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Topical vs. Oral NSAIDs for Arthritis

Updated on May 7, 2013
Clothes pins used to depict how arthritis sufferers endure their disease throughout the day.
Clothes pins used to depict how arthritis sufferers endure their disease throughout the day. | Source

Arthritis treatment deals with two main symptoms that bother most sufferers; Pain and Inflammation. The swelling in joints and the pain that goes along with it make using those joints difficult. When the swelling or inflammation is controlled the pain usually subsides along with it.

We'll discover the difference between topical and oral non-steroidal anti-inflammatory drugs or NSAIDs, and how treatment is administered for each. We'll also take a look at some of the side effects that NSAIDs has on your body.

In this hub we will cover the following topics concerning arthritis treatment:

  • What are NSAIDs
  • NSAIDs Treatment
  • Topical NSAIDs
  • What is Topical Treatment
  • Side effects of NSAIDs


I am not a doctor, nor am I a medical authourity on the subject of arthritis. This hub is an accumulation of my personal fight with arthritis symptons, treatment, and research. For information concerning your health, always check with your physician. In all you do, have peace. Kawi.

What are NSAIDS?

NSAID is an acronym for Non Steroidal Anti-Inflammatory Drugs. NSAIDs, like their counter-part steroids, also reduce inflammation by going after a chemical in the body called prostaglandins. Prostaglandins promote inflammation, fever, and pain - but they also do some good for the body by protecting your stomach lining against stomach acid, and assists your body with blood platelets. Platelets are the blood clotting capabilities that your blood has to help stop your body from bleeding out.

The enzymes responsible for producing prostaglandins are are called an equally hard to pronounce scientific word; cyclooxygenase or COX. Enzymes COX-1 and COX02 both produce prostaglandins that cause pain, fever, and inflammation or swelling, but only COX-1 makes the prostaglandins that actually protects the stomach and platelets.

Chronic swollen joints, swan's neck forming in the middle finger, swelling in thumb mid knuckle, and top knuckle in the index finger.
Chronic swollen joints, swan's neck forming in the middle finger, swelling in thumb mid knuckle, and top knuckle in the index finger. | Source

NSAIDS Treatment

NSAIDs are used to treat the following conditions; headaches, injuries, colds, joint pain from arthritis, fevers,menstrual cramps and tooth aches.

There are different types of NSAIDs, different in potency and in duration. They affect varying degrees of COX-1 and COX-2 which means some of them could cause more harm with ulcers and bleeding.

Aspirin is an NSAID that prevents the clotting of blood for four to seven days. This makes aspirin a very effective medicine to help patients fight against heart attacks and strokes.

The NSAID Ketorolac is a very potent drug used for great pain. It can only be taken for five days maximum due to this drug's dangerous side effects that can cause ulcers.

Celecoxib has the capability to block COX-2, and selects not to disturb COX-1. This lowers the probability for fewer ulcers and bleeding than other NSAIDs.

Inflammation in middle knuckle of hands are very common in arthritis sufferers.
Inflammation in middle knuckle of hands are very common in arthritis sufferers. | Source

Topical NSAIDS

Topical NSAIDs have been in use for many years - just not so much in the US. The more popular oral NSAIDs have cornered the market since the US Food and Drug Administration has only approved topical NSAIDs in 2007 - this makes topical NSAIDs a relatively new drug, giving oral NSAIDs a huge advantage over topical NSAIDs.

There are studies that have covered both sides of the spectrum when it comes to the effectiveness of topical NSAIDs. Some studies report that there is no difference in the control groups between topical NSAIDs and placebo treatments, others that say the effectiveness of the topical NSAIDs wears off after a few weeks, and still others that show that the topical NSAIDs are very effective to eliminate pain and swelling.

Although there are varying degrees of accuracy, or clarity of the topical drug from existing studies, it is clear that there is a need for more study.

What is Topical Treatment?

With Topical NSAIDs, the treatment is usually in the form of a squeeze tube, the cream is dispensed and applied to the specific area of pain and inflammation. Since the medication is applied directly to the affected area, the medicine can go to work effectively and quickly.

There are studies that suggest that the topical treatment should be used on hands and knees for best results. Obviously, if the location of the pain and swelling is deeper in the joint, the medicine would have a harder time to penetrate the tissue.

The good thing about Topical NSAIDs is that treatment is localized immediately - there is no need for the medicine to be ingested needlessly affecting the entire body.

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Side Effects of NSAIDS

Oral NSAIDs are bad news when it comes to side effects, especially if used long term. The oral NSAIDs side effects vary depending on the drug used. The most common serious side effect being bleeding in the upper intestine.

Since there is a low chance of the drug pooling in the body, studies show that chronic use of the topical NSAIDs have a lower chance of developing upper gastrointestinal bleeding. As far as more serious side effects due to prolonged use of topical NSAIDs, no studies are available at this time.

NSAIDs Side Effects

dizziness, headache, drowsiness, nausea, vomiting, constipation and diarrhea.
Liver and kidney failure, ulcers, upper gastrointestinal bleeding, and prolonged bleeding after injury or surgery.
Topical NSAIDs
There is a higher level of concentration in the dermis compared to oral NSAIDs.
Although prolonged use could cause more serious side effects, there are no studies available that indicate such.
Side effects vary depending on the drug used. For topical NSAIDs, systemic absorption is lower resulting in a more desirable outcome concerning side effects.


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    • KawikaChann profile image

      KawikaChann 2 months ago from Northwest, Hawaii, Anykine place

      Hi Joe,

      Thanks for visiting and leaving a comment, I appreciate it. I understand how you feel about writers that just spit stuff out without doing their own research or simply copy/paste.

      Your comment was that "Prostaglandins aren't considered chemicals. It's more closely associated with a hormone." I ask you then what is a hormone?

      Hormone: A chemical substance produced in the body that controls and regulates the activity of certain cells or organs.

      As for the rest of your comment, everyone is entitled to their own opinion - no matter how scalding. Good luck and hope we can converse again. Peace. Kawi.

    • joecseko profile image

      Joe Cseko jr 2 months ago from New York, USA, Earth

      Prostaglandins aren't considered chemicals. It's more closely associated with a hormone.

      You've plagiarized most of this. I'm reporting you!

      Hack! Much of what YOU wrote is wrong.

    • KawikaChann profile image

      KawikaChann 4 years ago from Northwest, Hawaii, Anykine place

      Thanks for your comment Alison - yes having topical NSAIDs is relatively new here in the US, I just wanted folks to know that it's available just for the purpose that it gives you an upset stomach. It's not as readily available as it is in the pill/tablet form. Peace. Kawi.

    • Alison Graham profile image

      Alison Graham 4 years ago from UK

      Clear explanations and good information here for anyone trying to decide whether to use oral or topical NSAIDs for the relief of their arthritis. Although I have not got the condition myself, I do use topical medication here in the UK for back pain as all the tablets I have tried cause tummy upset for me. Voted up and useful and shared.