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Topical NSAIDs Favored in 2013 Arthritis Guidelines

Darrell Hulisz, RPh, PharmD
Associate Profes

August 1, 2013

In May 2013, the American Academy of Orthopedic Surgeons released evidence based guidelines for treatment of osteoarthritis of the knee (OA).1 The guidelines recommend topical nonsteroidal anti-inflammatory drugs (NSAIDs) as first line therapy in patients with increased GI risk. This recommendation is based on the fact that both diclofenac gel and diclofenac solution have proven efficacy in the management of OA of the knee. Also factored into this recommendation is the observation that systemic (oral) NSAIDs are contraindicated for long-term use in patients with end stage renal disease. These guidelines also support the 2012 American College of Rheumatology guidelines that strongly recommend topical NSAIDs for knee OA instead of oral NSAID in patients 75 and over.2 Diclofenac gel has been shown to be more effective than placebo in the management of OA of the knee and topical diclofenac solution has demonstrated efficacy similar to that of oral diclofenac. There is little systemic absorption of topical NSAIDs, thus, adverse reactions with these drugs are mostly limited to minor local irritation, thus a much safer alternative to NSAIDs.

American Academy of Orthopedic Surgeons. Treatment of osteoarthritis of the knee. Evidence based guideline second edition. May 18, 2013.http://www.aaos.org/research/guidelines/TreatmentofOsteoarthritisoftheKneeGuideline.pdf

American College of Rheumatology. 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care & Research 2012:64(4):465-74.

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