NYT- shots beat pills for knee OA

[nvrsumr]

Shots Beat Pills for Knee Arthritis Relief
By NICHOLAS BAKALAR JANUARY 5, 2015 5:00 PM January 5, 2015 5:00 pm 16 Comments

• in Annals of Internal Medicine, reviewed 137 randomized trials involving more than 33,000 patients. Treatments included acetaminophen (Tylenol), diclofenac, ibuprofen, naproxen, celecoxib (Celebrex), corticosteroid and hyaluronic acid injections, and oral and injected placebos.
  
  With the exception of Tylenol and Celebrex, the nonsteroidal anti-inflammatory drugs, over all, provided clinically significant relief after three months when compared with a placebo. But the injections, and at least sometimes even the placebo injections, were more effective than any of the pills.
  
  The lead author, Dr. Raveendhara R. Bannuru, a researcher at Tufts Medical Center in Boston, said that although some treatments appear generally better than others, there is no single treatment that is best for everyone.
  
  “The key message is that hyaluronic acid and steroid injections are more effective than drugs,” he said.
  
  “But all the harms and benefits need to be taken into account,” he added. “I would advise people to talk to their physicians about the pros and cons, and choose the treatment appropriate for them.”

Wait we actually do something that works?

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[epidural man]

More effective and probably cheaper.

The two people I have injected Amniofix into the knee are doing phenomenally well. One had horrible arthritis and a lot of pain - with a significant limp. She walks normal now and reports feelling so much better. That was 6 months ago - much longer than steroid.

I know, I know...AmnioFix is horrible because the data is sparse....yeah yeah yeah. .....whatever.

 

[hyperalgesia]

After reading the Annals study, the takeaway is not encouraging, and the article gave me a headache. The conclusion of the authors is basically that IA injections, both steroid and hyaluronic acid, are minimally or not effective relative to IA placebo. The main point of the study is that there is an enormous IA placebo effect relative to oral placebo effect.

Edit: After reading this more carefully, the supplement that's free on the annals website has some good data. Both IA steroid and IA hyalgan are quite a bit more effective than placebo. I have regained some faith.

 

[SSdoc33]

More effective and probably cheaper.

The two people I have injected Amniofix into the knee are doing phenomenally well. One had horrible arthritis and a lot of pain - with a significant limp. She walks normal now and reports feelling so much better. That was 6 months ago - much longer than steroid.

I know, I know...AmnioFix is horrible because the data is sparse....yeah yeah yeah. .....whatever.

epirdural man, i think you should know that Amniofix is horrible and the data is sparse

 

[drusso]

After reading the Annals study, the takeaway is not encouraging, and the article gave me a headache. The conclusion of the authors is basically that IA injections, both steroid and hyaluronic acid, are minimally or not effective relative to IA placebo. The main point of the study is that there is an enormous IA placebo effect relative to oral placebo effect.

It's a difficult article especially given the fact that this "network meta-analysis" is not widely used. There are plenty of limitations of standard meta-analysis let alone "network" meta-analysis.

Still, this article raises an important practical and policy issue: If "integrated placebo" effect of an IA injection is more therapeutic than NSAIDS, potentially safer (no GI bleeds, nephropathy, etc), BUT **MORE** expensive then how should payors, policymakers, and physicians weight this knowledge into the risk/benefit ratios for patients?

 

[jsaul]

More effective and probably cheaper.

The two people I have injected Amniofix into the knee are doing phenomenally well. One had horrible arthritis and a lot of pain - with a significant limp. She walks normal now and reports feelling so much better. That was 6 months ago - much longer than steroid.

I know, I know...AmnioFix is horrible because the data is sparse....yeah yeah yeah. .....whatever.

insurances pay for amniofx?

 

[epidural man]

insurances pay for amniofx?

I doubt it.

 

[Ducttape]

thanks for your edit, hyperalgesia, i was going to respond to your initial comment. Drrusso, it seems obvious to me - and you - that policymakers should actually encourage injections over NSAID because of the risk/benefit ratio. but money is involved...