Topical nonsteroidal anti‐inflammatory drugs for management of osteoarthritis pain: A consensus recommendation

Abstract

Osteoarthritis (OA) contributes to significant medical and socioeconomic burden in many populations. Its prevalence is expected to rise continuously owing to the combined effects of aging and increase in risk factors, including obesity, physical inactivity, and joint injuries. Pain is a hallmark presentation of OA. Topical nonsteroidal anti‐inflammatory drugs (NSAIDs) are recommended by many international guidelines as an early treatment option of the management of osteoarthritic pain. However, the use of topical NSAIDs remains low in Malaysia and appears not to be a preferred agent in managing OA pain by prescribers. There is also limited guidance from local medical bodies on the use of topical NSAIDs to manage OA pain. This consensus recommendation is intended to serve as a practical guide for healthcare practitioners on the use of topical NSAIDs in the management of OA pain. Eight statements and recommendations were finalized covering the areas of OA burden, topical NSAIDs formulations, safety and efficacy of topical NSAIDs, and patient education. Robust evidence is available to support the efficacy and safety of topical NSAIDs, with its benefits further strengthened by ease of use and access. Taking these into consideration, we recommend that healthcare practitioners advocate for the early use of topical NSAIDs over oral NSAIDs for mild‐to‐moderate OA pain, while engaging in a shared decision‐making process with patients for optimal clinical outcomes.

Topical nonsteroidal anti‐inflammatory drug patches for osteoarthritis

“…As was outlined in the recent consensus article by Lee and colleagues in the Journal of Orthopaedic Research, topical nonsteroidal antiinflammatory drugs (NSAIDs) have become a first-line therapy for the treatment of pain associated with osteoarthritis (OA). 1 These recommendations for topical NSAIDs for OA are further supported by the formal clinical practice guidelines of the American Academy of Orthopedic Surgeons and the American College of Rheumatology. 2,3 As Lee et al point out, topical NSAIDs are indicated for reducing the pain and improving the function of OA because of ease of use, safety, and efficacy, thus, topical NSAIDs are recommended as firstline therapy for OA.…”

“…2,3 As Lee et al point out, topical NSAIDs are indicated for reducing the pain and improving the function of OA because of ease of use, safety, and efficacy, thus, topical NSAIDs are recommended as firstline therapy for OA. [1][2][3] Diclofenac gel is the most commonly used topical NSAID worldwide, although multiple other NSAIDs have been used in many diverse vehicles including cream, foam, spray, ointments, plasters, and patches. [4][5][6][7][8] In clinical trials, NSAID patches with diclofenac, flubiprofen, loxoprofen, and other NSAIDs have been shown to be effective for OA pain although toxicity may be greater than strictly topical NSAID due to greater systemic absorption from the patch design.…”

“…[4][5][6][7][8] In clinical trials, NSAID patches with diclofenac, flubiprofen, loxoprofen, and other NSAIDs have been shown to be effective for OA pain although toxicity may be greater than strictly topical NSAID due to greater systemic absorption from the patch design. 1,[4][5][6][7][8] Because of the intrinsic movements of the small joints of the hands and large joints such as the knee, topical NSAIDs are often mechanically removed by movement against clothing, washing, and abrasion and the beneficial effect is diminished. Clinically, we have found it is particularly difficult to retain a topical NSAID on the small joints of the OA hand, including the distal and proximal interphalangeal joint, the metacarpophalangeal and the first carpometacarpal joint.…”