Evidence map›Paper›PMID 29436380›Full record

SynthesisBritish journal of sports medicine2018

Relative efficacy and safety of topical non-steroidal anti-inflammatory drugs for osteoarthritis: a systematic review and network meta-analysis of randomised controlled trials and observational studies.

Chao Zeng, Jie Wei, Monica S M Persson, Aliya Sarmanova, Michael Doherty, Dongxing Xie, YiLun Wang, Xiaoxiao Li, Jiatian Li, Huizhong Long and 2 more

Open access · hybridAbstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in British journal of sports medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 94 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
94citing papers in PubMed, 11 pooled it
15.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

94 citing papers in PubMed, 11 syntheses or guidelines pooled it, 223 citations in OpenAlex.

  1. Impact of treatment duration on the effectiveness of opioid analgesia: a systematic review and meta-analysis.The British journal of general practice : the journal of the Royal College of General Practitioners · 2026
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34 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 6 institutions in 3 countries.

Chao Zeng *Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Jie Wei *Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Monica S M PerssonAcademic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK.
Aliya SarmanovaAcademic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK.
Michael DohertyAcademic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK.
Dongxing XieDepartment of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
YiLun WangDepartment of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Xiaoxiao LiHunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China.
Jiatian LiDepartment of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Huizhong LongDepartment of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Guanghua Lei *Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Weiya Zhang *Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK.
Xiangya Hospital Central South University · CNCentral South University · CNUniversity of Nottingham · GBCenter for Rheumatology · USHunan University · CNVersus Arthritis · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo compare the efficacy and safety of topical non-steroidal anti-inflammatory drugs (NSAIDs), including salicylate, for the treatment of osteoarthritis (OA).

methodsPubMed, Embase, Cochrane Library and Web of Science were searched from 1966 to January 2017. Randomised controlled trials (RCTs) comparing topical NSAIDs with placebo or each other in patients with OA and observational studies comparing topical NSAIDs with no treatment or each other irrespective of disease were included. Two investigators identified studies and independently extracted data. Bayesian network and conventional meta-analyses were conducted. The primary outcomes were pain relief for RCTs and risk of adverse effects (AEs) for observational studies.

results43 studies, comprising 36 RCTs (7 900 patients with OA) and seven observational studies (218 074 participants), were included. Overall, topical NSAIDs were superior to placebo for relieving pain (standardised mean difference (SMD)=-0.30, 95% CI -0.40 to -0.20) and improving function (SMD=-0.35, 95% CI -0.45 to -0.24) in OA. Of all topical NSAIDs, diclofenac patches were most effective for OA pain (SMD=-0.81, 95% CI -1.12 to -0.52) and piroxicam was most effective for functional improvement (SMD=-1.04, 95% CI -1.60 to -0.48) compared with placebo. Although salicylate gel was associated with higher withdrawal rates due to AEs, the remaining topical NSAIDs were not associated with any increased local or systemic AEs.

conclusionsTopical NSAIDs were effective and safe for OA. Diclofenac patches may be the most effective topical NSAID for pain relief. No serious gastrointestinal and renal AEs were observed in trials or the general population. However, confirmation of the cardiovascular safety of topical NSAIDs still warrants further observational study.

Indexed as

Administration, CutaneousAnti-Inflammatory Agents, Non-SteroidalBayes TheoremHumansOsteoarthritisPainRandomized Controlled Trials as TopicSalicylatesTransdermal PatchAnti-Inflammatory Agents, Non-SteroidalSalicylatesmeta-analysisosteoarthritis

Identifiers

PMID29436380
PMCPMC5931249
OpenAlexW2785418475

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.