Arthritis Creams: Brief Relief

An analysis of more than 35 years of research on anti-inflammatory creams and gels used widely in Europe has raised doubts over whether they really ease arthritis pain for very long.

Pain-relieving ointments that don't contain steroids are often recommended to people with arthritis as a more tolerable alternative to pills, which can cause stomach bleeding. The products are widely available in Europe.

In research published this week in the British Medical Journal, scientists concluded that creams containing pain killers like ibuprofen, called non-steroidal anti-inflammatory drugs, or NSAIDs, appear to work only for a week or two at most when rubbed onto aching joints. The analysis involved a review of evidence from 13 separate trials pooled together.

However, other experts said they are not convinced by the findings and that arthritis sufferers should not abandon the creams just yet.

"These trials are all small," said Andrew Moore, a pain research expert at Oxford University who was not connected with the analysis. "What you get is such variation that even a well-done trial can turn out positive or negative just by the random play of chance."

"It's not just topical NSAIDs they are looking at. It's different doses, different drugs, different durations. There are all sorts of things going on here. By the time you start cutting it down, you don't get enough information to be happy with,'' he said.

The studies involved the non-steroidal anti-inflammatories diclofenac, eltenac, ibuprofen and salicylate. The drugs, which come as creams, gels, sprays and sticks, are sold under scores of different brand names, such as Ibuleve, Deep Relief, Proflex and Volterol.

Most of the studies followed patients for one or two weeks and only four of them -- using two different drugs -- lasted for four weeks.

"For diclofanac, one week it was OK, two weeks it was OK, but after that there was no evidence. For others, they worked for two weeks and then the effect died down,"' said the study's lead investigator Weiya Zhang, a rheumatology epidemiologist at the University of Nottingham in England.

"At the moment, the evidence does really not support topical NSAIDs for more than two weeks," he said. "It's worth trying but don't expect too much.''

The creams are not as popular as their pill counterparts, but are often the first-line treatment especially for those with simple arthritis in a single joint.

About 15 percent of people over the age of 45 have osteoarthritis, which is characterized by progressive wearing away of the cartilage in the joints. It causes pain, stiffness and limitation of movement. There is no cure and treatment focuses on relieving pain and preventing the joint from becoming deformed.

Zhang theorized that the reason the studies showed the creams worked for two weeks, but not longer, could be that it is the rubbing rather than the ointment that relieves the pain and that rubbing will only work for so long. He said that until longer-duration studies a conducted, doubts will remain.

Moore said a major study that followed osteoarthritis patients for three months is finishing up now and has found that the creams and gels seem to be just as good for pain relief as the equivalent pills. Those results are expected to be published in the next few months.

By Emma Ross