BMJ, doi:10.1136/bmj.38159.639028.7C (published 30 July
Efficacy of topical non-steroidal anti-inflammatory
drugs in the treatment of osteoarthritis: meta-analysis
of randomised controlled trials
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 undertaken.
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.