR 1.36, 95% CI 0.73 to 2.53; 6 trials). The incidence of withdrawals due to adverse events was 65/1000 participants in with placebo and 77/1000 (range 59 to 100) participants with paracetamol (RR 1.19, 95% CI 0.91 to 1.55; 7 trials). Abnormal liver function occurred in 18/1000 participants treated with placebo and 70/1000 participants treated with paracetamol (RR 3.79, 95% CI 1.94 to 7.39), but the clinical importance of this effect was uncertain. None of the trials reported quality of life.Subgroup analyses indicated that the effects of paracetamol on pain and function did not differ according to the dose of paracetamol (3.0 g/day or less versus 3.9 g/day or greater).
</p>
<p>
<strong class="sub-title">
Authors&#x27; conclusions:
</strong>
Based on high-quality evidence this review confirms that paracetamol provides only minimal improvements in pain and function for people with hip or knee osteoarthritis, with no increased risk of adverse events overall. Subgroup analysis indicates that the effects on pain and function do not differ according to the dose of paracetamol. Due to the small number of events, we are less certain if paracetamol use increases the risk of serious adverse events, withdrawals due to adverse events, and rate of abnormal liver function tests.Current clinical guidelines consistently recommend paracetamol as the first-line analgesic medication for hip or knee osteoarthritis, given its low absolute frequency of substantive harm. However, our results call for reconsideration of these recommendations.
</p>
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<div class="conflict-of-interest" id="conflict-of-interest">
<h2 class="title">
Conflict of interest statement
</h2>
<div class="statement">
<p xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:p1="http://pubmed.gov/pub-one">AOL: no conflict of interest.</p>
<p xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:p1="http://pubmed.gov/pub-one">GCM, MBP, PHF, ROD, AJM, and MLF: conducted a systematic review that investigated the benefits of paracetamol for patients with osteoarthritis and spinal pain published in the <italic>BMJ</italic>.</p>
<p xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:p1="http://pubmed.gov/pub-one">ROD and AJM: investigators on the PACE (Placebo, Acetaminophen (paracetamol) or Celecoxib Efficacy Studies) trial of paracetamol in low back pain which was jointly funded by the National Health and Medical Research Council of Australia and GlaxoSmithKline Australia (a manufacturer of paracetamol).</p>
<p xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:p1="http://pubmed.gov/pub-one">AM: received research funding support from GlaxoSmithKline for a PhD scholarship.</p>
<p xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:p1="http://pubmed.gov/pub-one">DJH is a consultant for Flexion, Merck Serono, and Nestlé.</p>
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<h2 class="title">
Figures
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<div class="figure-caption-contents"><p> Prisma flow diagram of trials investigating efficacy of paracetamol versus placebo for osteoarthritis. </p></div>
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<div class="figure-caption-contents">Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.</div>
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<p> 4 </p>
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<div class="figure-caption-contents"><p> Forest plot of comparison: 1 Hip… </p></div>
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<div class="figure-caption-contents"><p> Forest plot of comparison: 1 Hip or knee osteoarthritis, outcome: 1.1 Pain. Pain scores… </p></div>
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<div class="figure-caption-contents">Forest plot of comparison: 1 Hip or knee osteoarthritis, outcome: 1.1 Pain. Pain scores are expressed on scale of 0 to 100. Immediate term = followup two weeks or less; short term = followup more than two weeks but three months or less.</div>
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<div class="figure-caption-contents"><p> Forest plot of comparison: 1 Hip… </p></div>
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<div class="figure-caption-contents"><p> Forest plot of comparison: 1 Hip or knee osteoarthritis, outcome: 1.2 Physical function (WOMAC).… </p></div>
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<div class="figure-caption-contents">Forest plot of comparison: 1 Hip or knee osteoarthritis, outcome: 1.2 Physical function (WOMAC). Physical function scores expressed on scale of 0 to 100. Immediate term = followup two weeks or less; short term = followup two weeks or greater but three months or less.</div>
