Intervention Review

Paracetamol versus nonsteroidal anti-inflammatory drugs for rheumatoid arthritis

  1. Troels Wienecke1,*,
  2. Peter C Gøtzsche2

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 26 JAN 2004

Assessed as up-to-date: 31 JUL 2007

DOI: 10.1002/14651858.CD003789.pub2

How to Cite

Wienecke T, Gøtzsche PC. Paracetamol versus nonsteroidal anti-inflammatory drugs for rheumatoid arthritis. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD003789. DOI: 10.1002/14651858.CD003789.pub2.

Author Information

  1. 1

    Køge, Denmark

  2. 2

    Rigshospitalet, Dept. 3343, The Nordic Cochrane Centre, Copenhagen Ø, Denmark

*Troels Wienecke, Ørbækvænge 7, Køge, 4600, Denmark. trowie01@glostruphosp.kbhamt.dk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 26 JAN 2004

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually preferred for simple analgesics such as paracetamol for rheumatoid arthritis. It is not clear, however, whether the trade-offs between benefits and harms of NSAIDs are preferable to those of paracetamol (paracetamol is also called acetaminophen).

Objectives

To compare the benefits and harms of paracetamol with NSAIDs in patients with rheumatoid arthritis.

Search methods

PubMed and EMBASE databases were searched up until August 2007. Reference lists of identified articles were also searched.

Selection criteria

Randomised double-blind studies comparing paracetamol with an NSAID.

Data collection and analysis

Decisions on inclusion of trials and data extraction were performed by the two authors independently.

Main results

Four cross-over studies, published between 1968 and 1982, involving 121 patients, and four different NSAIDs were included. The generation of the allocation sequence and the use of methods to conceal the allocation were not described in any of the studies. The studies were double-blind but it was not clear whether the blinding was effective. Methods for collecting adverse effects were not described. The NSAIDs were preferred more often than paracetamol by the patients or the investigator. In the largest trial, 20 out of 54 patients (37%) preferred ibuprofen and 7 out of 54 (13%) paracetamol. Investigators preference (as established by joint tenderness, grip strength and joint circumference) was 17 out of 35 for diclofenac versus 5 out of 35 for paracetamol in another trial. However, because of the weaknesses in the trials, no firm conclusion can be drawn.

Authors' conclusions

When considering the trade off between the benefits and harms of non-steroidal anti-inflammatory drugs and paracetamol/acetaminophen, it is not known whether one is better than the other for rheumatoid arthritis. But people with rheumatoid arthritis and the researchers in the study did prefer non-steroidal anti-inflammatory drugs more than acetaminophen/paracetamol. There is a need for a large trial, with appropriate randomisation, double-blinding, test of the success of the blinding, and with explicit methods to measure and analyse pain and adverse effects.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Paracetamol versus nonsteroidal anti-inflammatory drugs for rheumatoid arthritis

In rheumatoid arthritis (RA), the joints are swollen, stiff and painful. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are often recommended to ease the pain and swelling in the joints. Paracetamol (also known as acetaminophen) is another type of medication to relieve pain in RA.

This Cochrane review found only four old and small trials of poor quality that have compared the two types of drugs. There were a total of 121 patients in the four trials. In each trial, the patients tried both types of drugs, one after the other, in different periods of the trial.

In the largest trial, of 54 patients, where each drug was tested twice, 20 patients preferred ibuprofen on both occasions, and 7 paracetamol.

In the trials, each drug was used for only 4-7 days and side effects from the drugs were poorly reported. It is therefore not clear whether NSAIDs are better than paracetamol.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

Paracetamol與非類固醇消炎止痛藥用於治療類風濕性關節炎之比較

非類固醇消炎止痛藥比單純使用止痛藥如paracetamol較常用於治療類風濕性關節炎,但相較於paracetamol其優點與缺點不是很清楚(paracetamol又被稱為acetaminophen)。

目標

比較非類固醇消炎止痛藥與paracetamol用於治療類風濕性關節炎之優缺點。

搜尋策略

搜尋PubMed and EMBASE包括(直到2007年8月)。同時手動搜尋所選文章之參考文獻。

選擇標準

所有隨機對照雙盲試驗比較非類固醇消炎止痛藥與paracetamol。

資料收集與分析

兩位作者獨立進行研究的納入及資料摘錄。

主要結論

4個交叉研究發表於1968到1982間,包含121例病患,其中包括4種非類固醇消炎止痛藥。如何分配及分配隱密性在研究中皆未詳述。研究是雙盲但不清楚是否有效雙盲。副作用資料收集方法並未描述。醫師與病患較喜歡非類固醇消炎止痛藥。一篇研究37% (54人中有20人)患者喜歡非類固醇消炎止痛藥ibuprofen,而13% 4人中有7人) 喜歡用paracetamol。另一篇研究,根據關節疼痛、握力及關節周長評估, 35人中17人喜歡非類固醇消炎止痛藥diclofenac,而35人中有5人喜歡用paracetamol。但因研究缺點,無法下結論。

作者結論

考量非類固醇消炎止痛藥與單純使用止痛藥如paracetamol之優缺點,對類風濕性關節炎何者為優不是很清楚。但類風濕性關節炎病患及研究者較喜歡非類固醇消炎止痛藥。需要一大型隨機雙盲對照試驗且用詳盡的方式比較分析疼痛及副作用。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

Paracetamol與非類固醇抗炎藥治療類風濕關節炎。在類風濕關節炎中,關節會腫脹,僵硬和疼痛。非類固醇抗炎藥,如ibuprofen通常被建議使用,以減輕疼痛和關節腫脹。Paracetamol(又名acetaminophen)是另一種類型的藥物,用來緩解類風濕性關節炎疼痛。這次 Cochrane 回顧發現,只有4個舊的,小的且品質差的試驗有比較兩種類型的藥物。總共在這4個試驗有 21名病人。在每一個試驗中,在不同時期,病人嘗試這兩種藥,一個接一個。在最大的試驗中,54例,其中每個藥物測試兩次,20例患者較能接受ibuprofen,7 例較接受Paracetamol。在試驗中,每個藥物只使用約 4 – 7天,藥物副作用沒有報告。因此,不清楚是否NSAIDs優於Paracetamol。