Background: Knee osteoarthritis is a common disease in older age. Pain and limitation of movement are the main symptoms of knee osteoarthritis. Many pharmacological options are available for symptomatic relief but NSAIDs are mostly prescribed. Diacerein is also prescribed for osteoarthritis but data regarding its efficacy is still controversial. Moreover, studies regarding the comparison of diacerein with NSAIDs are deficient in Pakistan.
Objective: The objective of the study was to compare the clinical efficacy of naproxen (NSAID) with diacerein in treating knee osteoarthritis.
Methodology: Patients fulfilling inclusion criteria were included in the study. After written informed consent 60 patients of knee osteoarthritis were included in the study. They were divided randomly into two groups. Group A (n=30) was prescribed with tablet naproxen 500mg twice daily and group B (n=30) was given capsule diacerein 50mg twice daily for 12 weeks. Baseline VAS and WOMAC scores of the patients were noted. These scores were compared with scores achieved 12 weeks after intervention. Intra-group comparison of the scores was also carried out. SPSS version 23.0 was used for statistical analysis.
Results: WOMAC and VAS scores comparison of the two groups (A & B) before intervention showed an insignificant p-value that is 0.815 for the WOMAC score and 0.509 for the VAS score. After intervention means WOMAC score i.e.10.50 ± 2.46 of group A (treated with naproxen) was better than the mean 29.62 ± 7.03 of group B (treated with diacerein) showing significant p-value (< 0.001). Similarly mean VAS of group A 1.92 ± 0.58 improved more than the mean VAS of group B i.e 3.38 ± 0.75 with significant p-value (< 0.001). Intra-group comparison of the groups also showed a significant p-value.
Conclusion: Clinical efficacy of naproxen is better than diacerein in treating knee osteoarthritis.
Nelson AE Osteoarthritis year in review 2017: clinical. Osteoarthr Cartil. 2018; 26(3): 319–325. https://doi.org/10.1016/j.joca.2017.11.014
Kiadaliri AA, Lohmander LS, Moradi-Lakeh M, Petersson IF, Englund M. High and rising burden of hip and knee osteoarthritis in the Nordic region, 1990-2015. Acta Orthop, 2018; 89(2): 177-183. https://doi.org/10.1080/17453674.2017.1404791
Khanna V, Sharma R. Incidence of primary osteoarthritis knee below 40 years of age and its etiological factors: OPD survey of 200 knee pain patients. Ind J Orthop Surg 2019; 5(1): 88–94. https://doi.org/10.18231/j.ijos.2019.015
Abdel-Aziz MA, Ahmed HMS, EI-Nekeety AA, Sharaf HA, Abdel-Aziem SH, Abdel-Wahhab MA. Biosynthesis of gold nanoparticles for the treatment of osteoarthritis alone or in combination with Diacerein® in a rat model. Inflammopharm. 2021; 29(3): 705-719. https://doi.org/10.1007/s10787-021-00833-8
Mathiessen, A., Conaghan, P.G. Synovitis in osteoarthritis: current understanding with therapeutic implications. Arthritis Res Ther 2017; 19(1): 1-9. https://doi.org/10.1186/s13075-017-1229-9
Verbeek J, Mischke C, Robinson R, Ijaz S, Kuijer P, Kievit A, et al. Occupational Exposure to Knee Loading and the Risk of Osteoarthritis of the Knee: A Systematic Review and a Dose-Response Meta-Analysis. Saf Health Work. 2017; 8(2): 130-142. https://doi.org/10.1016/j.shaw.2017.02.001.
Ishijima, M., Kaneko, H., Hada, S. Kinoshita M, Sadatsuki R, Liu L, et al. Osteoarthritis as a Cause of Locomotive Syndrome: Its Influence on Functional Mobility and Activities of Daily Living. Clinic Rev Bone Miner Metab 2016; 14(2), 77–104. https://doi.org/10.1007/s12018-016-9212-6
Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino A, Mont MA. Knee Osteoarthritis: A Primer. Perm J. 2017 Sept; 21: 16-183. doi: 10.7812/TPP/16-183.
Stevens RM, Ervin J, Nezzer J, Nieves Y, Guedes K, Burges R, et al. Randomized, Double-Blind, Placebo-Controlled Trial of Intraarticular Trans-Capsaicin for Pain Associated With Osteoarthritis of the Knee. Arthritis Rheumatol. 2019; 71(9): 1524-1533. https://doi.org/10.1002/art.40894
Díaz-González F, Sánchez-Madrid F. NSAIDs: Learning new tricks from old drugs. Europ J Immun. 2015; 45(3): 679-686. https://doi.org/10.1002/eji.201445222
Holt RJ, Fort JG, Grahn AY, Kent JD, Bello AE. Onset and durability of pain relief in knee osteoarthritis: Pooled results from two placebo trials of naproxen/esomeprazole combination and celecoxib. Phys Sportsmed. 2015; 43(3): 200-212. https://doi.org/10.1080/00913847.2015.1074852
Ibargoyen-Roteta N, Del Pino MM, Gutiérrez-Ibarluzea I, Benguria-Arrate G, de Jauregui DR, Domingo-Rico C, et al. Variability in the prescription of drugs with uncertain effectiveness. The case of SYSADOA in the Basque Country. GMS Health Technol Assess. 2018 Nov 5; 14. doi: 10.3205/hta000130.
Fidelix TS, Macedo CR, Maxwell LJ, Trevisani VF. Diacerein for osteoarthritis. Cochrane Database of Systematic Reviews 2014, (2). Art. No.: CD005117. https://doi.org/10.1002/14651858.CD005117.pub3
Panova E, Jones G. Benefit-risk assessment of diacerein in the treatment of osteoarthritis. Drug safety. 2015; 38(3): 245-252. https://doi.org/10.1007/s40264-015-0266-z
DeRogatis M, Anis HK, Sodhi N, Ehiorobo JO, Chughtai M, Bhave A, Mont MA. Non-operative treatment options for knee osteoarthritis. Ann Transl Med. 2019 Oct; 7 (Suppl 7): S245. doi: 10.21037/atm.2019.06.68.
Sharma S, Rijal KP, Prasai T, Khanal H. Comparative study of efficacy and safety of diacerein versus Accelofenac in patient with knee osteoarthritis. Nepal Journal of Medical Sciences. 2021;6(1): 26-33.
Zheng WJ, Tang FL, Li J, Zhang FC, Li ZG, Su Y, et al. Evaluation of efficacy and safety of diacerein in knee osteoarthritis in Chinese patients. Chin Med Sci J. 2006 Jun; 21(2): 75-80. PMID: 16845791.
Pelletier JP, Raynauld JP, Dorais M, Bessette L, Dokoupilova E, Morin F, et al. DISSCO Trial Investigator Group. An international, multicentre, double-blind, randomized study (DISSCO): effect of diacerein vs celecoxib on symptoms in knee osteoarthritis. Rheumat (Oxford). 2020 Dec ; 59(12): 3858-3868. https://doi.org/10.1093/rheumatology/keaa072
Couto A, Troullos E, Moon J, Perdes-Diaz A, & An R. Analgesic efficacy and safety of non-prescription doses of non-prescription doses of naproxen sodium in management of moderate osteoarthritis of the knee or hip. Curr Med Res opin.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright (c) 2023 Mehtab Munir, Ayesha Khan, Tauseef Sayyar, Maria Mufti, Iqra Siddiqui, Sara Tariq Abbasi