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<p> 6 </p>
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<div class="figure-caption-contents"><p> Forest plot of comparison: 1 Hip… </p></div>
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<div class="figure-caption-contents"><p> Forest plot of comparison: 1 Hip or knee osteoarthritis, outcome: 1.4 Adverse events (AE).… </p></div>
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<div class="figure-caption-contents">Forest plot of comparison: 1 Hip or knee osteoarthritis, outcome: 1.4 Adverse events (AE). Any = number of participants reporting any AE; serious = number of participants reporting any serious AE (as defined by each study); withdrawals = number of participants withdrawn from study because of AEs; liver = number of participants with abnormal results on liver function tests.</div>
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<p> 1.1. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 1 Hip or knee… </p></div>
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<p> 1.1. Analysis </p>
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<div class="figure-caption-contents"><p> Comparison 1 Hip or knee osteoarthritis, Outcome 1 Pain intensity. </p></div>
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1.1. Analysis
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<div class="figure-caption-contents">Comparison 1 Hip or knee osteoarthritis, Outcome 1 Pain intensity.</div>
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<p> 1.2. Analysis </p>
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<div class="figure-caption-contents"><p> Comparison 1 Hip or knee osteoarthritis, Outcome 2 Physical function (Western Ontario and… </p></div>
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1.2. Analysis
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<div class="figure-caption-contents">Comparison 1 Hip or knee osteoarthritis, Outcome 2 Physical function (Western Ontario and McMaster Universities Osteoarthritis Index).</div>
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<img class="figure-thumb" itemprop="thumbnail"
id="article-image-8"
src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/d4ea7e8acf7a/nCD013273-CMP-001-03.gif"
alt="1.3" />
</a>
<meta itemprop="width" itemtype="http://schema.org/ImageObject" content="566">
<meta itemprop="height" itemtype="http://schema.org/ImageObject" content="541">
<div class="figure-caption figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="caption" aria-hidden="true">
<div class="caption-wrap">
<strong class="figure-label">
<p> 1.3. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 1 Hip or knee… </p></div>
</div>
</div>
<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 1.3. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 1 Hip or knee osteoarthritis, Outcome 3 Adverse events (AE). </p></div>
</div>
<figcaption id="figure-caption-8" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
1.3. Analysis
</strong>
<div class="figure-caption-contents">Comparison 1 Hip or knee osteoarthritis, Outcome 3 Adverse events (AE).</div>
</figcaption>
</figure>
<figure class="figure-item tail"
itemscope itemtype="http://schema.org/ImageObject"
itemprop="associatedMedia"
data-slide-index="9"
data-label-slug="14">
<a class="figure-link"
href="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/9cb1aeeb18ca/nCD013273-CMP-001-04.jpg"
itemprop="contentUrl"
aria-describedby="figure-caption-9"
role="button"
data-image-width="566"
data-image-height="197"
data-image-alt="1.4"
data-pmc-id="PMC6388567"
data-figure-id="CD013273-fig-0010">
<img class="figure-thumb" itemprop="thumbnail"
id="article-image-9"
src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/f78992814c78/nCD013273-CMP-001-04.gif"
alt="1.4" />
</a>
<meta itemprop="width" itemtype="http://schema.org/ImageObject" content="566">
<meta itemprop="height" itemtype="http://schema.org/ImageObject" content="197">
<div class="figure-caption figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="caption" aria-hidden="true">
<div class="caption-wrap">
<strong class="figure-label">
<p> 1.4. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 1 Hip or knee… </p></div>
</div>
</div>
<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 1.4. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 1 Hip or knee osteoarthritis, Outcome 4 Walking disability. </p></div>
</div>
<figcaption id="figure-caption-9" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
1.4. Analysis
</strong>
<div class="figure-caption-contents">Comparison 1 Hip or knee osteoarthritis, Outcome 4 Walking disability.</div>
</figcaption>
</figure>
<figure class="figure-item tail"
itemscope itemtype="http://schema.org/ImageObject"
itemprop="associatedMedia"
