Topical nonsteroidal anti-inflammatory drugs in the treatment of knee osteoarthritis: a systematic review and meta-analysis

Wolff, Dylan; Christophersen, Christy; Brown, Symone M.; Mulcahey, Mary K.

doi:10.1080/00913847.2021.1886573

Cited by 33 publications

(25 citation statements)

References 23 publications

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“…4 Topical anti-in ammatory drugs are an alternative treatment choice, with fewer gastrointestinal complications relative to oral drugs. [16][17][18] In phonophoresis, ultrasound is used to deliver therapeutic drugs by absorption and permeation through the skin. 21 Despite its wide usage, supporting scienti c evidence is insu cient, especially with regard to symptomatic knee osteoarthritis.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Phonophoresis On Patients With Knee Osteoarthritis: A Systematic Review And Meta-Analysis of Randomized Controlled Trials

Yang

Chen

Peng

et al. 2021

Preprint

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Phonophoresis is an alternative treatment for knee osteoarthritis. However, evidence supporting the advantages of phonophoresis remains inconsistent. This systematic review and meta-analysis was conducted to illustrate the effect of phonophoresis. The PubMed, Cochrane Library, and Embase databases were searched for relevant studies from the date of their inception to 28 June, 2021. The eligibility criteria were: (1) randomized controlled trials (RCTs); (2) patients diagnosed as having knee osteoarthritis; (3) treatment with either phonophoresis or therapeutic ultrasound with placebo gels; and (4) reporting clinical and functional outcomes. Continuous variables are expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Analysis was performed using RevMan 5.3 software. The analysis included nine RCTs covering a total of 423 patients. The intervention group significantly outperformed the control group in visual analog scale score [SMD = −0.65, 95% CI (−1.04, −0.25), P = 0.001], Western Ontario and McMaster Universities Arthritis Index (WOMAC) score [SMD = −0.71, 95% CI (−1.26, −0.16), P = 0.01], and walk test score [SMD = −0.67, 95% CI (−1.21, −0.13), P = 0.02]. As a result, phonophoresis might alleviate pain and improve function in the short term. Further high-quality, large-scale RCTs are required to confirm the benefits.

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Section: Discussionmentioning

confidence: 99%

“…Topical gels are an alternative treatment with fewer complications compared with oral anti-in ammatory drugs. [16][17][18] As a treatment modality, ultrasound has been studied for many decades. 19 Its therapeutic effect is mainly derived from the absorption of mechanical energy and the production of heat in tissues.…”

Section: Introductionmentioning

confidence: 99%

Effect of Phonophoresis On Patients With Knee Osteoarthritis: A Systematic Review And Meta-Analysis of Randomized Controlled Trials

Yang

Chen

Peng

et al. 2021

Preprint

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“…The current therapeutic options advanced in various evidence-based clinical guidelines include nonpharmacological therapies, weight loss, oral pharmacological medications, exercise, topical therapies, surgical treatments, and intra-articular therapies [10][11][12]. Notably, nonsteroidal anti-inflammatory drugs (NSAIDs) and intra-articular hyaluronic acid or corticosteroids are the most frequently used in clinical practice [13][14][15]. Long-term use of NSAIDs and corticosteroids, on the other hand, has serious adverse effects [16].…”

Section: Introductionmentioning

confidence: 99%

The Efficacy and Safety of Chinese Herbal Medicine in the Treatment of Knee Osteoarthritis: An Updated Systematic Review and Meta-Analysis of 56 Randomized Controlled Trials

