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Effective Pain Relief for Patients With Hand or Knee Osteoarthritis

Topical NSAIDS (Non-steroidal anti-inflammatory drugs) Provide Effective Pain Relief for Patients With Hand or Knee Osteoarthritis With Similar Efficacy, and Fewer Side Effects, Than Oral NSAIDS.

Along with lifestyle measures outlined in previous posts this is an important piece of supportive evidence.

Andrew Östör, Pippa A Watson

Evid Based Med. 2013;18(5):174-175.

Topical NSAIDs were first licensed in the USA by the Food and Drug Administration in 2007, and were recommended as a first line treatment for osteoarthritis by the National Institute of Clinical Excellence (NICE) in 2008.[1] Multiple systematic reviews have examined topical NSAID use in hand and knee osteoarthritis and have in general found their use favourable. This current review has established that topical NSAIDS are an effective treatment for hand and knee osteoarthritis after having examined high quality, larger, longer duration studies (up to 12 weeks). It appears that the formulation is important with NSAID solution (NNT 6.4) being more efficacious than NSAID gel (NNT 11), this came close to statistical significance despite the relatively small number of events. Although minor skin reactions were more frequent, there was no increase in serious adverse events including GI bleeding, a well-recognised and potentially life-threatening complication of oral NSAIDs. No evidence of benefit, however, was found for their use in other painful conditions including ‘soft tissue rheumatism’, ‘cervical and lumbar back pain’ and ‘musculoskeletal pain’. This may be due to less precise descriptions of the underlying diagnoses. Currently, topical NSAIDS can be endorsed from the evidence as effective for hand and knee osteoarthritis. This review supports the decision by NICE to recommend topical NSAIDS as the first-line therapy for osteoarthritis. They should be considered in preference to oral NSAIDs due to their equivalent efficacy and improved safety profile. Future studies are required to further evaluate the role of topical NSAIDs in the treatment of other musculoskeletal conditions, NSAIDS other than diclofenac and to determine whether their chronic use results in side effects such as GI bleeding, ischaemic heart disease and renal failure.

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