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Efficacy and safety of topical NSAIDs in the management of osteoarthritis: Evidence from real-life setting trials and surveys.
Semin Arthritis Rheum 2016; 45(4 Suppl):S18-21SA

Abstract

Topical non-steroidal anti-inflammatory drugs (NSAIDs) are recommended in international and national guidelines as an early treatment option for the symptomatic management of knee and hand osteoarthritis (OA), and may be used ahead of oral NSAIDs due to their superior safety profile. The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm recommends topical NSAIDs for knee OA in addition to the pharmacological background of symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) and rescue analgesia with paracetamol and non-pharmacological treatment, if the patient is still symptomatic. Topical NSAIDs have a moderate effect on pain relief, with efficacy similar to that of oral NSAIDs, with the advantage of a better risk:benefit ratio. In real-life studies, topical and oral NSAIDs demonstrate an equivalent effect on knee pain over 1 year of treatment, with fewer adverse events due to lower systemic absorption of topical NSAIDs compared with oral NSAIDs. As a result, topical NSAIDs may be the preferred treatment option, especially in OA patients aged ≥75 years, and those with co-morbidities or at an increased risk of cardiovascular, gastrointestinal, or renal side effects. Furthermore, using topical NSAIDs in inflammatory rheumatic diseases leads to a 40% reduction in the need for concomitant oral NSAIDs. When selecting a topical NSAID, absorption and bioavailability are important because of heterogeneity among topical drug formulations. Molecules like etofenamate have a bioavailability of >20% and evidence for accumulation in synovial tissues, with efficacy demonstrated as improvement in pain and function in real-life studies of OA patients. Diclofenac also shows good efficacy alongside evidence that diclofenac accumulates in the synovium.

Authors+Show Affiliations

Rehabilitation Unit, Rheumatology Department, Hôpital Cochin, AP-HP, INSERM UMR-S 1124, Université Paris Descartes, 27 rue de faubourg saint Jacques, 75014 Paris, France. Electronic address: francois.rannou@cch.aphp.fr.Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.

Pub Type(s)

Journal Article
Practice Guideline

Language

eng

PubMed ID

26806189

Citation

Rannou, François, et al. "Efficacy and Safety of Topical NSAIDs in the Management of Osteoarthritis: Evidence From Real-life Setting Trials and Surveys." Seminars in Arthritis and Rheumatism, vol. 45, no. 4 Suppl, 2016, pp. S18-21.
Rannou F, Pelletier JP, Martel-Pelletier J. Efficacy and safety of topical NSAIDs in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin Arthritis Rheum. 2016;45(4 Suppl):S18-21.
Rannou, F., Pelletier, J. P., & Martel-Pelletier, J. (2016). Efficacy and safety of topical NSAIDs in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Seminars in Arthritis and Rheumatism, 45(4 Suppl), pp. S18-21. doi:10.1016/j.semarthrit.2015.11.007.
Rannou F, Pelletier JP, Martel-Pelletier J. Efficacy and Safety of Topical NSAIDs in the Management of Osteoarthritis: Evidence From Real-life Setting Trials and Surveys. Semin Arthritis Rheum. 2016;45(4 Suppl):S18-21. PubMed PMID: 26806189.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy and safety of topical NSAIDs in the management of osteoarthritis: Evidence from real-life setting trials and surveys. AU - Rannou,François, AU - Pelletier,Jean-Pierre, AU - Martel-Pelletier,Johanne, Y1 - 2015/12/02/ PY - 2015/10/12/received PY - 2015/11/25/revised PY - 2015/11/25/accepted PY - 2016/1/26/entrez PY - 2016/1/26/pubmed PY - 2016/12/15/medline KW - Hand osteoarthritis KW - Knee osteoarthritis KW - Personalized medicine KW - Topical non-steroidal anti-inflammatory drugs (NSAIDs) SP - S18 EP - 21 JF - Seminars in arthritis and rheumatism JO - Semin. Arthritis Rheum. VL - 45 IS - 4 Suppl N2 - Topical non-steroidal anti-inflammatory drugs (NSAIDs) are recommended in international and national guidelines as an early treatment option for the symptomatic management of knee and hand osteoarthritis (OA), and may be used ahead of oral NSAIDs due to their superior safety profile. The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm recommends topical NSAIDs for knee OA in addition to the pharmacological background of symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) and rescue analgesia with paracetamol and non-pharmacological treatment, if the patient is still symptomatic. Topical NSAIDs have a moderate effect on pain relief, with efficacy similar to that of oral NSAIDs, with the advantage of a better risk:benefit ratio. In real-life studies, topical and oral NSAIDs demonstrate an equivalent effect on knee pain over 1 year of treatment, with fewer adverse events due to lower systemic absorption of topical NSAIDs compared with oral NSAIDs. As a result, topical NSAIDs may be the preferred treatment option, especially in OA patients aged ≥75 years, and those with co-morbidities or at an increased risk of cardiovascular, gastrointestinal, or renal side effects. Furthermore, using topical NSAIDs in inflammatory rheumatic diseases leads to a 40% reduction in the need for concomitant oral NSAIDs. When selecting a topical NSAID, absorption and bioavailability are important because of heterogeneity among topical drug formulations. Molecules like etofenamate have a bioavailability of >20% and evidence for accumulation in synovial tissues, with efficacy demonstrated as improvement in pain and function in real-life studies of OA patients. Diclofenac also shows good efficacy alongside evidence that diclofenac accumulates in the synovium. SN - 1532-866X UR - https://www.unboundmedicine.com/medline/citation/26806189/Efficacy_and_safety_of_topical_NSAIDs_in_the_management_of_osteoarthritis:_Evidence_from_real_life_setting_trials_and_surveys_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0049-0172(15)00285-1 DB - PRIME DP - Unbound Medicine ER -