Evolving guidelines in the use of topical nonsteroidal anti-inflammatory drugs in the treatment of osteoarthritis

Casilda M Balmaceda

doi:10.1186/1471-2474-15-27

Abstract

BackgroundNonsteroidal anti-inflammatory drugs (NSAIDs) are a standard treatment for osteoarthritis (OA), but the use of oral NSAIDs has been linked to an elevated risk for cardiovascular and gastrointestinal adverse events and renal toxicity. Topical NSAIDs are thought to afford efficacy that is comparable to oral formulations while reducing widespread systemic drug exposure, which may provide a benefit in terms of safety and tolerability. As a result, European treatment guidelines have, for many years, recommended the use of topical NSAIDs as a safe and effective treatment option for OA. Following the recent approval of several topical NSAID formulations by the US Food and Drug Administration, US treatment guidelines are increasingly recommending the use of topical NSAIDs as an alternative therapy and, in some cases, as a first-line option for OA. This commentary summarizes OA treatment guidelines that are currently available and discusses their potential evolution with regard to the increased inclusion of topical NSAIDs.

Highlights

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a standard treatment for osteoarthritis (OA), but the use of oral NSAIDs has been linked to an elevated risk for cardiovascular and gastrointestinal adverse events and renal toxicity
Osteoarthritis (OA) is a chronic, painful, degenerative joint condition that most commonly affects the hips, knees, and hands and often requires long-term treatment to manage acute symptoms and prevent long-term complications. These complications include the destruction of articular cartilage and subchondral bone, bone remodelling, atrophy of periarticular muscles, capsular stretching, and synovitis in weight-bearing joints [1]
To use topical or oral NSAIDs or tramadol as first-line pharmacologic treatment options for the management of OA of the knee [33]. These guidelines determined that the data available for acetaminophen, opioids, and pain patches was inconclusive regarding their efficacy for treating OA of the knee

Summary

Background

Osteoarthritis (OA) is a chronic, painful, degenerative joint condition that most commonly affects the hips, knees, and hands and often requires long-term treatment to manage acute symptoms and prevent long-term complications. AAOS = American Association of Orthopaedic Surgeons; ACR = American College of Rheumatology; AGS = American Geriatric Society; APS = American Pain Society; COX = cyclo-oxygenase; EULAR = European League Against Rheumatism; FDA = US Food and Drug Administration; GI = gastrointestinal; NICE = National Institute for Health and Clinical Excellence; NSAID = nonsteroidal anti-inflammatory drug; OA = osteoarthritis; OARSI = Osteoarthritis Research Society International. To use topical or oral NSAIDs or tramadol as first-line pharmacologic treatment options for the management of OA of the knee [33] These guidelines determined that the data available for acetaminophen, opioids, and pain patches was inconclusive regarding their efficacy for treating OA of the knee. If longterm tolerability data demonstrate that there is a significant reduction in the frequency of cardiovascular and gastrointestinal AEs with topical NSAIDs compared to oral NSAIDs, revising or removing the black box warning requirement for topical NSAIDs may be warranted

Conclusions

11. National Collaborating Centre for Chronic Conditions: Osteoarthritis

13. Roth SH

18. Whelton A

33. Rosemont IL

38. Towheed TE