What is the evidence for topical NSAIDs in the treatment of osteoarthritis of the knee?
AMSTAR Rating
Summary
Patient Population:
The majority of participants were experiencing hand or knee OA. Mean age ranged from 59-65. Studies included both male and female participants.
Intervention:
Diclofenac, ketaprofen, piroxecam, eltenac, felbenac, flurbiprofen, piketoprofen, nimesulide, flufenamate, indomethacin, and ibuprofen.
Comparison:
Primary outcome was “clinical success” which the authors defined at a 50% reduction in pain or a rating of very good or excellent on an assessment of global patient outcome. Treatment was compared to a placebo. There were 34 studies identified by the authors that met the inclusion criteria. Two studies were available only as synopses from the drug manufacturer. 17 studies were rated 5/5 on the Jadad scale. No studies rated less than 2. Risk of bias assessment indicated that the main deficiencies tended to be in study size and trial duration – particularly in the case of older studies identified.
Outcome:
- Clinical Success: topical diclofenac vs. placebo – relative benefit of treatment was 2.0 at 2-3 weeks (95% CI 1.5 to 2.6; 40% of patients reported successful treatment vs. 20% in placebo; NNT = 5).
- Clinical Success: topical diclofenac vs. placebo – relative benefit of treatment was 1.7 at 4-6 weeks (95% CI 1.3 to 2.2; 48% of patients reported successful treatment vs. 28% in placebo; NNT = 5.2).
- Clinical Success: topical diclofenac vs. placebo – relative benefit of treatment was 1.2 at 8-12 weeks (95% CI 1.1 to 1.3; 60% of patients reported successful treatment vs. 50% in placebo; NNT = 10).
- There was no significant difference between treatment with oral NSAIDs vs. topical NSAIDs.
Guideline Recommendations
| Source | Recommendation |
|---|---|
| ACR (2019) | Strongly recommended |
| AAOS (2013) | Strong evidence for use |
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Topical Diclofenac
Clinical Success at 2-3 weeks
Clinical Success at 4-6 weeks
Clinical Success at 8-12 weeks
Topical NSAIDs vs. Oral NSAIDs
Clinical Success