data-slide-index="10"
data-label-slug="15">
<a class="figure-link"
href="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/ad700b4f08fc/nCD013273-CMP-001-05.jpg"
itemprop="contentUrl"
aria-describedby="figure-caption-10"
role="button"
data-image-width="566"
data-image-height="119"
data-image-alt="1.5"
data-pmc-id="PMC6388567"
data-figure-id="CD013273-fig-0011">
<img class="figure-thumb" itemprop="thumbnail"
id="article-image-10"
src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/ae8ac5b0f9b1/nCD013273-CMP-001-05.gif"
alt="1.5" />
</a>
<meta itemprop="width" itemtype="http://schema.org/ImageObject" content="566">
<meta itemprop="height" itemtype="http://schema.org/ImageObject" content="119">
<div class="figure-caption figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="caption" aria-hidden="true">
<div class="caption-wrap">
<strong class="figure-label">
<p> 1.5. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 1 Hip or knee… </p></div>
</div>
</div>
<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 1.5. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 1 Hip or knee osteoarthritis, Outcome 5 Rescue medication. </p></div>
</div>
<figcaption id="figure-caption-10" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
1.5. Analysis
</strong>
<div class="figure-caption-contents">Comparison 1 Hip or knee osteoarthritis, Outcome 5 Rescue medication.</div>
</figcaption>
</figure>
<figure class="figure-item tail"
itemscope itemtype="http://schema.org/ImageObject"
itemprop="associatedMedia"
data-slide-index="11"
data-label-slug="16">
<a class="figure-link"
href="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/9e0badb15f0f/nCD013273-CMP-001-06.jpg"
itemprop="contentUrl"
aria-describedby="figure-caption-11"
role="button"
data-image-width="566"
data-image-height="119"
data-image-alt="1.6"
data-pmc-id="PMC6388567"
data-figure-id="CD013273-fig-0012">
<img class="figure-thumb" itemprop="thumbnail"
id="article-image-11"
src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/edbf9b17f305/nCD013273-CMP-001-06.gif"
alt="1.6" />
</a>
<meta itemprop="width" itemtype="http://schema.org/ImageObject" content="566">
<meta itemprop="height" itemtype="http://schema.org/ImageObject" content="119">
<div class="figure-caption figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="caption" aria-hidden="true">
<div class="caption-wrap">
<strong class="figure-label">
<p> 1.6. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 1 Hip or knee… </p></div>
</div>
</div>
<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 1.6. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 1 Hip or knee osteoarthritis, Outcome 6 Patient adherence. </p></div>
</div>
<figcaption id="figure-caption-11" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
1.6. Analysis
</strong>
<div class="figure-caption-contents">Comparison 1 Hip or knee osteoarthritis, Outcome 6 Patient adherence.</div>
</figcaption>
</figure>
<figure class="figure-item tail"
itemscope itemtype="http://schema.org/ImageObject"
itemprop="associatedMedia"
data-slide-index="12"
data-label-slug="21">
<a class="figure-link"
href="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/2619e788ef39/nCD013273-CMP-002-01.jpg"
itemprop="contentUrl"
aria-describedby="figure-caption-12"
role="button"
data-image-width="566"
data-image-height="245"
data-image-alt="2.1"
data-pmc-id="PMC6388567"
data-figure-id="CD013273-fig-0013">
<img class="figure-thumb" itemprop="thumbnail"
id="article-image-12"
src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/fd276e84910d/nCD013273-CMP-002-01.gif"
alt="2.1" />
</a>
<meta itemprop="width" itemtype="http://schema.org/ImageObject" content="566">
<meta itemprop="height" itemtype="http://schema.org/ImageObject" content="245">
<div class="figure-caption figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="caption" aria-hidden="true">
<div class="caption-wrap">
<strong class="figure-label">
<p> 2.1. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 2 Knee osteoarthritis, Outcome… </p></div>
</div>
</div>
<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 2.1. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 2 Knee osteoarthritis, Outcome 1 Pain intensity. </p></div>
</div>
<figcaption id="figure-caption-12" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
2.1. Analysis
</strong>
<div class="figure-caption-contents">Comparison 2 Knee osteoarthritis, Outcome 1 Pain intensity.</div>
</figcaption>
</figure>
<figure class="figure-item tail"
itemscope itemtype="http://schema.org/ImageObject"
itemprop="associatedMedia"
data-slide-index="13"
data-label-slug="22">
<a class="figure-link"
href="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/b630d55d86e0/nCD013273-CMP-002-02.jpg"
