Table 7.35Adverse events

AEs outcomeReferenceInterventionAssessment timeOutcome/effect size
Knee osteoarthritis
Minor skin dryness1 MA (Towheed 2006) 3 RCTsTopical diclofenac vs placeboOver treatment periodMinor skin dryness
RR 1.74, 95% CI 1.37 to 2.22
Favours topical Pennsaid
Paresthsia, rash, any AEs, gastrointestinal (GI) AEs1 MA (Towheed 2006) 3 RCTsTopical diclofenac vs placeboOver treatment periodNS
GI AEs1 MA (Towheed 2006) 1 RCTTopical diclofenac vs oral diclofenacOver treatment periodRR 0.72, 95% CI 0.59 to 0.87
Favours topical Pennsaid
Severe GI AEs1 MA (Towheed 2006) 1 RCTTopical diclofenac vs oral diclofenacOver treatment periodRR 0.35, 95% CI 0.17 to 0.72
Favours topical Pennsaid
Dry skin reactions1 MA (Towheed 2006) 1 RCTTopical diclofenac vs oral diclofenacOver treatment periodRR 20.8, 95% CI 7.7 to 55.9
Favours oral diclofenac
Rash1 MA (Towheed 2006) 1 RCTTopical diclofenac vs oral diclofenacOver treatment periodRR 7.2, 95% CI 2.9 to 18.1
Favours oral diclofenac
Total number of AEs1 RCT (Niethard et al. 2005) N=238Topical diclofenac vs placeboOver treatment periodBoth: 9%
GI AEs1 RCT (Niethard et al. 2005) N=238Topical diclofenac vs placeboOver treatment period0% (topical)
1.7% (placebo)
Skin AEs1 RCT (Niethard et al. 2005) N=238Topical diclofenac vs placeboOver treatment period2.9% (topical)
2.5% (placebo)
AEs1 RCT (Trnavsky et al. 2004) N=50Topical ibuprofen vs placeboOver treatment periodNone in either group
Knee or hand or mixed sites
Number of patients with AEs; number of patients with GI AEs; number of patients with CNS AEs; local AEs – skin reactions1 MA (Lin et al. 2004) (N=1108)Topical NSAIDs vs placeboOver treatment periodNS
Local AEs – skin reactions1 MA (Lin et al. 2004) (N=443)Topical NSAIDs vs oral NSAIDsOver treatment periodRate ratio 5.29, 95% CI 1.14 to 24.51, p≤0.05
Favours oral NSAIDs
Number of patients with AEs or GI AEs1 MA (Lin et al. 2004) (N=764)Topical NSAIDs vs oral NSAIDsOver treatment periodNS
Number of patients with CNS AEs1 MA (Lin et al. 2004) (N=443)Topical NSAIDs vs oral NSAIDsOver treatment periodNS

From: 7, Pharmacological management of osteoarthritis

Cover of Osteoarthritis
Osteoarthritis: National Clinical Guideline for Care and Management in Adults.
NICE Clinical Guidelines, No. 59.
National Collaborating Centre for Chronic Conditions (UK).
Copyright © 2008, Royal College of Physicians of London.

All rights reserved. No part of this publication may be reproduced in any form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.