The Effect of Diacerein with and Without Diclofenac Sodium on Knee Pain Severity and Walking Time in Patients with Knee Osteoarthritis

Introduction: Diacerein (4, 5-diacetyloxy-9, 10-dioxo-anthracene-2-carboxylic acid) appeared promising in osteoarthritis (OA) treatment for its IL-1 inhibitory properties. However, it is a slow-acting disease-modifying drug, and its effect would appear after few weeks of its intake. Therefore, it was suggested to be prescribed in combination with NSAID during the early few weeks of its administration. Objective: To assess the efficacy and safety of diacerein with and without diclofenac in patients with knee OA. Participants: Sixty patients with primary knee OA. Methods: Clinical, laboratory and relevant radiological examination were performed. Patients were divided randomly into 3 groups. Group I (n=20) received diacerein (50 mg twice daily) ; Group II (n=20) received oral diclofenac sodium (75 mg/day) ; and Group III (n=20) received both diacerein and diclofenac in the previous doses. Medications were given for 2 months. Assessment of pain severity (VAS) and the 20 meters fast walking time were done before treatment and at 1 and 2 months after treatment. Patients were observed for adverse reactions during the study. Results: There was a drop out of 10 patients in group II. Following treatment, there was significant improvement in pain severity in group I and III (p = 0.033 and 0.048; respectively) ; and in the walking time in group I (p = 0.001), with no inter-group differences. Few side effects were reported. Mild diarrhea was found in 40 % and urine discoloration in 100 % of patients of groups I and III. Nausea was reported in 20 % of patients of groups II and III. Heartburn was reported in patients of group II (20 %) and group III (25 %). Conclusion: Diacerein improved knee pain and the walking time with mild adverse reactions. Adding diclofenac to diacerein appeared of no additional benefit, when assessment was done 1 and 2 months after drug intake. The findings recommend using diacerein in knee OA in those who can tolerate it, especially when NSAIDs are contraindicated.