itemprop="contentUrl"
aria-describedby="figure-caption-13"
role="button"
data-image-width="566"
data-image-height="233"
data-image-alt="2.2"
data-pmc-id="PMC6388567"
data-figure-id="CD013273-fig-0014">
<img class="figure-thumb" itemprop="thumbnail"
id="article-image-13"
src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/07411cccd66f/nCD013273-CMP-002-02.gif"
alt="2.2" />
</a>
<meta itemprop="width" itemtype="http://schema.org/ImageObject" content="566">
<meta itemprop="height" itemtype="http://schema.org/ImageObject" content="233">
<div class="figure-caption figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="caption" aria-hidden="true">
<div class="caption-wrap">
<strong class="figure-label">
<p> 2.2. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 2 Knee osteoarthritis, Outcome… </p></div>
</div>
</div>
<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 2.2. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 2 Knee osteoarthritis, Outcome 2 Physical function (Western Ontario and McMaster Universities… </p></div>
</div>
<figcaption id="figure-caption-13" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
2.2. Analysis
</strong>
<div class="figure-caption-contents">Comparison 2 Knee osteoarthritis, Outcome 2 Physical function (Western Ontario and McMaster Universities Osteoarthritis Index).</div>
</figcaption>
</figure>
<figure class="figure-item tail"
itemscope itemtype="http://schema.org/ImageObject"
itemprop="associatedMedia"
data-slide-index="14"
data-label-slug="23">
<a class="figure-link"
href="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/04aedf238b22/nCD013273-CMP-002-03.jpg"
itemprop="contentUrl"
aria-describedby="figure-caption-14"
role="button"
data-image-width="566"
data-image-height="197"
data-image-alt="2.3"
data-pmc-id="PMC6388567"
data-figure-id="CD013273-fig-0015">
<img class="figure-thumb" itemprop="thumbnail"
id="article-image-14"
src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/ac050616ace4/nCD013273-CMP-002-03.gif"
alt="2.3" />
</a>
<meta itemprop="width" itemtype="http://schema.org/ImageObject" content="566">
<meta itemprop="height" itemtype="http://schema.org/ImageObject" content="197">
<div class="figure-caption figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="caption" aria-hidden="true">
<div class="caption-wrap">
<strong class="figure-label">
<p> 2.3. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 2 Knee osteoarthritis, Outcome… </p></div>
</div>
</div>
<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 2.3. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 2 Knee osteoarthritis, Outcome 3 Walking disability. </p></div>
</div>
<figcaption id="figure-caption-14" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
2.3. Analysis
</strong>
<div class="figure-caption-contents">Comparison 2 Knee osteoarthritis, Outcome 3 Walking disability.</div>
</figcaption>
</figure>
<figure class="figure-item tail"
itemscope itemtype="http://schema.org/ImageObject"
itemprop="associatedMedia"
data-slide-index="15"
data-label-slug="31">
<a class="figure-link"
href="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/0a0ac5b228de/nCD013273-CMP-003-01.jpg"
itemprop="contentUrl"
aria-describedby="figure-caption-15"
role="button"
data-image-width="566"
data-image-height="233"
data-image-alt="3.1"
data-pmc-id="PMC6388567"
data-figure-id="CD013273-fig-0016">
<img class="figure-thumb" itemprop="thumbnail"
id="article-image-15"
src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/c962fa58b3df/nCD013273-CMP-003-01.gif"
alt="3.1" />
</a>
<meta itemprop="width" itemtype="http://schema.org/ImageObject" content="566">
<meta itemprop="height" itemtype="http://schema.org/ImageObject" content="233">
<div class="figure-caption figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="caption" aria-hidden="true">
<div class="caption-wrap">
<strong class="figure-label">
<p> 3.1. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 3 Subgroup analysis: paracetamol… </p></div>
</div>
</div>
<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 3.1. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 3 Subgroup analysis: paracetamol 3.0 g/day or less versus 3.9 g/day or… </p></div>
</div>
<figcaption id="figure-caption-15" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
3.1. Analysis
</strong>
<div class="figure-caption-contents">Comparison 3 Subgroup analysis: paracetamol 3.0 g/day or less versus 3.9 g/day or more, Outcome 1 Pain intensity: immediate term.</div>
</figcaption>
</figure>
<figure class="figure-item tail"
itemscope itemtype="http://schema.org/ImageObject"
itemprop="associatedMedia"
data-slide-index="16"
data-label-slug="32">
<a class="figure-link"
href="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/df017f43e31f/nCD013273-CMP-003-02.jpg"
