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Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomised controlled trials

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.38159.639028.7C (Published 05 August 2004) Cite this as: BMJ 2004;329:324
  1. Jinying Lin, visiting scholar1,
  2. Weiya Zhang (weiya.zhang{at}nottingham.ac.uk), senior lecturer in epidemiology1,
  3. Adrian Jones, consultant2,
  4. Michael Doherty, professor1
  1. 1 Academic Rheumatology, University of Nottingham, City Hospital, Nottingham NG5 1PB
  2. 2 Rheumatology Unit, City Hospital
  1. Correspondence to: W Zhang
  • Accepted 24 May 2004

Abstract

Objective To assess the efficacy of topical non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of osteoarthritis.

Data sources Medline, Embase, Scientific Citation Index, CINAHL, Cochrane Library, and abstracts from conferences.

Review methods Inclusion criterion was randomised controlled trials comparing topical NSAIDs with placebo or oral NSAIDs in osteoarthritis. Effect size was calculated for pain, function, and stiffness. Rate ratio was calculated for dichotomous data such as clinical response rate and adverse event rate. Number needed to treat to obtain the clinical response was estimated. Quality of trial was assessed, and sensitivity analyses were undertaken.

Results Topical NSAIDs were superior to placebo in relieving pain due to osteoarthritis only in the first two weeks of treatment. Effect sizes for weeks 1 and 2 were 0.41 (95% confidence interval, 0.16 to 0.66) and 0.40 (0.15 to 0.65), respectively. No benefit was observed over placebo in weeks 3 and 4. A similar pattern was observed for function, stiffness, and clinical response rate ratio and number needed to treat. Topical NSAIDs were inferior to oral NSAIDs in the first week of treatment and associated with more local side effects such as rash, itch, or burning (rate ratio 5.29, 1.14 to 24.51).

Conclusion Randomised controlled trials of short duration only (less than four weeks) have assessed the efficacy of topical NSAIDs in osteoarthritis. After two weeks there was no evidence of efficacy superior to placebo. No trial data support the long term use of topical NSAIDs in osteoarthritis.

Footnotes

  • We thank Katja Schmidt from University of Exeter and Plymouth for her help in translating the German papers. Jinying Lin is a visiting scholar from the People's Hospital of Guangxi Province, People's Republic of China.

  • Contributors JL was involved in reading the papers, quality assessment, data extraction, analysis, and writing. WZ was involved in planning, searching, reading the papers, quality assessment, data extraction, analysis, and writing. AJ was involved in reading the papers, quality assessment, data extraction, and editing. MD was involved in planning and editing; he will act as guarantor for the paper.

  • Funding UK Arthritis Research Campaign (grant Nos D0565 and D0593).

  • Competing interests None declared.

  • Ethical approval Not required.

  • Accepted 24 May 2004
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