December 2004

Topical arthritis drugs don't work over long term, pose risks

Doctors often tell patients with osteoarthritis to use topical non‑steroidal anti‑inflammatory drugs (NSAIDS) to relieve the pain, often continuing the treatment for months. However, a new study reveals that the drugs are only beneficial for the first two weeks.

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, England analyzed 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.

The drugs also pose more serious risks. The authors noted that "Non‑steroidal anti‑inflammatory drugs (NSAIDs) are widely used to relieve pain in musculoskeletal tissues,but their use comes at the cost of toxicity, with a 2‑4% annual incidence of serious gastrointestinal ulcer and complications ‑‑ four times higher than in non‑users."  Osteoarthritis is the most common form of arthritis and the major cause of disability in elderly people.

SOURCE: "Efficacy of topical non‑steroidal anti‑inflammatory drugs in the treatment of osteoarthritis: meta‑analysis of randomised controlled trials," Jinying Lin, et.al. British Medical Journal, July 2004.