itemprop="contentUrl"
aria-describedby="figure-caption-16"
role="button"
data-image-width="566"
data-image-height="290"
data-image-alt="3.2"
data-pmc-id="PMC6388567"
data-figure-id="CD013273-fig-0017">
<img class="figure-thumb" itemprop="thumbnail"
id="article-image-16"
src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/301238523086/nCD013273-CMP-003-02.gif"
alt="3.2" />
</a>
<meta itemprop="width" itemtype="http://schema.org/ImageObject" content="566">
<meta itemprop="height" itemtype="http://schema.org/ImageObject" content="290">
<div class="figure-caption figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="caption" aria-hidden="true">
<div class="caption-wrap">
<strong class="figure-label">
<p> 3.2. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 3 Subgroup analysis: paracetamol… </p></div>
</div>
</div>
<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 3.2. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 3 Subgroup analysis: paracetamol 3.0 g/day or less versus 3.9 g/day or… </p></div>
</div>
<figcaption id="figure-caption-16" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
3.2. Analysis
</strong>
<div class="figure-caption-contents">Comparison 3 Subgroup analysis: paracetamol 3.0 g/day or less versus 3.9 g/day or more, Outcome 2 Pain intensity: short term.</div>
</figcaption>
</figure>
<figure class="figure-item tail"
itemscope itemtype="http://schema.org/ImageObject"
itemprop="associatedMedia"
data-slide-index="17"
data-label-slug="33">
<a class="figure-link"
href="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/4d422ffbeeeb/nCD013273-CMP-003-03.jpg"
itemprop="contentUrl"
aria-describedby="figure-caption-17"
role="button"
data-image-width="566"
data-image-height="169"
data-image-alt="3.3"
data-pmc-id="PMC6388567"
data-figure-id="CD013273-fig-0018">
<img class="figure-thumb" itemprop="thumbnail"
id="article-image-17"
src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/4911e742b5d1/nCD013273-CMP-003-03.gif"
alt="3.3" />
</a>
<meta itemprop="width" itemtype="http://schema.org/ImageObject" content="566">
<meta itemprop="height" itemtype="http://schema.org/ImageObject" content="169">
<div class="figure-caption figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="caption" aria-hidden="true">
<div class="caption-wrap">
<strong class="figure-label">
<p> 3.3. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 3 Subgroup analysis: paracetamol… </p></div>
</div>
</div>
<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 3.3. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 3 Subgroup analysis: paracetamol 3.0 g/day or less versus 3.9 g/day or… </p></div>
</div>
<figcaption id="figure-caption-17" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
3.3. Analysis
</strong>
<div class="figure-caption-contents">Comparison 3 Subgroup analysis: paracetamol 3.0 g/day or less versus 3.9 g/day or more, Outcome 3 Physical function: immediate term.</div>
</figcaption>
</figure>
<figure class="figure-item tail"
itemscope itemtype="http://schema.org/ImageObject"
itemprop="associatedMedia"
data-slide-index="18"
data-label-slug="34">
<a class="figure-link"
href="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/e81c315a2bb6/nCD013273-CMP-003-04.jpg"
itemprop="contentUrl"
aria-describedby="figure-caption-18"
role="button"
data-image-width="566"
data-image-height="290"
data-image-alt="3.4"
data-pmc-id="PMC6388567"
data-figure-id="CD013273-fig-0019">
<img class="figure-thumb" itemprop="thumbnail"
id="article-image-18"
src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfe9/6388567/4395743afd8a/nCD013273-CMP-003-04.gif"
alt="3.4" />
</a>
<meta itemprop="width" itemtype="http://schema.org/ImageObject" content="566">
<meta itemprop="height" itemtype="http://schema.org/ImageObject" content="290">
<div class="figure-caption figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="caption" aria-hidden="true">
<div class="caption-wrap">
<strong class="figure-label">
<p> 3.4. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 3 Subgroup analysis: paracetamol… </p></div>
</div>
</div>
<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> 3.4. Analysis </p>
</strong>
<div class="figure-caption-contents"><p> Comparison 3 Subgroup analysis: paracetamol 3.0 g/day or less versus 3.9 g/day or… </p></div>
</div>
<figcaption id="figure-caption-18" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
3.4. Analysis
</strong>
<div class="figure-caption-contents">Comparison 3 Subgroup analysis: paracetamol 3.0 g/day or less versus 3.9 g/day or more, Outcome 4 Physical function: short term.</div>
</figcaption>
</figure>
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Paracetamol as first line for treatment of knee and hip osteoarthritis.
