{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T23:19:08Z","timestamp":1777936748218,"version":"3.51.4"},"reference-count":25,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Rehabilitation Process and Outcome"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec>\n                    <jats:title>A Narrative Review:<\/jats:title>\n                    <jats:p>The use of the topical nonsteroidal anti-inflammatory drugs (NSAID) ibuprofen for the treatment of knee osteoarthritis. Supporting clinician decision-making in the first-line treatment of osteoarthritis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To open discussion at a clinical level on the guidelines for the pharmacological management of osteoarthritis of the knee, this narrative review looks into the use of topical NSAID being a clinically effective, safe, and cost-efficient treatment compared to an oral alternative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>With the over prescription of NSAIDs in the age of above 65 years, there has been a call for increased restrictions of the sale of oral preparations of NSAIDs. It is our view that there is still a lack of awareness in the benefit of topical NSAIDs to the patient (no evidence of adverse reactions recorded by the Joint Formulary Committee [JFC] to date) as well as provider (topical application is cheaper as a National Health Service [NHS] prescription).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Key online resources included PubMed, Athens, Cochrane Library, Google Scholar, MEDLINE, and relevant clinical and commissioning guidelines with the final date of data collection in March 2017. We also contacted the manufacturer and license holder directly for further clarification. Randomized, double-blind control studies, commissioned reports, International Guidelines, MEHA Guidelines, and license holder data were included. Where possible studies included had to have fair randomization and adhere to key treatment pathways as highlighted by National Institute for Health and Clinical Excellence (NICE) and other guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>Current guidelines advise that patients who seek initial treatment of osteoarthritis of the knee should consider a combination of treatment modalities, including pharmacological therapies, particularly the use of NSAIDs. At a clinical level, a reoccurring issue identified with this advice is the inappropriate use of oral NSAIDs, and the concern that the risks associated with ease of access (\u201cover the counter\u201d), and overuse, may result in systemic adverse events in this cohort of patients. Multiple studies have examined the negative effect of oral NSAIDs and the associated risks of use. We were unable to source studies that showed any adverse systemic events from the use of topical NSAIDs; however, there are good quality trials comparing oral to topical NSAIDs, showing similar levels of efficacy at 6 and 12\u2009weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Topical NSAIDs provide good levels of pain relief in subjects with mild to moderate knee osteoarthritis. There is also evidence for the use of the topical application being a clinically effective, safe, and cost-efficient treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1179572720914945","type":"journal-article","created":{"date-parts":[[2020,6,11]],"date-time":"2020-06-11T14:55:31Z","timestamp":1591887331000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["A Narrative Review: The Use of the Topical NSAID Ibuprofen for the Treatment of Knee Osteoarthritis. Supporting Clinician Decision-Making in the First-Line Treatment of Osteoarthritis"],"prefix":"10.1177","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2229-4196","authenticated-orcid":false,"given":"Catrin","family":"Hawthorn","sequence":"first","affiliation":[{"name":"CMATS Carmarthenshire, Glangwilli General Hospital, Hywel Dda University Health Board, Carmarthen, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,6,11]]},"reference":[{"key":"bibr1-1179572720914945","unstructured":"National Institute for Health and Clinical Excellence. Osteoarthritis: The Care and Management of Osteoarthritis in Adults (NICE Clinical Guideline 59). London, England: National Institute for Health and Clinical Excellence; 2008. http:\/\/www.nice.org.uk\/nicemedia\/pdf\/CG59NICEguideline.pdf. Accessed January 5, 2017."},{"key":"bibr2-1179572720914945","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2014.05.014"},{"key":"bibr3-1179572720914945","doi-asserted-by":"crossref","unstructured":"Olsen AM, Fosb\u00f8l EL, Lindhardsen J, et al. Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction: a nationwide cohort study. Circulation. 