Topical nonsteroidal anti-inflammatory drugs for management of osteoarthritis pain: A consensus recommendation

Journal

Journal of Orthopaedic Research

Year

2023

Materials & Methods

Members of the working group include orthopedic surgeons and rheumatologists who are key opinion leaders and researchers in Malaysia. Six members were invited to the first meeting to discuss issues on the unmet needs in OA pharmacological treatment, especially in the context of the use of topical NSAIDs based on clinical experience and current literature. Points raised during the meeting were then drafted into recommendation statements. These statements were judged to be the most relevant and beneficial to healthcare professionals in their clinical practice based on the current assessment of knowledge gaps on topical NSAIDs in OA pain management. Literature to support or refute the statements were gathered based on published evidence. This was done through a search of medical literature in the English language using PubMed, Scopus, and Google Scholar databases. Search terms included: “topical NSAIDs,” “osteoarthritis,” “guidelines,” “recommendation” “randomised controlled trials,” “systematic review,” and “meta-analyses.” Reference lists of retrieved articles were searched. The recommendations proposed at the meeting were refined based on the evidence gathered. The strength of the recommendations was based on the three-level rating system adapted from the Scottish Intercollegiate Guidelines Network Grading System: Grade A: At least one meta-analysis, systematic review, or randomized-controlled trial (RCT), or evidence rated as good and directly applicable to the target population. Grade B: Evidence from well-conducted clinical trials, directly applicable to the target population and demonstrating overall consistency of results; or evidence extrapolated from meta-analysis, systematic review, or RCT. Grade C: Evidence from expert committee reports, or opinions and/or clinical experiences of respected authorities; indicates absence of directly applicable clinical studies of good quality. All group members were invited to provide their feedback independently, after which a second meeting was called to review the recommended revisions by the group members. The statements and recommendations were further revised based on the feedback and justifications received from all members. A unanimous consensus was achieved among all members on the final statements and recommendations presented here.

Conclusion

This publication presents evidence-based consensus recommendations on the use of topical NSAIDs for the management of mild-to-moderate OA pain. In agreement with major OA treatment guidelines, the panel supports the use of topical NSAIDs over oral NSAIDs as first-line treatment of mild-to-moderate OA pain. This recommendation is mainly driven by the findings of numerous trials that topical NSAIDs have comparable efficacy but a lower risk of systemic side effects to oral NSAIDs. Patient education is important in the shared decision-making process between the healthcare professional and patient in choosing the most appropriate preparation and formulation. This in turn improves treatment adherence thus reducing pain, leading to an improvement in patients' quality of life.

Resources and Links

Phone Number: +603 2781 4519 / +603 2781 4520

https://onlinelibrary.wiley.com/doi/10.1002/jor.25549

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