Sammanfattning
Background: The object of this review article is to summarise the current knowledge on how the route of administration (topical vs. oral) of NSAIDs affects their final concentration in the various joint tissues and muscle (Ctissue), compared to blood plasma (Cplasma). Whether the ratio Ctissue/Cplasma is more beneficial after topical administration, and if the concentrations reached in target tissue are of sufficient magnitude to achieve a therapeutic effect, will be discussed.
Material and methods: Systematic search in the databases Medline, Pubmed and Cochrane Library with subsequent inclusion/exclusion based on predefined criteria.
Results: Seven papers fulfilled all inclusion criteria, whilst 10 studies provided supporting data. The ratio Ctissue/Cplasma increased after topical administration for muscles and other nearby tissues like tendons. Levels of Ctissue associated with therapeutic effect were reached. The exception was synovial fluid, where Ctissue was too low to prove efficient, and the results regarding the influence of administration route on the ratios, were conflicting. Generally, the number of test ubjects was limited, and the individual variation among them was high.
Conclusion: Topical NSAIDs are advantageous in cases of muscle, tendon and soft tissue inflammation, but not arthritis. A high individual variation is expected for both administration ways.