2011;123(20):2226-2235. http:\/\/circ.ahajournals.org\/content\/123\/20\/2226.full.pdf. Accessed April 12, 2017.","DOI":"10.1161\/CIRCULATIONAHA.110.004671"},{"key":"bibr4-1179572720914945","doi-asserted-by":"publisher","DOI":"10.2147\/TCRM.S24458"},{"key":"bibr5-1179572720914945","first-page":"CD007402","volume":"6","author":"Derry S","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr6-1179572720914945","first-page":"571","volume":"21","author":"American Academy of Orthopaedic Surgeons","year":"2013","journal-title":"J Am Acad Orthop Surg"},{"key":"bibr7-1179572720914945","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2009.02376.x"},{"key":"bibr8-1179572720914945","doi-asserted-by":"crossref","unstructured":"Hochberg MC, Altman RD, April Benkhalti KTM, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012;64:465-474. http:\/\/www.rheumatology.org\/practice\/clinical\/guidelines\/PDFs\/ACR_OA_Guidelines_FINAL.pdf. Accessed March 23, 2017.","DOI":"10.1002\/acr.21596"},{"key":"bibr9-1179572720914945","doi-asserted-by":"crossref","unstructured":"Jordan KM, Arden NK, Doherty M, et al. EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a task force of the standing committee for International Clinical Studies Including Therapeutic Trials (ESCISIT) [extended report]. Ann Rheum Dis. 2003;62:1145-1155.\u2009http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1754382\/pdf\/v062p01145.pdf. Accessed January 5, 17.","DOI":"10.1136\/ard.2003.011742"},{"key":"bibr10-1179572720914945","doi-asserted-by":"crossref","unstructured":"Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16:137-162. https:\/\/www.oarsi.org\/sites\/default\/files\/library\/2013\/pdf\/part_ii_oarsi_recommendations_for_management_of_hipknee_oa_2007.pdf. Accessed December 10, 2016.","DOI":"10.1016\/j.joca.2007.12.013"},{"key":"bibr11-1179572720914945","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-6-44"},{"key":"bibr12-1179572720914945","first-page":"457","volume":"13","author":"Tiso RL","year":"2010","journal-title":"Pain Physician"},{"key":"bibr13-1179572720914945","volume-title":"British National Formulary","author":"Joint Formulary Committee","year":"2014","edition":"68"},{"key":"bibr14-1179572720914945","doi-asserted-by":"crossref","unstructured":"Bushra R, Aslam N. An overview of clinical pharmacology of ibuprofen. Oman Med J. 2010;25:155-1661. www.ncbi.nlm.nih.gov. Accessed February 19, 2017.","DOI":"10.5001\/omj.2010.49"},{"key":"bibr15-1179572720914945","doi-asserted-by":"publisher","DOI":"10.1111\/pme.12288"},{"key":"bibr16-1179572720914945","unstructured":"Voltaren Gel\n                      [package insert]. Chadds Ford, PA: Endo Pharmaceuticals Inc; 2009. http:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2009\/022122s006lbl.pdf. Accessed March 10, 2016."},{"key":"bibr17-1179572720914945","unstructured":"Amdipharm Mercury Company Limited. SPC oral ibuprofen 400mg. https:\/\/www.medicines.org.uk\/emc\/search\/?q=ibuprofena=178. Updated 2014. Accessed February 23, 2016."},{"key":"bibr18-1179572720914945","unstructured":"Amdipharm Mercury Company Limited. SPC topical ibuprofen 10%. https:\/\/www.medicines.org.uk\/emc\/search. Updated 2014. Accessed February 23, 2016."},{"key":"bibr19-1179572720914945","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2009.03.008"},{"key":"bibr20-1179572720914945","unstructured":"MHRA scientific discussion: Ibuleve Pain relief gel 5%. PL 00173\/0408 application for marketing and sale. MHRA-UKPAR; July 6, 2010."},{"key":"bibr21-1179572720914945","unstructured":"MHRA scientific discussion: Nurofen Maximum Pain relief gel 10%. PL 10972\/0089 application for marketing and sale. MHRA-UKPAR; July 27, 2012."},{"key":"bibr22-1179572720914945","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(96)03033-3"},{"key":"bibr23-1179572720914945","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-200831060-00009"},{"key":"bibr24-1179572720914945","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.95B7.30904"},{"key":"bibr25-1179572720914945","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1M059"}],"container-title":["Rehabilitation Process and Outcome"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1179572720914945","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1179572720914945","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1179572720914945","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T03:42:33Z","timestamp":1777693353000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1179572720914945"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":25,"alternative-id":["10.1177\/1179572720914945"],"URL":"https:\/\/doi.org\/10.1177\/1179572720914945","relation":{},"ISSN":["1179-5727","1179-5727"],"issn-type":[{"value":"1179-5727","type":"print"},{"value":"1179-5727","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1]]},"article-number":"1179572720914945"}}