PMID- 21084786
OWN - NLM
STAT- MEDLINE
DCOM- 20110214
LR  - 20111018
IS  - 1941-9260 (Electronic)
IS  - 0032-5481 (Linking)
VI  - 122
IP  - 6
DP  - 2010 Nov
TI  - Topical nonsteroidal anti-inflammatory drugs for osteoarthritis.
PG  - 98-106
LID - 10.3810/pgm.2010.11.2227 [doi]
AB  - Nonsteroidal anti-inflammatory drugs (NSAIDs) are mainstays of the treatment of 
      osteoarthritis (OA) but have dose- and age-related risks of gastrointestinal, 
      cardiovascular, and renal adverse events (AEs). As a result, US and international 
      guidelines recommend caution when prescribing oral NSAIDs, particularly in older 
      patients and those with significant comorbidities. For OA of the hands and knees, 
      topical NSAIDs provide efficacy similar to oral NSAIDs, with far less systemic 
      distribution. Treatment-related cardiovascular, renal, and other serious AEs with 
      topical NSAIDs have not been reported. At present, only 2 topical NSAIDs are 
      approved in the United States for the treatment of OA: diclofenac sodium 1% gel 
      for hand or knee OA and diclofenac sodium 1.5% in 45.5% dimethylsulfoxide 
      solution for knee OA. Clinical trial data for these products have demonstrated 
      efficacy superior to placebo or similar to oral diclofenac with AE profiles 
      similar to placebo, except for application site reactions. In large double-blind 
      trials, gastrointestinal AEs were infrequent and did not include ulcers, 
      perforations, or bleeding. The purpose of this brief review is to examine the 
      data from controlled double-blind trials evaluating the use of topical NSAIDs in 
      patients with OA. Articles included were identified via a search of PubMed 
      covering the period from January 1, 2005 through March 31, 2010. Reference lists 
      from OA treatment guidelines and meta-analyses were reviewed for additional 
      citations of importance.
FAU - Barthel, H Richard
AU  - Barthel HR
AD  - hrbarthel@earthlink.net
FAU - Axford-Gatley, Robert A
AU  - Axford-Gatley RA
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - England
TA  - Postgrad Med
JT  - Postgraduate medicine
JID - 0401147
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
SB  - IM
CIN - Postgrad Med. 2011 Sep;123(5):251-2; author reply 253-4. PMID: 21904108
MH  - Administration, Oral
MH  - Administration, Topical
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Inflammatory Agents, Non-Steroidal/*administration & dosage/adverse effects
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Female
MH  - Hand Joints/*drug effects/pathology
MH  - Humans
MH  - Male
MH  - Osteoarthritis/*diagnosis/*drug therapy
MH  - Osteoarthritis, Knee/diagnosis/drug therapy
MH  - Pain Measurement/*drug effects
MH  - Prognosis
MH  - Randomized Controlled Trials as Topic
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Treatment Outcome
MH  - United States
EDAT- 2010/11/19 06:00
MHDA- 2011/02/15 06:00
CRDT- 2010/11/19 06:00
PHST- 2010/11/19 06:00 [entrez]
PHST- 2010/11/19 06:00 [pubmed]
PHST- 2011/02/15 06:00 [medline]
AID - 10.3810/pgm.2010.11.2227 [doi]
PST - ppublish
SO  - Postgrad Med. 2010 Nov;122(6):98-106. doi: 10.3810/pgm.2010.11.2227.