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<span class="docsum-authors full-authors">Onakpoya IJ.</span>
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<span class="docsum-journal-citation full-journal-citation">BMJ Evid Based Med. 2020 Feb;25(1):40. doi: 10.1136/bmjebm-2019-111213. Epub 2019 Jun 15.</span>
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References
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<h4 class="refs-list-title">References to studies included in this review</h4>
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<h5 class="refs-list-title">Altman 2007 {published data only}</h5>
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Altman RD, Zinsenheim JR, Temple AR, Schweinle JE. Threemonth efficacy and safety of acetaminophen extendedrelease for osteoarthritis pain of the hip or knee: a randomized, doubleblind, placebocontrolled study. Osteoarthritis and Cartilage 2007;15:45461.
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<h5 class="refs-list-title">Amadio 1983 {published data only}</h5>
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<li>
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<li
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Amadio P, Doyle M. Evaluation of acetaminophen in the management of osteoarthritis of the knee. Current Therapeutic Research Clinical and Experimental 1983;34(1):5966.
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</ol>
</li>
</ol>
</div>
<div class="refs-list">
<h5 class="refs-list-title">Case 2003 {published data only}</h5>
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<li>
<ol class="references-and-notes-list">
<li
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Case JP, Baliunas AJ, Block JA. Lack of efficacy of acetaminophen in treating symptomatic knee osteoarthritis: a randomized, doubleblind, placebocontrolled comparison trial with diclofenac sodium. Archives of Internal Medicine 2003;163(2):16978.
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<h5 class="refs-list-title">Golden 2004 {published data only}</h5>
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<li>
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<li
class="skip-numbering"
value="1">
Golden HE, Moskowitz RW, Minic M. Analgesic efficacy and safety of nonprescription doses of naproxen sodium compared with acetaminophen in the treatment of osteoarthritis of the knee. American Journal of Therapeutics 2004;11:8594.
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<div class="refs-list">
<h5 class="refs-list-title">HerreroBeaumont 2007 {published data only}</h5>
<ol id="top-references-list-6" class="references-list">
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HerreroBeaumont G, Ivorra JA, Carmen Trabado M, Blanco FJ, Benito P, MartínMola E, et al. Glucosamine sulfate in the treatment of knee osteoarthritis symptoms: a randomized, doubleblind, placebocontrolled study using acetaminophen as a side comparator. Arthritis and Rheumatism 2007;56(2):55567.
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<h5 class="refs-list-title">MiceliRichard 2004 {published data only}</h5>
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MiceliRichard C, Bars M, Schmidely N, Dougados M. Paracetamol in osteoarthritis of the knee. Annals of the Rheumatic Diseases 2004;63(8):92330.
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<h5 class="refs-list-title">Pincus 2004a {published data only}</h5>
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<li
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Pincus T, Koch G, Lei H, Mangal B, Mangal B, Sokka T, Moskowitz R, et al. 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. Annals of the Rheumatic Diseases 2004;63(8):9319.
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<h5 class="refs-list-title">Pincus 2004b {published data only}</h5>
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<li
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Pincus T, Koch G, Lei H, Mangal B, Mangal B, Sokka T, Moskowitz R, et al. 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. Annals of the Rheumatic Diseases 2004;63(8):9319.
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<h5 class="refs-list-title">Prior 2014 {published data only}</h5>
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<li>
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<li
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value="1">
Prior MJ, Harrison DD, Frustaci ME. A randomized, doubleblind, placebocontrolled 12 week trial of acetaminophen extended release for the treatment of signs and symptoms of osteoarthritis. Current Medical Research &amp; Opinion 2014;30(11):237787.
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<a
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<h5 class="refs-list-title">Zoppi 1995 {published data only}</h5>
<ol id="top-references-list-11" class="references-list">
<li>
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<li
class="skip-numbering"
value="1">
Zoppi M, Peretti G, Boccard E. Placebocontrolled study of the analgesic efficacy of an effervescent formulation of 500 mg paracetamol in arthritis of the knee or the hip. European Journal of Pain 1995;16:12.
</li>
</ol>
</li>
</ol>
</div>
</div>
<div class="refs-list">
<h4 class="refs-list-title">References to studies excluded from this review</h4>
<div class="refs-list">
<h5 class="refs-list-title">Ha 2016 {published data only}</h5>
<ol id="top-references-list-13" class="references-list">
<li>
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<li
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value="1">
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Lao L, Hochberg M, Lee DY, Gilpin AM, Fong HH, Langenberg P, et al. HuoLuoXiaoLing (HLXL)Dan, a Traditional Chinese Medicine, for patients with osteoarthritis of the knee: a multisite, randomized, doubleblind, placebocontrolled phase II clinical trial. Osteoarthritis and Cartilage 2015;23(12):21028.
