Topical non-steroidal anti-inflammatory drugs for pain in osteoarthritis of the knee – an evidence based review

Abstract

Aim: Osteoarthritis (OA) is a common form of degenerative joint disease with increasing prevalence. The knee is the most frequently affected joint and pain is an incapacitating symptom. The first line of treatment includes oral analgesics like acetaminophen and oral non-steroidal anti-inflammatory drugs (NSAID). However, the latter are associated with potentially severe side effects, making topical NSAID a possible, safer alternative. The aim of this review is to examine the evidence for the efficacy and safety of topical NSAID in the management of OA of the knee. Data sources: The National Guideline Clearinghouse, TRIP, The Cochrane Library, DARE, Bandolier, MEDLINE and other sites of international scientific associations were searched. Review methods: Databases were searched for guidelines and publications appearing between January and December 2012, in Portuguese, English or Spanish, using the search terms (“Administration, Topical” OR “Administration, Cutaneous”) AND (“Anti-Inflammatory Agents, Non-Steroidal”) AND “Osteoarthritis”. To evaluate the level of evidence and the strength of recommendations, the Strength of Recommendation Taxonomy (SORT) of the American Academy of Family Physicians was used. Results: We found 96 articles, of which 8 fulfilled the inclusion criteria. There were 4 guidelines and 4 meta-analyses selected for inclusion in this review. These studies show the short-term benefits for pain relief in OA of the knee with the use of topical NSAID. They demonstrate its tolerability and safety profile with few adverse effects. Conclusions: The available evidence from Randomized Controlled Trials of up to 12 weeks duration supports the efficacy of topical NSAID for pain control in OA of the knee (SORT B). Studies differed in the drugs investigated, as well as in the duration of treatment. This heterogeneity limits the conclusions that can be drawn and the generalizability of results. Studies with a longer period of follow-up are required.