Background/Purpose: Patients with rheumatic diseases, including rheumatoid arthritis (RA), describe symptoms such as pain and stiffness as important factors affecting their quality of life. The most widely used drugs to decrease inflammation and manage mild-to-moderate pain in RA patients are NSAIDs. In our previous meta-analysis, we demonstrated that ketoprofen was superior to ibuprofen and/or diclofenac in relieving different kinds of moderate-to-severe pain conditions, and so the aim of this systematic review of the literature and meta-analysis of randomised controlled trials (RCTs) was to compare the clinical efficacy of these drugs in patients with the specific pain associated with RA.

Methods: We made a systematic search of the Medline and Embase databases from their inception to March 2014 in accordance with the Cochrane Collaboration guideline in order to identify RCTs directly comparing the recommended therapeutic doses of oral ketoprofen (50-200 mg/day), ibuprofen (600-1800 mg/day) and diclofenac (75-150 mg/day) for RA pain relief. The meta-analysis was made using the standardized mean difference (SMD) of each included RCT and a fixed effects model.

Results: Five RCTs, involving a total of 456 patients met the inclusion criteria. The meta-analysis showed a statistically significant difference in clinical efficacy in favour of ketoprofen (SMD= 0.34; CI 95% 0.16-0.52; p=0.0002). The heterogeneity test for the efficacy outcome was not statistically significant and equal to zero (χ²=3.67 – df=4 – P=0.45 – I²=0%), thus demonstrating the homogeneity of the trials and the validity of the meta-analysis findings. The meta-analysis did not reveal any significant differences between drugs in terms of tolerability (the percentage of patients developing adverse events) or safety (withdrawn patients).

Conclusion: The result of this meta-analysis shows that therapeutic doses of ketoprofen are more efficacious than ibuprofen and diclofenac in managing RA-related pain, thus supporting its use in clinical practice.