New guidelines for topical NSAIDs in the osteoarthritis treatment paradigm

Abstract

Background:

Osteoarthritis (OA), the most common form of arthritis, often affects hands, hips, and knees and involves an estimated 26.9 million US adults. Women have a higher prevalence of OA, and the risk of developing OA increases with age, obesity, and joint malalignment. OA typically presents with pain and reduced function. Therapeutic programs are often multimodal and must take into account pharmaceutical toxicities and patient comorbidities. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with cardiovascular, gastrointestinal, and renal adverse events. Topical NSAIDs offer efficacy with reduced systemic drug exposure.

Research design and methods

This is a review of current guideline recommendations regarding the use of topical NSAIDs in OA of the hand and knee. Articles were identified by PubMed search (January 1, 2000 to May 21, 2010).

Results:

Several current guidelines for management of OA recommend topical NSAIDs, indicating them as a safe and effective treatment. One guideline recommends that topical NSAIDs be considered as first-line pharmacologic therapy. A US guideline for knee OA recommends topical NSAIDs in older patients and in patients with increased gastrointestinal risk.

Conclusions:

The consensus across US and European OA guidelines is that topical NSAIDs are a safe and effective treatment for OA. Because the research base on topical NSAIDs for OA is small, guidelines will continue to evolve.

Key words::

• Guidelines
• Hand osteoarthritis
• Knee osteoarthritis
• Nonsteroidal anti-inflammatory drugs
• Topical administration

Transparency

Declaration of funding

Endo Pharmaceuticals Inc., Chadds Ford, PA, USA funded editorial support for the development of this manuscript but made no contribution to its content.

Declaration of financial/other relationships

R.D.A. has disclosed that he has received research grants from Novartis and Ferring; consulting fees from Endo, Novartis, Ferring and Rottapharma; and has participated in speakers’ bureaus for Ferring.

Acknowledgments

Editorial support (literature search, document retrieval, medical writing, and copyediting) for the development of this manuscript was provided by Nicole Strangman, PhD, and Robert Gatley, MD, of Complete Healthcare Communications, Inc., Chadds Ford, PA, USA with funding from Endo.