NSAID systemic exposure is a real concern for many patients
The Osteoarthritis Research Society International (OARSI) Expert Consensus Guidelines recommend topical NSAIDs as first-line medications for OA knee pain in patients with comorbidities1
Many of your patients with OA knee pain may also have other comorbidities.2-8 For these patients, consider if adding another oral medication to their list of treatments is right for them, or if a topical could be an appropriate option.
Common comorbidities that your patients with OA knee pain may have:
Coronary heart disease2
Renal impairment (CKD)3
Concomitant medications are highest among patients with common chronic comorbid conditions:
Mean number of drug classes used by newly diagnosed diabetes patients9
Median number of medications taken 5 years after diabetes diagnosis10
Percent of patients with hypertension taking multiple antihypertension medications11
Mean number of medications patients with CKD take12
Consider the risk of NSAIDs
- Physicians should weigh the risks of NSAIDs, including severe cardiovascular (CV) risks, when considering topical NSAIDs in high-risk patients1,13
- Even topical NSAIDs pose serious CV and GI risks13
- Hypertension can occur with NSAID treatment. Monitor blood pressure closely13
- Long-term administration of NSAIDs can result in renal papillary necrosis, other renal injury, and renal toxicity13
Experts recommend topical NSAIDs for patients with OA knee pain
OARSI Expert Consensus Guidelines recommend topical NSAIDs as first-line medications for OA knee pain in patients with comorbidities.1
The American College of Rheumatology (ACR) guidelines recommend topical NSAIDs as one of the pharmacologic modalities for the initial management of knee OA.14
The Technical Expert Panel (TEP) also “strongly recommends the use of topical rather than oral NSAIDs” in patients ≥75 years of age
The CDC recommends topical NSAIDs in addition to other non-opioids as first-line medications for OA knee pain.15
GI=gastrointestinal; NSAID=nonsteroidal anti-inflammatory drug; OA=osteoarthritis.
- McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014;22(3):363-388.
- Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29-e322.
- Kidney Disease Statistics for the United States. National Institute of Diabetes and Digestive and Kidney Diseases website. https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease. Accessed January 7, 2018.
- El-Tawil AM. Trends on gastrointestinal bleeding and mortality. World J Gastroenterol. 2012;18(11):1154-1158.
- Rates of diagnosed diabetes per 100 civilian, non-institutionalized population, by age, US, 1980-2014. CDC website.
- Nwankwo T, Yoon SS, Burt V, Gu Q. Hypertension among adults in the United States: National Health and Nutrition Examination Survey, 2011-2012. NCHS Data Brief. 2013;(133):1-8.
- Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity among adults: United States, 2011-2012. NCHS Data Brief. 2013;(131):1-8.
- Pratt LA, Brody DJ. Depression in the U.S. household population, 2009-2012. NCHS Data Brief. 2014;(172):1-8.
- Schmittdiel JA, Raebel MA, Dyer W, et al. Prescription medication burden in patients with newly diagnosed diabetes: a SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) study. J Am Pharm Assoc (2003). 2014;54(4):374-382.
- Black JA, Simmons RK, Boothby CE, et al. Medication burden in the first 5 years following diagnosis of type 2 diabetes: findings from the ADDITION-UK trial cohort. BMJ Open Diabetes Res Care. 2015;3(1):e000075.
- Gu Q, Burt VL, Dillon CF, Yoon S. Trends in antihypertensive medication use and blood pressure control among United States adults with hypertension: the National Health and Nutrition Examination Survey, 2001-2010. Circulation. 2012;126(17):2105-2114.
- Bailie GR, Eisele G, Liu L, et al. Patterns of medication use in the RRI-CKD study: focus on medications with cardiovascular effects. Nephrol Dial Transplant. 2005;20(6):1110-1115.
- PENNSAID (diclofenac sodium topical solution) 2% [package insert]. Lake Forest, IL: Horizon Pharma USA, Inc; May 2016.
- Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012;64(4):465-474.
- Centers for Disease Control and Prevention. CDC Guideline for Prescribing Opioids for Chronic Pain. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugoverdose/prescribing/clinical-tools.html. Accessed September 10, 2017.