A Narrative Review: The Use of the Topical NSAID Ibuprofen for the Treatment of Knee Osteoarthritis. Supporting Clinician Decision-Making in the First-Line Treatment of Osteoarthritis.

IF 2.3 Q1 REHABILITATION Rehabilitation Process and Outcome Pub Date : 2020-06-11 eCollection Date: 2020-01-01 DOI:10.1177/1179572720914945
Catrin Hawthorn
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引用次数: 3

Abstract

A narrative review: The use of the topical nonsteroidal anti-inflammatory drugs (NSAID) ibuprofen for the treatment of knee osteoarthritis. Supporting clinician decision-making in the first-line treatment of osteoarthritis.

Objective: To open discussion at a clinical level on the guidelines for the pharmacological management of osteoarthritis of the knee, this narrative review looks into the use of topical NSAID being a clinically effective, safe, and cost-efficient treatment compared to an oral alternative.

Background: With the over prescription of NSAIDs in the age of above 65 years, there has been a call for increased restrictions of the sale of oral preparations of NSAIDs. It is our view that there is still a lack of awareness in the benefit of topical NSAIDs to the patient (no evidence of adverse reactions recorded by the Joint Formulary Committee [JFC] to date) as well as provider (topical application is cheaper as a National Health Service [NHS] prescription).

Methods: Key online resources included PubMed, Athens, Cochrane Library, Google Scholar, MEDLINE, and relevant clinical and commissioning guidelines with the final date of data collection in March 2017. We also contacted the manufacturer and license holder directly for further clarification. Randomized, double-blind control studies, commissioned reports, International Guidelines, MEHA Guidelines, and license holder data were included. Where possible studies included had to have fair randomization and adhere to key treatment pathways as highlighted by National Institute for Health and Clinical Excellence (NICE) and other guidelines.

Discussion: Current guidelines advise that patients who seek initial treatment of osteoarthritis of the knee should consider a combination of treatment modalities, including pharmacological therapies, particularly the use of NSAIDs. At a clinical level, a reoccurring issue identified with this advice is the inappropriate use of oral NSAIDs, and the concern that the risks associated with ease of access ("over the counter"), and overuse, may result in systemic adverse events in this cohort of patients. Multiple studies have examined the negative effect of oral NSAIDs and the associated risks of use. We were unable to source studies that showed any adverse systemic events from the use of topical NSAIDs; however, there are good quality trials comparing oral to topical NSAIDs, showing similar levels of efficacy at 6 and 12 weeks.

Conclusion: Topical NSAIDs provide good levels of pain relief in subjects with mild to moderate knee osteoarthritis. There is also evidence for the use of the topical application being a clinically effective, safe, and cost-efficient treatment.

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叙述性回顾:局部使用非甾体抗炎药布洛芬治疗膝骨关节炎。支持临床医生在骨关节炎一线治疗中的决策。
一个叙述性的回顾:使用外用非甾体抗炎药(NSAID)布洛芬治疗膝骨关节炎。支持临床医生在骨关节炎一线治疗中的决策。目的:为了在临床层面上对膝关节骨关节炎的药理学治疗指南进行讨论,这篇叙述性综述着眼于与口服替代药物相比,局部使用非甾体抗炎药是一种临床有效、安全且具有成本效益的治疗方法。背景:随着65岁以上人群非甾体抗炎药处方的过度使用,越来越多的人呼吁加大非甾体抗炎药口服制剂的销售限制。我们认为,对于局部使用非甾体抗炎药对患者的益处(迄今为止联合处方委员会[JFC]没有记录不良反应的证据)和提供者(局部使用比国民健康服务[NHS]处方更便宜)仍然缺乏认识。方法:主要在线资源包括PubMed、Athens、Cochrane Library、Google Scholar、MEDLINE以及相关临床和试验指南,数据最终收集日期为2017年3月。我们也直接联系了制造商和许可证持有人进一步澄清。纳入随机、双盲对照研究、委托报告、国际指南、MEHA指南和许可证持有人数据。在可能的情况下,纳入的研究必须公平随机化,并坚持国家健康与临床卓越研究所(NICE)和其他指南所强调的关键治疗途径。讨论:目前的指南建议,寻求膝关节骨关节炎初始治疗的患者应考虑综合治疗方式,包括药物治疗,特别是使用非甾体抗炎药。在临床层面,这一建议所确定的一个反复出现的问题是口服非甾体抗炎药的不当使用,以及对易于获得(“非处方”)和过度使用相关风险的担忧,可能导致该队列患者的全身不良事件。多项研究调查了口服非甾体抗炎药的负面影响和使用的相关风险。我们无法找到表明局部使用非甾体抗炎药有任何不良系统事件的研究来源;然而,有比较口服非甾体抗炎药和外用非甾体抗炎药的高质量试验,在6周和12周时显示出相似的疗效水平。结论:局部使用非甾体抗炎药可以很好地缓解轻度至中度膝骨关节炎患者的疼痛。也有证据表明,局部应用是一种临床有效、安全、经济的治疗方法。
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