Benefits short-lived with arthritis lotions

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Based on data from previous studies, the use of externally applied NSAIDs—a group of anti-inflammatory drugs that includes ibuprofen and ketoprofen—don’t help patients with arthritis over the long term, UK researchers report.

After 2 weeks, these so-called topical NSAIDs are no better than inactive “placebo” lotions.

“Evidence to support the long-term use of topical NSAIDs in osteoarthritis is absent,” Dr. Weiya Zhang and colleagues, from the University of Nottingham, note in the online issue of the British Medical Journal.

"Current recommendations that support their use in osteoarthritis need to be revised.”

Zhang and colleagues conducted a analysis of 13 trials comparing topical NSAIDs with placebo or NSAIDs pills for arthritis. In all, the trials involved 1983 patients.

Only in the first 2 weeks were topical NSAIDs superior to placebo in relieving pain. A similar pattern was found for function and stiffness.

Also, the analysis showed that topical NSAIDs were inferior to oral drugs from the first week of treatment.

The results indicate that “this group of agents has a short-lived effect. The reason for this short-lived effect is not clear—it probably is a placebo effect,” Zhang told Reuters Health.

“For this disease, we really need a long-term treatment. However, from the evidence pool at the moment, we haven’t identified any study on these particular drugs over a month,” he added.

Evidence-based guidelines from the European League Against Rheumatism (EULAR) and the American College of Rheumatology currently recommend topical NSAIDs as an effective alternative for osteoarthritis, he said.

Zhang is himself involved in the EULAR guideline group. “I think, for the next update of EULAR guidelines we are going to put this message in.”

Because oral NSAIDs can be tough on the stomach, “we’re trying to find a better option,” he said. “Topical is one of the options. Unfortunately, it’s not that promising from current evidence.”

SOURCE: BMJ Online First, July 28, 2004.

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