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<h5 class="refs-list-title">Papou 2015 {published data only}</h5>
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Papou A, Hussain S, McWilliams D, Zhang W, Doherty M. Sensitivity to change of SF36 health survey and patient generated index in people with chronic knee pain commenced on oral analgesia: analysis of data from a clinical trial. Annals of the Rheumatic Diseases 2015;74:363.
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<h5 class="refs-list-title">Park 2015 {published data only}</h5>
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Park YB, Ha CW, Cho SD, Lee MC, Lee JH, Seo SS, et al. A randomized study to compare the efficacy and safety of extendedrelease and immediaterelease tramadol HCl/acetaminophen in patients with acute pain following total knee replacement. Current Medical Research and Opinion 2015;31(1):7584.
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<h5 class="refs-list-title">Skou 2015 {published data only}</h5>
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Skou ST, Rasmussen S, Laursen MB, Rathleff MS, ArendtNielsen L, Simonsen O, et al. The efficacy of 12 weeks nonsurgical treatment for patients not eligible for total knee replacement: a randomized controlled trial with 1year followup. Osteoarthritis and Cartilage 2015;23(9):146575.
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<h5 class="refs-list-title">van Tunen 2016 {published data only}</h5>
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Tunen JA, Leeden M, Bos WH, Cheung J, Esch M, Gerritsen M, et al. Optimization of analgesics for greater exercise therapy participation among patients with knee osteoarthritis and severe pain: a feasibility study. Arthritis Care and Research 2016;68(3):33240.
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<h5 class="refs-list-title">Verkleij 2015 {published data only}</h5>
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Verkleij SP, Luijsterburg PA, Willemsen SP, Koes BW, Bohnen AM, BiermaZeinstra SM. Effectiveness of diclofenac versus paracetamol in knee osteoarthritis: a randomised controlled trial in primary care. British Journal of General Practice 2015;65(637):5307.
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<h5 class="refs-list-title">Zheng 2015 {published data only}</h5>
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Zheng Y, Kostenbader K, Barrett T, Hisaw E, Giuliani MJ, Chen Y, Young JL. Tolerability of biphasicrelease hydrocodone bitartrate/acetaminophen tablets (MNK155): a phase III, multicenter, openlabel study in patients with osteoarthritis or chronic low back pain. Clinical Therapeutics 2015;1(37):123547.
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<h4 class="refs-list-title">References to ongoing studies</h4>
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<h5 class="refs-list-title">ACTRN12613000840785 {published data only}</h5>
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A randomized, blinded, comparatorcontrolled trial investigating a 28day course of Lyrica in participants with knee osteoarthritis who exhibit neuropathic pain, compared with a 28day course of acetaminophen. Ongoing study 17 June 2013.
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<h5 class="refs-list-title">NCT01105936 {published data only}</h5>
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A randomised, doubleblind, evaluation of the effects of paracetamol on the BOLD fMRI response to painful stimuli in subjects with osteoarthritis. Ongoing study 1 September 2010.
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<h5 class="refs-list-title">NCT01420666 {published data only}</h5>
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<h5 class="refs-list-title">NCT02311881 {published data only}</h5>
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An efficacy and safety study of sustainedrelease paracetamol in subjects with osteoarthritis. Ongoing study 9 December 2014.
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<h5 class="refs-list-title">NCT02845271 {published data only}</h5>
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Altman R, Brandt K, Hochberg M, Moskowitz R, Bellamy N, Bloch DA, et al. Design and conduct of clinical trials in patients with osteoarthritis: recommendations from a task force of the Osteoarthritis Research Society. Results from a workshop. Osteoarthritis Cartilage 1996;4(4):21743.
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Zhang W, Doherty M, Arden N, Bannwarth B, Bijlsma J, Gunther KP, et al. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Annals of the Rheumatic Diseases 2005;64:66981.
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<h5 class="refs-list-title">Zhang 2007</h5>
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Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis and Cartilage 2007;15(19):9811000.
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Zhang WG, Nuki RW, Moskowitz S, Abramson RD, Altman NK, Arden S, et al. OARSI recommendations for the management of hip and knee osteoarthritis: part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis and Cartilage 2010;18(4):47699.
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