doi:10.1136/bmj.38159.639028.7C (published 30 July 2004)
Efficacy of topical non-steroidal anti-inflammatory drugs in
the treatment of osteoarthritis: meta-analysis of randomised
Jinying Lin 1, Weiya Zhang 1, Adrian Jones 2, Michael Doherty
1 Academic Rheumatology, University of Nottingham, City Hospital,
Nottingham NG5 1PB
2 Rheumatology Unit, City Hospital
Objective To assess the efficacy of topical non-steroidal
anti-inflammatory drugs (NSAIDs) in the treatment of osteoarthritis.
Data sources Medline, Embase, Scientific Citation Index,
CINAHL, Cochrane Library, and abstracts from conferences.
Review methods Inclusion criterion was randomised controlled
trials comparing topical NSAIDs with placebo or oral NSAIDs
in osteoarthritis. Effect size was calculated for pain, function,
and stiffness. Rate ratio was calculated for dichotomous data
such as clinical response rate and adverse event rate. Number
needed to treat to obtain the clinical response was estimated.
Quality of trial was assessed, and sensitivity analyses were
Results Topical NSAIDs were superior to placebo in relieving
pain due to osteoarthritis only in the first two weeks of treatment.
Effect sizes for weeks 1 and 2 were 0.41 (95% confidence interval,
0.16 to 0.66) and 0.40 (0.15 to 0.65), respectively. No benefit
was observed over placebo in weeks 3 and 4. A similar pattern
was observed for function, stiffness, and clinical response
rate ratio and number needed to treat. Topical NSAIDs were inferior
to oral NSAIDs in the first week of treatment and associated
with more local side effects such as rash, itch, or burning
(rate ratio 5.29, 1.14 to 24.51).
Conclusion Randomised controlled trials of short duration
only (less than four weeks) have assessed the efficacy of topical
NSAIDs in osteoarthritis. After two weeks there was no evidence
of efficacy superior to placebo. No trial data support the long
term use of topical NSAIDs in osteoarthritis.