Does paracetamol still have a future in osteoarthritis?

Bruno da Costa and colleagues

present an excellent network meta-analysis of several non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen) for the treatment of osteoarthritis symptoms. On the basis of the clinical trials analysed, they report that the assessed NSAIDs are more or less effective to relieve pain in osteoarthritis, with a degree of dose dependence. This study looked at the so-called coxibs as well as diclofenac, naproxen, ibuprofen, and paracetamol, which were mainly used as comparators. Other widely used NSAIDs were not included in this meta-analysis, probably because no recent trials have been done of these drugs or because any recent trials that did assess them were too small. These omissions are unfortunate because these drugs might be as effective but much cheaper than the newest drugs.