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.2-7 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 disease2,7
Renal impairment (CKD)3
Use of concomitant medications is highest among patients with common chronic comorbid conditions:
Mean number of drug classes used by newly diagnosed diabetes patients8
Median number of medications taken 5 years after diabetes diagnosis9
Percent of patients with hypertension taking multiple antihypertension medications10
Mean number of medications patients with CKD take11
Consider the risk of NSAIDs
- Physicians should weigh the risks of NSAIDs, including severe cardiovascular (CV) risks, when considering topical NSAIDs12
- Even topical NSAIDs pose serious CV and GI risks12
- Hypertension can occur with NSAID treatment. Monitor blood pressure closely12,13
- Long-term administration of NSAIDs can result in renal papillary necrosis, other renal injury, and renal toxicity12,13
Experts recommend topical NSAIDs for patients with OA knee pain
Strongly recommends topical NSAIDs for patients with OA of the knee(s) and should be considered prior to the use of oral NSAIDs due to lower systemic exposure14
Strongly recommends topical NSAIDs as first-line medications for OA knee pain in patients with or without comorbidities1
What’s your treatment strategy for patients with OA knee pain?
Consider a topical for your patients.Get the details
GI=gastrointestinal; NSAID=nonsteroidal anti-inflammatory drug; OA=osteoarthritis.
- Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non‐surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578‐1589.
- 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.
- National Institute of Diabetes and Digestive and Kidney Diseases. 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 June 14, 2020.
- Centers for Disease Control and Prevention. National diabetes statistics report 2020. Centers for Disease Control and Prevention website. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed June 14, 2020.
- 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.
- Arthritis Foundation. Arthritis by the numbers. Arthritis Foundation website. https://www.arthritis.org/getmedia/73a9f02d-7f91-4084-91c3-0ed0b11c5814/abtn-2020-final.pdf. Accessed June 14, 2020.
- 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% [prescribing information] Horizon.
- Crofford LJ. Use of NSAIDs in treating patients with arthritis. Arthritis Res Ther. 2013;15(suppl 3):S2.
- Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2020;72(2):149-162.