Home > News

FRIDAY, July 30 (HealthDayNews) -- Topical painkillers used to treat osteoarthritis offer only passing relief, a new study finds.

In formal medical language, non-steroidal anti-inflammatory creams (NSAIDs) give only temporary help for the pain of the joint condition, said the report in the July 31 issue of the British Medical Journal.

Doctors often prescribe topical NSAIDs to avoid the intestinal bleeding that can occur when the drugs are taken orally, said Weiya Zhang, a senior lecturer in epidemiology at the University of Nottingham, and lead author of the report.

But there was very little research on the longer-term pain relief provided by the topical NSAIDs, Zhang said. So he and his colleagues examined the medical literature and gathered information from 13 studies that looked at the efficacy of treatment with topical versions of NSAIDs. The drugs ranged from over-the-counter medications such as aspirin and ibuprofen, to prescription drugs such a diclofenac (Cataflam, Voltaren) and piroxicam (Feldene, Nu-Pirox). The trials included nearly 2,000 patients and lasted up to four weeks.

"After two weeks, there was no evidence of efficacy," Zhang said. "We really need some sort of long-term treatment for this disease."

Osteoarthritis generally occurs later in life, as the cartilage that cushions joints is degraded over the years. It's the most common form of arthritis and a major cause of disability in older people. The damaged joints generally are in the fingers, knees, hips and spine, and the pain can be intense.

A newer class of drugs, Cox-2 inhibitors, can be an alternative to NSAIDs, Zhang said. But these drugs, the first of which were Celebrex and Vioxx, are expensive and can cause intestinal problems, he said.

The new study results "coincide with the experience of those who use topical NSAIDs," said Dr. Frank B. Kelly, a member the American Academy of Orthopaedic Surgeons' board of directors, who is in private practice in Macon, Ga. Those drugs are more effective for soft-tissue problems such as tendonitis, he said.

Kelly said his treatment regimen for the pain of osteoarthritis starts with lifestyle changes. "About 90 percent of what we do is nonsurgical," he said.

Weight loss can help someone who is obese, as can an exercise program aimed at strengthening muscles, Kelly said. If drug treatment is needed, he generally starts with an oral anti-inflammatory medication such as buffered aspirin or ibuprofen. Cox-2 inhibitors can be used if those drugs fail to give relief. If all else fails, injections of a steroid such as cortisone might be tried, he said.

More information

For more on osteoarthritis, visit the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

(SOURCES: Weiya Zhang, Ph.D, senior lecturer, epidemiology, University of Nottingham, England; Frank B. Kelly, M.D., orthopedic surgeon, Macon, Ga.; July 30, 2004, British Medical Journal)

Copyright © 2004 ScoutNews LLC. All rights reserved.