Zhou

Zheng

Chen

et al. 2022

Oxidative Medicine and Cellular Longevity

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Objective. This systematic review and meta-analysis were performed to investigate the efficacy and safety of Chinese herbal medicine (CHM) in the treatment of knee osteoarthritis (KOA). Methods. An electronic search was conducted in eight databases (PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese VIP Database, and Wanfang Database) from inception until December 2019. The risk of bias assessment of the included RCTs was evaluated by Cochrane collaboration’s tool. The inclusion criteria were RCTs that investigated the efficacy and safety of CHM in the treatment of KOA, with no restrictions on publication status or language. The exclusion criteria included nonrandomized or quasi-RCTs, no clear KOA diagnostic approach, combined Chinese medicinal herbs with other traditional Chinese medicine treatment modalities, and published using repeated data and missing data. We computed the relative risk (RR) and the standard mean difference (SMD) for dichotomous outcomes and continuous outcomes, respectively. When heterogeneity was detected or there was significant statistical heterogeneity ( P < 0.05 or I 2 > 50 % ), a random-effects model was employed, followed by further subgroup analysis and metaregression estimations to ascertain the origins of heterogeneity. Otherwise, we used a fixed-effects model ( P ≥ 0.05 or I 2 ≤ 50 % ). The primary outcome measures were visual analog score (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm score, and Lequesne index. Secondary outcome measures were the total clinical effective rate and adverse events. The meta-analysis was performed using the Stata 14.0 software. Results. A total of 56 RCTs comprising 5350 patients met the inclusion criteria. This meta-analysis showed that application of CHM as adjuvant therapy or monotherapy for KOA can significantly decrease VAS, WOMAC, and the Lequesne index and improve the Lysholm score as well as the total effective rate. In addition, this treatment has fewer adverse effects, suggesting that CHM is generally safe and well tolerated among patients with KOA. Conclusion. Our study offers supportive evidence that CHM, either adjuvant therapy or monotherapy, reduces the VAS, WOMAC, and Lequesne index and improves the Lysholm score and overall effective rate in patients with KOA. Additionally, CHM was well tolerated and safe in KOA patients. We found frequently used CHMs that might contribute to the formulation of a herbal formula that could be considered for further clinical use. However, given the heterogeneity and limited sample size in this study, larger multicenter and high-quality RCTs are needed to validate the benefits of CHM in the treatment of KOA.

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“…The treatment of knee osteoarthritis remains unresolved. Most conventional therapy concentrates on relieving pain and other complains of the disease [ 2 – 4 ], but their efficacy on the development of the disease is limited, and they are usually accompanied by many adverse effects that encouraged the usage of safer therapy with natural origin [ 5 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Resveratrol on Serum Levels of Type II Collagen and Aggrecan in Patients with Knee Osteoarthritis: A Pilot Clinical Study

Marouf¹

2021

BioMed Research International

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Treatment of knee osteoarthritis (OA) remains a challenging concern. Preclinical studies provided accumulating evidence on resveratrol efficacy in ameliorating degenerative articular damage. The present study was conducted to evaluate the effects of resveratrol as monotherapy on the serum level of type II collagen (Coll 2-1) and aggrecan in patients with knee osteoarthritis. The study was an open-labeled noncontrolled clinical trial. Resveratrol 500 mg/day in a single oral dose was given to the patients with knee osteoarthritis for 90 days. The serum levels of Coll-2-1, aggrecan, and biomarkers of inflammation were measured pre- and posttreatment. Hematological profiles and both hepatic and renal function markers were investigated at the baseline and at the end of the treatment for evaluating the tolerability and safety of resveratrol. Visual Analog Scale (VAS) for pain and Knee injury and Osteoarthritis Outcome Score (KOOS) for disease activity were clinically assessed monthly. Administration of 500 mg resveratrol for three months led to a nonsignificant decrease in the serum level of Coll 2-1 while a significant increase in aggrecan serum level. Resveratrol significantly improves pain score measured by VAS and KOOS after 30 days. Improvements in patients’ activity and functional status were also evident at day 30 and kept on for three months which was reflected by KOOS subscale scores and with a significant improvement in all KOOS areas. In conclusion, oral administration of resveratrol as a monotherapy provides a remarkable improvement in the clinical status of the patients but has no significant effect on serum levels of Coll 2-1.

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Topical nonsteroidal anti-inflammatory drugs in the treatment of knee osteoarthritis: a systematic review and meta-analysis

Cited by 33 publications

References 23 publications

Effect of Phonophoresis On Patients With Knee Osteoarthritis: A Systematic Review And Meta-Analysis of Randomized Controlled Trials

Effect of Phonophoresis On Patients With Knee Osteoarthritis: A Systematic Review And Meta-Analysis of Randomized Controlled Trials

The Efficacy and Safety of Chinese Herbal Medicine in the Treatment of Knee Osteoarthritis: An Updated Systematic Review and Meta-Analysis of 56 Randomized Controlled Trials

Effect of Resveratrol on Serum Levels of Type II Collagen and Aggrecan in Patients with Knee Osteoarthritis: A Pilot Clinical Study

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