If you have arthritis in just one or two joints, you may not need to expose yourself to the risks of oral non-steroidal anti-inflammatory drugs (NSAIDs) – such as ulcers; stomach upset; or potential heart, kidney or liver problems – in order to achieve some relief. Rubbing an NSAID on your skin is now possible.
The FDA recently approved Voltaren Gel as the first prescription skin gel to treat osteoarthritis (OA) pain. The gel contains diclofenac sodium, an NSAID that is the main ingredient in Voltaren pills. (Read the latest FDA warnings on topical analgesics.)
A prescription topical NSAID is great news for select people with arthritis, says Roy D. Altman, MD, a professor of medicine in the division of rheumatology and immunology at the University of California, Los Angeles (UCLA).
Voltaren Gel may be a good option if:
• You have arthritis in smaller joints. “The new Voltaren Gel gives patients the ability to apply something topically, which will not give significant blood levels, but will penetrate the skin and help reduce pain,” Dr. Altman says. “Voltaren Gel works as well as its oral predecessor when it comes to joints that are closer to the surface, such as the hands, knees, and perhaps the elbows and ankles.”
In the studies that led to the new gel’s approval, pain levels fell by 46 percent among people with hand OA after they applied Voltaren Gel for six weeks. In a 12-week study of people with knee OA, there was a 51-percent reduction in pain.
• You are older than 65. “A lot of elderly patients can’t take oral NSAIDs because they have stomach or heart risk factors, and they can’t take narcotic analgesics because they could become so drowsy they could fall and break a bone,” Dr. Altman says.
• You want to avoid pills. Some people with OA who want to avoid systemic side effects seek compounding pharmacies, so that they can have their favorite painkiller made into a topical formula. Pharmacists literally can take the medication out of the capsule and make it into a gel – voilà!
“This can be fairly expensive, however, and it can be inconsistent from one batch to another,” says Dr. Altman. “The new gel is less expensive and more consistent than a compounded topical formula. In addition, it comes with disposable dosing strips that show you exactly how much gel to use.” You squeeze the gel onto a card along the line for your dose, wipe the card directly onto your joint and rub it gently into the skin.
Voltaren Gel may not be a good option if:
• You also take oral NSAIDs. It’s not that the gel’s active ingredient doesn’t get into your bloodstream – it does, Dr. Altman says. “Some does get absorbed, just substantially less than with a pill,” he says. Specifically, 94 percent less is absorbed from the gel than from its oral counterpart. However, the new gel should not be used in combination with oral NSAIDs or aspirin because of the potential for adverse effects. When used alone, the only real side effects of the topical products are skin reactions where they are applied.
• You have several affected joints. “Voltaren Gel works fairly quickly – within a week – but the pill works quicker,” says Dr. Altman. And taking a pill would be a lot easier for someone who has multiple joints affected by arthritis, he says.
