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.