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Safety and Efficacy of a Novel Topical Analgesic for Treatment of Basal Thumb Arthritis: A Pilot Study
Patrick M. Kane, MD1; Michael P. Gaspar, MD1; Mihir M. Sheth, BS2; Evan Baron, BS2; Sidney M. Jacoby1; Eon K. Shin, MD1
1Philadelphia Hand Center, Philadelphia, PA; 2Thomas Jefferson University, Philadelphia, PA

Objective: To measure the efficacy and safety of a novel topical anti-inflammatory/analgesic formulation for the treatment of primary thumb carpometacarpal (CMC) osteoarthritis (OA).

Methods: A retrospective review of patients prescribed a custom topical analgesic containing active ingredients: Meloxicam, Baclofen and Lidocaine, with a 3% pentoxifylline base (Bellevue Pharmacy, St. Louis, MO) for treatment of thumb CMC OA was performed. Patients were excluded if they had corticosteroid injection of the affected joint within 2 months of treatment with the topical. Patients were given a QuickDASH survey after completing a course of topical treatment and results were compared to pre-treatment scores, when available. In addition, patients were given a 9-item survey regarding specific physical properties related to the cream itself (the "Cream Score"). Each item was scored 1-5, with 1 being the best possible score for each item (total minimum score = 9, maximum = 45). Patients were also asked to list any local adverse reactions or systemic side-effects or from using the cream.

Results: A total of 22 (19 female, 3 male) patients satisfied inclusion in this study. Average age was 54.8 +/- 10.5 years. Mean post-treatment QuickDASH was 22.3 +/- 7.3 compared to 25.4 +/- 6.6 pre-treatment (p = 0.252). For QuickDASH item regarding pain severity, mean post-treatment item score was 2.5 +/- 0.94 compared to 3.3 +/- 0.83 (p = 0.027). The mean Cream Score for all patients was 12 +/- 3.12. No patients reported any local adverse skin reactions. In addition, no cardiac events, gastrointestinal bleeding or ulcers were reported.

Conclusion: In this pilot study, we found that a novel topical analgesic/anti-inflammatory medication containing Meloxicam, Baclofen and Lidocaine was safe and well tolerated when used in for the treatment of patients with thumb CMC OA. Patients reported improvements in outcome scores, particularly with regards to pain, which saw significant improvement when compared to pre-treatment levels. Further investigation regarding this cream's efficacy in treating thumb CMC arthritis and other upper-extremity conditions is warranted.

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