Knee osteoarthritis

Chronic degenerative knee joint disease with cartilage destruction, subchondral bone remodelling, and synovitis. Standard therapy: physical rehabilitation, weight reduction, paracetamol, NSAIDs, intra-articular corticosteroid and hyaluronic acid injections. Effectiveness of nutraceuticals (chondroprotectors, collagen) is limited.

ICD-10 M1711 drugs

Also known as: Gonarthrosis, Knee OA

Drugs used for this condition

AAceclofenacSecond line · NSAID, acetic acid derivative, COX-1/COX-2 inhibitorSymptomatic treatment of knee and hip osteoarthritis with marked pain. OARSI 2019 and EULAR 2023 set topical NSAIDs and paracetamol as first-line pharmacotherapy; oral NSAIDs including aceclofenac are second-line with shortest possible duration.
AEtoricoxibSecond line · Selective COX-2 inhibitor (coxib)Symptomatic treatment of knee and hip osteoarthritis when pain persists despite paracetamol and topical NSAIDs. OARSI 2019 and EULAR 2023 set topical NSAIDs and paracetamol as first-line pharmacotherapy for osteoarthritis; oral NSAIDs including coxibs are second-line with shortest possible duration. Dose 30–60 mg daily.
BBetamethasoneSecond line · Glucocorticoid for systemic useThe AEMPS Celestone Cronodose label describes intra-articular use in osteoarthritis: 1 ml into a large joint such as the knee, repeated as required at one to four week intervals, with pain and stiffness easing 2–4 hours after the injection. The 2019 ACR and Arthritis Foundation guideline keeps intra-articular glucocorticoid among the options for knee osteoarthritis while noting that the effect is short-lived and that movement, strength work and weight form the base of treatment. The practical reading for a patient: the injection carries you through a flare rather than replacing rehabilitation, and frequent repeats into the same joint are unwelcome. Part of the drug reaches the bloodstream after injection, so in someone with diabetes glucose can climb over the following days.
BBoswelliaAdd-on therapy · Botanical supplement, gum resin of Boswellia serrata (Indian frankincense), standardised by AKBA (acetyl-11-keto-beta-boswellic acid); popular iHerb «joint health» categoryBoswellia is an over-the-counter herbal extract. The Yu meta-analysis (BMC Complement Med Ther 2020) pooled 7 RCTs with 545 participants: in knee osteoarthritis, boswellia extracts (100–250 mg AKBA-standardised per day, 4–24 weeks) reduced VAS pain by a mean 17 mm and improved WOMAC versus placebo. The effect is comparable to weak NSAIDs in small samples. The double-blind RCT by Sengupta (Arthritis Res Ther 2008) with 5-Loxin 100 mg/day for 90 days showed a clinically meaningful pain reduction by day 7. OARSI 2019 mentions boswellia conditionally for knee osteoarthritis as an option when NSAIDs are contraindicated, not as first line. Standard care under NICE 2022 and OARSI 2019 is exercise, weight control, paracetamol or topical NSAIDs, with oral NSAIDs in short courses if needed. If boswellia is considered instead of NSAIDs because of gastritis or cardiovascular risk, discuss with a doctor – the extract is generally well tolerated but interacts with warfarin and lowers some drugs via CYP3A4.
CAdemetionineAdd-on therapy · Amino acids and derivatives. Hepatoprotective agentSoeken 2002 meta-analysis (J Fam Pract) included 11 SAMe vs NSAID and placebo RCTs in knee and hip osteoarthritis: SAMe 1200 mg/day was as effective as NSAIDs (ibuprofen, naproxen, piroxicam) on pain and function scales with better gastrointestinal tolerability. AAOS 2021 does not include SAMe among the supplements it assesses; the Cochrane review 2009 (Rutjes) called the SAMe data inconclusive because of small low-quality RCTs and called for large trials. ESCEO 2019 for knee osteoarthritis lists prescription glucosamine sulfate and chondroitin sulfate, paracetamol, topical NSAIDs, then systemic NSAIDs at the lowest effective course and intra-articular hyaluronic acid. If SAMe was recommended as a substitute for NSAIDs or for severe osteoarthritis with arthroplasty indication, consider seeking a second opinion from an orthopaedic surgeon.

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit