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."
American College of Rheumatology