A slightly swollen and aching knee. Walking is difficult, the stairs are almost impossible, and so begins the downward spiral of inactivity, immobility, and weight gain. Osteoarthritis of the knee is a familiar picture, presenting usually when it is too painful to ignore but too early for surgery. Patients have often already made the diagnosis themselves and seek a solution. They want pain relief so they can walk, kneel, climb a ladder, shop, or simply get around in comfort. Most patients have tried paracetamol, hot water bottles, someone else's great new tablets, a cabbage leaf, various herbal or homoeopathic medications, prayer, copper bracelets, and many other remedies before asking for help. Most general practitioners would reach for the keyboard tapping out their favourite non-steroidal anti-inflammatory (NSAID).

NSAIDs do not seem to offer a long term solution. In a comprehensive systematic review and meta-analysis of randomised placebo controlled trials in this issue of the journal, we learn that NSAIDs can reduce short term pain only …