BMJ  2008;336:344 (16 February), doi:10.1136/bmj.39486.438426.3A

Letters

Osteoarthritis of the knee

Topical NSAIDs have unknown effectiveness

The first 150 words of the full text of this article appear below.

Dieppe claimed in an editorial about osteoarthritis that topical non-steroidal anti-inflammatory drugs (NSAIDs) are as effective as oral NSAIDs.1 He refers to a report from the National Institute for Health and Clinical Excellence (NICE), which describes two meta-analyses. He notes that the authors assessed the trials for quality, but the 424 page report says nothing about that quality. The authors of one the meta-analyses, however, reported that the trials were of poor quality and that the effect decreased with increasing sample size of the trials.2 There are other problems with the trials, and the results are difficult to interpret.

Dieppe also quotes a systematic review of topical NSAIDs in people with musculoskeletal pain. The authors reported that small trials exaggerated the effects. When some of the same authors updated this review in people with acute musculoskeletal pain, the effect again decreased significantly and substantially with increasing sample size of the . . . [Full text of this article]

Peter C Gøtzsche, director

1 Nordic Cochrane Centre, Rigshospitalet, Department 3343, DK-2100 Copenhagen Ø, Denmark

pcg@cochrane.dk


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