(HealthDay News) — Using data from 137 studies, researchers have concluded that all of the widely used arthritis treatments provide more relief from knee pain over three months than do placebo pills. The findings are published in the January 6 issue of the Annals of Internal Medicine.

Raveendhara Bannuru, MD, of Tufts Medical Center in Boston, and colleagues used a statistical method that allowed comparison of results from previous clinical trials that tested either oral medications or injections. In general, all therapies were better than placebo pills at easing pain at the three-month mark. But they were not all equal. Overall, the biggest benefit came from injections of hyaluronic acid (HA). Over the years, studies have been mixed as to whether injections of synthetic HA help arthritic joints, and the treatment remains up for debate. Bannuru cautioned that his team found a large placebo effect across the HA studies, which suggests there is something about the “delivery method” – injections into the knee joint, whatever the substance – that helps ease some people’s pain.

While injections of HA were found most effective, this was followed closely by cortisone. Nonsteroidal anti-inflammatory drugs (NSAIDs) came in next, with acetaminophen rounding out the bottom of the list – which is not surprising, though it is important, Bannuru told HealthDay. He noted that acetaminophen is often the first painkiller of choice for arthritis, because NSAIDs are linked to increased risks of heart attack and stroke in older adults who take them long-term.

And because acetaminophen is less risky, it is still a “very reasonable” place to start, Lisa Mandl, MD, a rheumatologist at the Hospital for Special Surgery in New York City, told HealthDay. “However, I would suggest using a high dose for a short trial period. And if it’s not effective quickly, move on to another option,” said Mandl, who cowrote an editorial published with the study. And based on these findings, she said, injections – whether HA or cortisone – could well be worth a try. That’s partly because they often work, but also because they can avoid the systemic side effects of oral painkillers.

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