The author discusses relative advantage of paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) application in the symptomatic treatment of osteoarthritis. While older studies demonstrated a similar efficacy of paracetamol and NSAIDs, latest cross-over trials revealed superiority of NSAIDs, particularly in patients with initially higher level of pain. About 60% of patients prefer NSAIDs, but nearly 40% of them describe quite a similar efficacy of paracetamol. Paracetamol has been considered to be a safe drug. Two epidemiological studies showed comparable frequencies of gastrointestinal adverse events between higher doses of paracetamol and NSAIDs. Nevertheless, there is no evidence for increased risk of gastric ulcer after paracetamol use. Considering the cost/benefit ratio, the most advisable approach is to initiate analgesic treatment with paracetamol and to continue with it over long termtreatment, if satisfactory. The use of NSAIDs is recommended when paracetamol is insufficient in pain control. The concept of phasic treatment - short term use of NSAIDs during pain exacerbation and long termadministration of paracetamol afterwards is also recommended.

        Key words: osteoarthritis, paracetamol, non-steroidal anti-inflammatory drugs