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Use of paracetamol in rheumatic disease
Study
Results
Comment

Bandolier has long been encouraged by readers to find evidence that paracetamol is the best thing since sliced bread for arthritic and rheumatic conditions, or that it does not work in these same conditions. There are some strong views, but very little hard evidence from randomised trials that helps. What do patients think? A survey of patients with rheumatoid arthritis, osteoarthritis and fibromyalgia may help [1].

Study


As part of a long term prospective study going on since 1974, 2,085 participants were mailed a six-monthly questionnaire. All had clinically defined rheumatoid arthritis, osteoarthritis or fibromyalgia. In July 1998 four additional questions were asked about the use of paracetamol. These addressed use of paracetamol, effectiveness of paracetamol, effectiveness compared with NSAIDs and satisfaction compared with NSAIDs considering both effectiveness and adverse effects.

Results


The questionnaire was returned by 1,799 patients (86%), of whom 1,187 had taken paracetamol. There were 825 responders with rheumatoid arthritis, 668 with osteoarthritis and 286 with fibromyalgia.

Of those who had taken paracetamol, 37% had found it moderately or very effective and 63% found slight or no effective (Figure 1). Responses on questions of efficacy and satisfaction compared with NSAIDs were similar. About 60% found paracetamol less effective or satisfactory than NSAIDs, 25% found it about the same, and 13% found it more effective or satisfactory (Figures 2 and 3).

Figure 1: How 1,187 patients rated the effectiveness of paracetamol



Figure 2: How patients rated effectiveness of paracetamol compared with NSAIDs


Figure 3: How patients rated effectiveness and adverse effects of paracetamol compared with NSAIDs

Comment


There were minor differences between responders and non-responders in the survey, and minor differences between disease states and with age, but none of any obvious importance. Obviously this is much less satisfactory than a properly conducted, large, long term randomised trial. But in the absence of those, what this does is to confirm our prejudices.

It demonstrates that for a significant minority of patients paracetamol can be effective, and given the cost and safety issues, it is reasonable as a first choice, or as an addition to NSAIDs. It also shows that for many patients it simply isn't good enough, and that patients may not be best served by persevering with an ineffective medicine.

Reference:

  1. F Wolfe, S Zhao, N Lane. Preference for nonsteroidal antiinflammatory drugs over acetaminophen by rheumatic disease patients. Arthritis & Rheumatism 2000 43: 378-385.
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