PAIN+ CPN

Doctor, I have knee osteoarthritis. What are the side effects of the treatments available to me?

Lifestyle modifications (exercise and weight loss) were not associated with side effects. Oral pharmacological treatments were associated with gastrointestinal side effects, some of which could be serious. Injectable therapies were typically associated with some pain and swelling at the injection site.  Patients may wish to discuss these side effects with their doctor when choosing treatment options.

What is the evidence?


Researchers looked at patients receiving treatment for knee osteoarthritis. They looked at the side effects that were reported with these treatments after taking them for at least one year. They found that:


  • Lifestyle modifications (including exercise and/or weight loss) were not associated with side effects
  • Glucosamine and chondroitin sulphate were associated with minor gastrointestinal side effects, such as indigestion
  • Paracetamol was associated with minor hepatic (liver), renal (kidney) and gastrointestinal side effects
  • Non-steroidal anti-inflammatory agents (NSAIDS) were associated with renal and gastrointestinal side effects. Importantly, some patients on NSAIDs had gastrointestinal bleeding, a potentially serious side effect.
  • Injectable therapies, such as corticosteroids, hyaluronic acid, platelet-rich plasma, and stem cells, were mainly associated with some injection pain and swelling, as well as some cases of synovitis (inflammation of tissues around the knee joint).
  • Surgical options, including arthroscopic meniscectomy and total knee replacement, are associated with more complications than non-surgical treatments
  • Opioid treatments are commonly prescribed for knee osteoarthritis, but this review did not find any studies that followed patients up for at least 1 year. Opioids have been associated with gastrointestinal side effects, as well as the risks of addiction and misuse.


What kind of study was this?


This was a systematic review. A systematic review summarises all available studies on a health care intervention to provide high quality evidence on the effectiveness of that health care intervention.


Who participated in the study? This review included 34 studies involving people who received treatments for knee osteoarthritis.


How was the study done? The reviewers were interested in the types of side effects that are typically experienced with different treatments, and how serious those side effects were. Treatments of interest included lifestyle modifications, glucosamine, chondroitin sulphate, paracetamol, NSAIDs, injectable therapies, opioids, and surgical options.


Why was this research done?


Millions of people live with a diagnosis of knee osteoarthritis, a chronic degenerative joint disease. There is no cure for knee osteoarthritis. The median age of diagnosis is typically around 55 years, and people often live 30 years with the disease.

Since there is no cure for knee osteoarthritis, treatments are generally meant to reduce pain and improve function. Individuals who use pharmacological treatments to manage their knee osteoarthritis may take these medications for many years. It is important, therefore, for patients to know the long-term potential side effects of potential treatments for knee osteoarthritis, as part of a decision-making process about which treatment may be right for them.


This Evidence Summary is based on the following article:

Charlesworth J, Fitzpatrick J, Perera NKP, et al. Osteoarthritis- a systematic review of long-term safety implications for osteoarthritis of the knee. BMC Musculoskelet Disord. 2019 Apr 9;20(1):151. doi: 10.1186/s12891-019-2525-0. PubMed

Published: Wednesday, May 29, 2019