Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomised controlled trials

Dear Editor

Topical NSAIDs may have fewer potentially serious adverse effects
than oral preparations [1] but they are not immune. Topical NSAIDs have to
be absorbed to exert their therapeutic effects, and so they can cause
systemic adverse effects. They have been implicated in cases of renal
failure,[2-4] gastrointestinal haemorrhage,[5] and asthma.[6] Prescribers
should be vigilant to topical NSAIDs causing systemic ADRs and report
suspected adverse reactions to drug regulatory agencies.

1. Lin J, Zhang W, Jones A, Doherty M. Efficacy of topical non-
steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta
-analysis of randomised controlled trials. BMJ 2004; 329: 324.

2. Krummel T, Dimitrov Y, Moulin B, Hannedouche T. Drug points: Acute
renal failure induced by topical ketoprofen. BMJ 2000; 320: 93.

3. Evans JM, McGregor E, McMahon AD, et al. Non-steroidal anti-
inflammatory drugs and hospitalization for acute renal failure. QJM 1995;
88: 551-7.

4. Fernando AH, Thomas S, Temple RM, Lee HA. Renal failure after
topical use of NSAIDs. BMJ 1994; 308: 533.

5. Evans JM, McMahon AD, McGilchrist MM, et al. Topical non-steroidal
anti-inflammatory drugs and admission to hospital for upper
gastrointestinal bleeding and perforation: a record linkage case-control
study. BMJ 1995; 311: 22-6.

6. Gaynes BI, Fiscella R. Topical nonsteroidal anti-inflammatory
drugs for ophthalmic use: a safety review. Drug Saf. 2002; 25: 233-50.

Competing interests:
None declared