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Topical NSAIDs tolerated best for knee pain

Topical NSAIDs are as effective for knee pain as oral forms, but better tolerated, say primary care researchers.

Their trial involved randomising 282 patients aged 50 years or over to a topical or oral NSAID – first choice ibuprofen - for their chronic knee pain.

Pain and disability measures were similar in both groups, but the topical treatment was associated with fewer respiratory side effects: seven per cent compared to 17% of patients taking oral treatments.

Serum creatinine levels were higher in those taking the oral form and numbers leaving the treatment group due to adverse effects were also greater.

Dr Iain Gilchrist, a GP in Bishop's Stortford, Hertfordshire, and treasurer of the Primary Care Rheumatology Society, said he was slightly surprised by these results. ‘My impression was that topical treatments were not as effective as oral medications,' he said.

Dr Gilchrist said many patients liked using topical treatments and he found less GI side-effects with them. ‘GPs prescribing topical NSAIDs may run into problems with prescribing advisers, but if you can prove that it is cost effective and there are fewer side-effects then they can counter the argument,' he said.

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