Osteoarthritis affects 65% of the French population over the age of 65. Osteoarthritis is a painful condition and results in reduced physical function and quality of life, and increased risk of all cause mortalityThis study evaluates the efficacy of oral codeine, with or without paracetamol and/or NSAIDs, in the treatment of arthritic pain.Included studies assessed codeine efficacy for arthritic pain in adults at all stages, excluding spinal pain. Risk of bias was analyzed using the RoB2 method. The primary outcome was pain reduction. Meta-analyses were conducted with Revman 5.4.1, and evidence levels were assessed using REB and GRADE methods.Six RCTs, with one showing low risk of bias, were included, enrolling 621 patients. The meta-analysis showed evidence of a beneficial effect of codein on arthrosis (SMD = -0.64 [-1.11; -0.17]) over 32 hours to 4 weeks. However, REB and GRADE methods concluded "lack of evidence" and "very low evidence," respectively. Secondary analyses showed limited efficacy for codeine combined with paracetamol or ibuprofen. Codeine’s efficacy over 32 hours was classified as a signal requiring confirmationThere is no strong evidence to support codeine’s use for peripheral osteoarthritis pain beyond 32 hours of treatment. Secondary analyses didn't find efficacy for combinations with paracetamol or ibuprofen. Adverse effects further weaken the benefit-risk ratio. This review underscores the need for robust RCTs to evaluate codeine’s role in osteoarthritis management This is the first systematic evaluation of the efficacy of codeine in the treatment of osteoarthritis. More high-quality studies with minimal bias are needed to strengthen and refine current evidence.Prescribing codeine is not recommended for osteoarthritis according to current scientific knowledge.