Twelve high quality studies (Baer 2005, Roth 2004, Conaghan 2013, Simon 2009, Kneer 2013, Rother 2013, Bookman 2004, Wadsworth 2016, Sandelin 1997, Dehghan 2019, Dehghan 2020, Rother 2007) and two moderate quality studies (Barthel 2009, Ottillinger 2001) show that topical NSAIDs could result in improved function and quality of life over placebo gel. However, inconsistent evidence suggests no significant difference in pain and adverse events between topical NSAIDs and control.
Benefits/Harms of Implementation
Topical NSAIDs are now available over the counter for patients to buy and use. Topical NSAIDs should be used with caution in certain health conditions such as stage 4-5 chronic kidney disease, coronary artery disease, and congestive heart failure. There is a risk for skin sensitivity.
Outcome Importance
Improved function and quality of life improvement are the important outcomes from Topical NSAID use.
Cost Effectiveness/Resource Utilization
Since this will now be available over the counter, prescription coverage will be less. This could pose as a barrier to those without health savings accounts or without insurance. Also, patients might not be willing to apply a topical gel multiple times a day.
Acceptability
The use of a topical gel for osteoarthritis of the knee should be an acceptable method of treatment if cost is not prohibitive and the patient does not have any skin irritation from the gel.
Feasibility
Topical NSAIDs will be available at pharmacies over the counter. The main barrier will be cost and having to apply the gel multiple times a day.
Future Research
Future research might be directed at determining if continued topical NSAID use is required to sustain
benefits or if benefits continue after usage for a defined period of time.
- Ottillinger, B., Gömör, B., Michel, B. A., Pavelka, K., Beck, W., Elsasser, U. Efficacy and safety of eltenac gel in the treatment of knee osteoarthritis. Osteoarthritis and Cartilage 2001; 3: 273- 280
- Roth, S. H., Shainhouse, J. Z. Efficacy and safety of a topical diclofenac solution (pennsaid) in the treatment of primary osteoarthritis of the knee: a randomized, double-blind, vehicle-controlled clinical trial. Archives of internal medicine 2004; 18: 2017- 2023
- Rother, M., Conaghan, P. G. A randomized, double-blind, phase III trial in moderate osteoarthritis knee pain comparing topical ketoprofen gel with ketoprofen-free gel. Journal of Rheumatology 2013; 10: 1742-8
- Rother, M., Lavins, B. J., Kneer, W., Lehnhardt, K., Seidel, E. J., Mazgareanu, S. Efficacy and safety of epicutaneous ketoprofen in Transfersome (IDEA-033) versus oral celecoxib and placebo in osteoarthritis of the knee: multicentre randomised controlled trial. Annals of the Rheumatic Diseases 2007; 9: 1178-1183
- Sandelin, J., Harilainen, A., Crone, H., Hamberg, P., Forsskåhl, B., Tamelander, G. Local NSAID gel (eltenac) in the treatment of osteoarthritis of the knee. A double blind study comparing eltenac with oral diclofenac and placebo gel. Scandinavian Journal of Rheumatology 1997; 4: 287- 292
- Simon, L. S., Grierson, L. M., Naseer, Z., Bookman, A. A., Zev Shainhouse, J. Efficacy and safety of topical diclofenac containing dimethyl sulfoxide (DMSO) compared with those of topical placebo, DMSO vehicle and oral diclofenac for knee osteoarthritis. Pain 2009; 3: 238-245
- Wadsworth, L. T., Kent, J. D., Holt, R. J. Efficacy and safety of diclofenac sodium 2% topical solution for osteoarthritis of the knee: a randomized, double-blind, vehicle-controlled, 4 week study. Current Medical Research & Opinion 2016; 2: 241-50
- Baer, P. A., Thomas, L. M., Shainhouse, Z. Treatment of osteoarthritis of the knee with a topical diclofenac solution: a randomised controlled, 6-week trial. BMC Musculoskeletal Disorders 2005; 0: 44
- Barthel, H. R., Haselwood, D., Longley, S., Gold, M. S., Altman, R. D. Randomized controlled trial of diclofenac sodium gel in knee osteoarthritis. Seminars in Arthritis and Rheumatism 2009; 3: 203â212
- Bookman, A. A., Williams, K. S., Shainhouse, J. Z. Effect of a topical diclofenac solution for relieving symptoms of primary osteoarthritis of the knee: a randomized controlled trial. CMAJ : Canadian Medical Association journal 2004; 4: 333-338
- Conaghan, P. G., Dickson, J., Bolten, W., Cevc, G., Rother, M. A multicentre, randomized, placebo- and active-controlled trial comparing the efficacy and safety of topical ketoprofen in Transfersome gel (IDEA-033) with ketoprofen-free vehicle (TDT 064) and oral celecoxib for knee pain associated with osteoarthritis. Rheumatology 2013; 7: 1303-12
- Dehghan, M., Asgharian, S., Khalesi, E., Ahmadi, A., Lorigooini, Z. Comparative study of the effect of Thymus daenensis gel 5% and diclofenac in patients with knee osteoarthritis. BioMedicine; 2: 9
- Dehghan, M., Saffari, M., Rafieian-kopaei, M., Ahmadi, A., Lorigooini, Z. Comparison of the effect of topical Hedera helix L. extract gel to diclofenac gel in the treatment of knee osteoarthritis. Journal of Herbal Medicine 2020; 0:
- Kneer, W., Rother, M., Mazgareanu, S., Seidel, E. J., European, Idea-study group A 12-week randomized study of topical therapy with three dosages of ketoprofen in Transfersome gel (IDEA-033) compared with the ketoprofen-free vehicle (TDT 064), in patients with osteoarthritis of the knee. Journal of pain research 2013; 0: 743-53