(published 30 July 2004)
of topical non-steroidal anti-inflammatory drugs
in the treatment of osteoarthritis: meta-analysis
of randomised controlled trials
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
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
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.