New ACR guidelines recommend use of topical NSAIDs for older patients with knee OA

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The American College of Rheumatology (ACR) Subcommittee on Osteoarthritis Guidelines has approved and issued several updates to clinical practice guidelines for the treatment of osteoarthritis (OA).    

The new guidelines, published in the April issue of Arthritis Care & Research, conditionally recommend that healthcare providers consider topical nonsteroidal anti-inflammatory drugs (NSAIDs) as one option for the initial management of knee OA, along with other treatments including acetaminophen, oral NSAIDs, tramadol and intraarticular corticosteroid injections. In addition, the guidelines strongly recommend the use of oral or topical NSAIDs or intraarticular corticosteroid injections in patients with an unsatisfactory clinical response to full-dose acetaminophen, and furthermore strongly recommend topical over oral NSAIDs in those patients aged 75 years or older initiating NSAID therapy.

Commenting on the new guidelines, Marc C. Hochberg, MD, MPH, said, "Osteoarthritis is the most common form of arthritis affecting adults in the United States and is the principal cause of musculoskeletal pain, limitation in physical activity and reduction in health-related quality of life. It is important for all primary care providers and specialists taking care of patients with osteoarthritis to recognize that there is a lot that can be offered to the patient to reduce their pain and improve their function." Dr. Hochberg is professor of medicine and epidemiology and public health, University of Maryland School of Medicine, Baltimore, and chair of the Task Force that developed the new ACR recommendations.

Knee OA is a chronic condition in which joint cartilage--the smooth tissue that cushions the bone and allows easy joint movement--breaks down, leading to pain and loss of physical function. Mallinckrodt LLC, a Covidien company, markets PENNSAID® (diclofenac sodium topical solution) 1.5% w/w, a topical NSAID. PENNSAID is the only U.S. Food and Drug Administration (FDA)-approved topical NSAID for the treatment of the signs and symptoms of knee OA, which demonstrated statistically significant differences in pain and physical function compared to placebo.

"Knee OA pain is one of the top five causes of disability in American adults," said Alfredo Bozzini, Interim Chief Medical Officer, Pharmaceuticals, Covidien. "We support the ACR treatment guidelines and believe topical NSAIDs, like PENNSAID, provide an effective option for reducing knee OA pain."

"The American College of Rheumatology osteoarthritis treatment guidelines propose to advance the use of topical NSAIDs beyond what the American Geriatric Society and American Academy of Orthopedic Surgeons recommend," said Dr. Joseph Markenson, attending physician at the Hospital for Special Surgery and professor of clinical medicine at Weill Cornell Medical College. "The updated guidelines are helpful to physicians in their clinical practice, especially when seeing patients over 75 years of age."


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