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Bursitis and periarticular inflammation
NATHANAEL WOOD AND JOHN H. BURTON
n Agents
n NSAIDs
n Corticosteroids
n Local anesthetics
n Hyaluronate
n Evidence
There are few rigorously conducted clinical trials assessing specific therapy
for nonseptic bursitis. In fact, many “bursitis” studies actually include
patients with various related periarticular inflammatory disorders (e.g. bursitis,
capsulitis, tendinitis). First-line treatments of nonseptic bursitis include
NSAIDs, aspiration, and injection therapy with corticosteroids and local
anesthetics. Disease processes in the periarticular regions (e.g. epicondylitis)
are usually treated with NSAIDs, in similar fashion to the recommendations
outlined for bursitis. Some periarticular conditions warranting special
mention are included in the following discussion.
With regard to systemic drug therapy, NSAIDs are the analgesic mainstay,
with much of the available evidence addressing use of diclofenac. Anillustrative
study examined patients with acute shoulder tendinitis or bursitis and
showed that nearly all patients (90%) had pain reduction after two weeks of
diclofenac (50 mg PO BID or TID, with misoprostol added for GI protection). 1
An RCT enrolling patients who failed with other NSAIDs found that once-daily
PO oxaprozin (1200 mg) provided pain relief equivalent to that achieved by
PO diclofenac TID (50 mg per dose); patients receiving oxaprozin showed
improved overall function scores on a variety of measures. 2 Results for periarticular
inflammation other than bursitis are similar to the findings for bursitis.
For example, Cochrane review of lateral epicondylitis trials found no evidence
of difference between NSAIDs, or for use of topical rather than PO NSAIDs. 3
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