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Pharmacological therapies 

Pharmacological therapies
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date: 30 October 2020

Topical pharmacological agents such as non-steroidal anti-inflammatory drugs (NSAIDs) and capsaicin are widely recommended as first-line analgesics in the treatment of osteoarthritis (OA) of the knee, hand, and potentially other peripheral joints in view of their safety and efficacy. Although initial studies were short in duration (2–4 weeks), recent randomized controlled trials have confirmed the efficacy of topical NSAIDs over longer (12-week) study periods. Systematic reviews demonstrate that their efficacy can be equivalent to oral NSAIDs for OA pain, but they have a significantly better systemic toxicity profile than the corresponding oral formulations. Topical capsaicin is less well studied than topical NSAIDs but has been demonstrated to be effective in several placebo-controlled clinical trials. Local warming and an uncomfortable burning sensation is a common problem with initial applications, but this subsides with continued treatment and can be minimized by using a low-strength preparation (e.g. 0.025%) initially. Several other topical treatments such as drug-free transfersome gel and local lignocaine patches have been shown to be effective in controlling pain due to OA. However, they have been studied in relatively few studies and currently are not recommended for general use.

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