Topical nonsteroidal anti-inflammatory drugs (NSAIDs) may be preferable to systemic oral formulations when treating osteoarthritis (OA) in older patients and those with comorbidities, according to a review published online in Seminars Arthritis Rheumatism.1

“Topical NSAIDs have a moderate effect on pain relief, with efficacy similar to that of oral NSAIDs, and the advantage of a better risk-to-benefit ratio,” lead author François Rannou, MD, PhD, from the rheumatology department at Hôpital Cochin, Université Paris Descartes, France, told Clinical Pain Advisor.

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Dr. Rannou and colleagues arrived at this conclusion after examining treatment guidelines and evidence from surveys, randomized controlled trials, and trials in real-life settings.

OA affects over 20 million Americans and is most prevalent among the elderly, causing potentially debilitating symptoms of muscle weakness, pain, and joint stiffness. Commonly impacted joints include those subject to wear and tear, such as those of the hands and knees.2,3

Though often used to manage OA symptoms, oral NSAIDs are linked to an increased risk for potentially severe toxicity that limits their use in elderly patients and those with predisposing comorbidities and risk factors.4,5 Topical NSAIDs, which offer effective analgesia with limited systemic impact, represent a viable treatment option in this population.

Examining OA Guidelines      

While almost universally recommending topical NSAIDs for knee and hand OA, European and US guidelines differ in terms of when and how they are to be used (Table).1,6

Only the United Kingdom’s National Institute for Health and Clinical Excellence (NICE) guidelines recommend first-line use of topical NSAIDs ahead of oral NSAIDs and other analgesics, researchers found.5

Their findings also suggest that OA guidelines developed by US medical associations generally lag behind those of their European counterparts. However, inclusion of topical NSAIDs was recently boosted by US Food and Drug Association (FDA) approval of several new formulations, a trend that is expected to continue.6

The preponderance of guidelines and their lack of consensus can make it difficult for clinicians to determine an optimal therapeutic strategy. One important factor to consider is the medical association behind the guideline, writes Casilda Balmaceda, MD, a neurologist in private practice in New York, NY.6