Do NSAID gels and creams work for knee arthritis?

What it is

NSAID stands for non steroidal anti inflammatory drug. Ibuprofen and diclofenac are examples. Rubbed into the skin over the knee as a gel or cream, a small amount reaches the joint. Less reaches the rest of the body than with tablets.

What the research shows

A Cochrane review pooled 39 studies with 10,631 people. Diclofenac gel was tested in six trials with 2,343 people. About 10 people needed to use it for 1 to get a good result that a plain gel would not have given. Ketoprofen gel was tested in four trials with 2,573 people. About 7 people needed to use it for 1 extra good result.

Almost all of this evidence came from people with knee arthritis. There was no evidence for other long lasting painful conditions. Few trials compared a gel with tablets, and they suggested similar pain relief, but the quality of that evidence was low. Most guidelines now advise trying a gel before tablets. The international OARSI guideline, the American College of Rheumatology and the UK NICE guideline all put gels first among medicines for knee arthritis, and the Australian GP guideline lists them as a reasonable option for flares.

Risks and effort

Diclofenac gel caused more mild skin reactions than a plain gel or tablets. Ketoprofen gel did not.

What usually works instead

Exercise and strength work for the leg muscles have the best evidence. See Does exercise work for knee arthritis? and Osteoarthritis of the Knee.

Questions people ask

Why do so many people feel nothing?

The numbers show that most people did not get a good result beyond the plain gel. A gel works for some people and not for others, and it can be tried for a few weeks.

Is a gel as good as tablets?

The few trials that compared them found similar relief. The quality was low, so this is uncertain.

Does it work on other joints?

The review found no evidence for other long lasting painful conditions.

Is it safe with other medicines?

Ask your doctor or pharmacist, especially if you take blood thinners or have kidney problems.

Sources

Select a source to read what the study or guideline found, in plain words, with a link to the original.

• 1Cochrane review of anti-inflammatory gels, 2016Review
• 2OARSI guideline for knee and hip osteoarthritis, 2019International guideline
• 3American College of Rheumatology guideline, 2020US guideline
• 4NICE guideline on osteoarthritis, 2022UK guideline
• 5RACGP guideline for knee and hip osteoarthritis, 2018Australian guideline

Last reviewed 24 October 2026. Next review due October 2028.