In April 2019 researchers from the UK, Belgium, Italy and Switzerland published their review on the benefits and harm of using paracetamol for osteoarthritic pain. Paracetamol is generally recommended for pain relief at an early stage in the management of osteoarthritis, and, although frequently prescribed, there is evidence which suggests its effectiveness in relieving osteoarthritic pain is low. There have also been concerns over the safety of paracetamol as many individuals have experienced gastrointestinal, cardiovascular, liver and kidney problems following its use. Information on the long term safety of paracetamol comes mainly from observational evidence which is difficult to interpret given the potential biases involved in such information. Nevertheless, paracetamol can cause a considerable degree of toxicity, especially when taken at the upper end of the suggested doses for pain relief. Paracetamol has been linked to liver function abnormalities and there is also evidence for liver failure associated with non-intentional paracetamol overdose. Safety data for paracetamol use in those aged over 65 years is, however, sparse although there is some evidence that frail elderly people may have impaired paracetamol clearance (a delay in eliminating it from the body). Given that the benefit of taking paracetamol for relief of osteoarthritic joint pain is uncertain and potential safety issues have been raised, more careful consideration concerning its use is required.
Conaghan PG et al. Safety of Paracetamol in Osteoarthritis: What Does the Literature Say? Drugs Aging. 2019 Apr;36(Suppl 1):7-14.