Osteoarthritis patients looking for pain relief have a new option that doesn't involve popping a pill. Voltaren Gel, made by Novartis and newly approved by the Food and Drug Administration, is applied directly to the skin covering the arthritic knee or hand.
The gel is the first topical nonsteroidal anti-inflammatory prescription medication for osteoarthritis pain approved in the United States, according to Novartis. It may appeal to people who are worried about side effects with the oral NSAIDs, which can include heart attack, stroke, and bleeding or ulceration of the stomach or intestines. Voltaren may be less likely to cause such problems because it is applied locally, experts say.
"The advantage to this preparation is that it seems like it's providing comparable relief, but with little systemic absorption," says Raymond Flores, associate professor of medicine in the rheumatology division at the University of Maryland School of Medicine, who regularly treats osteoarthritis patients and is not affiliated with Novartis. Topical NSAIDs have been available for some time in other countries, where evidence suggests they do offer comparable relief. A 2004 British Medical Journal review of 13 clinical trials found them to be less effective than oral NSAIDs during the first week but equally good at handling pain during Weeks 2 through 4. In Novartis's trials, Voltaren relieved hand pain by 42 percent after four weeks and 46 percent after six weeks. Knee patients saw their pain cut in half after 12 weeks of using the gel. Still, says Flores, people with pain in multiple joints are likely to need the systemic help of an oral medication. And the gel shouldn't be used by patients also taking oral NSAIDs, according to the label.
Voltaren is different from over-the-counter remedies like Bengay and Icy Hot because it contains an anti-inflammatory ingredient called diclofenac sodium; the other ointments don't contain NSAIDs and work primarily by temporarily heating or numbing the affected area. Diclofenac is the most commonly used NSAID in the world and the second-most-used NSAID in the United States after naproxen, according to Roy Altman, a Novartis consultant and professor of medicine in the rheumatology division at the University of California-Los Angeles.