This challenges current guidelines from Europe and America that topical NSAIDS are an effective treatment for osteoarthritis, the most common form of arthritis.
Researchers in Nottingham analysed 13 trials comparing topical NSAIDS with placebo or oral NSAIDS in osteoarthritis. The trials lasted up to four weeks and involved 1,983 patients.
Topical NSAIDS were superior to placebo in relieving pain due to osteoarthritis only in the first two weeks of treatment. Trials lasting four weeks showed no benefit. A similar pattern was found for function and stiffness. Topical NSAIDS were inferior to oral NSAIDS in the first week of treatment and were associated with more local side effects such as rash, itch, or burning.
Evidence to support the long term use (more than one month) of topical NSAIDS in osteoarthritis is absent, say the authors. Current recommendations for their use in osteoarthritis need to be revised, they conclude.