Topical NSAIDS for Knee Osteoarthritis Pain Relief

PainRelief.com Interview with:
Dylan Wolff
M.D. Candidate

Dylan Wolff
M.D. Candidate
Dr. Mary Mulcahey

Mary K. Mulcahey, MD, FAAOS, FAOA
Director, Women’s Sports Medicine Program
Associate Professor
Assistant Program Director
Department of Orthopaedic Surgery
Tulane University School of Medicine
New Orleans, LA


PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Osteoarthritis Research Society (OARSI) guidelines include topical non-steroidal anti-inflammatory drugs (NSAIDs) as a level 1A recommendation for non-operative management of knee osteoarthritis, but previous reviews have demonstrated that clinical adoption of this treatment option lags. We conducted a systematic review and meta-analysis of 18 studies evaluating diclofenac, ketoprofen, and ibuprofen in topical preparations. We found that they are safe and effective for reducing pain and improving physical function in patients with knee osteoarthritis. Diclofenac had the strongest quality and number of studies and showed a moderate effect size for symptomatic improvement. With regards to safety, adverse events were low in the topical treatment groups, and topical preparations containing dimethyl sulfoxide (DMSO) showed a higher odds ratio for adverse events than preparations without DMSO. 

PainRelief.com: What should readers take away from your report?

Response: Readers should consider topical NSAIDs as first-line treatment option for non-operative management of knee osteoarthritis. Topical therapies have demonstrated low serum concentrations and can be a safer choice for patients at higher risk of cardiovascular and gastrointestinal adverse effects of oral NSAID administration. Additionally, patient preference surveys have shown that patients prefer topical treatments for osteoarthritis and often use over the counter topical biologically based and complementary therapies. 

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: Future research could investigate the effects of topical NSAIDs on disease progression by monitoring inflammatory markers or radiographic evidence. Future studies could also monitor patients after treatment cessation to elucidate the ideal duration and durability of treatment. 

PainRelief.com: Is there anything else you would like to add?

Response: Any disclosures? 

Please see the full disclosures in the paper. This review was not funded.

Citation:

Wolff DG, Christophersen C, Brown SM, Mulcahey MK. Topical nonsteroidal anti-inflammatory drugs in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Phys Sportsmed. 2021 Mar 4:1-11. doi: 10.1080/00913847.2021.1886573. Epub ahead of print. PMID: 33554694.

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