Main Article Content

Abstract

Background: Infl ammation is an important mechanism in the pathogenesis of osteoarthritis (OA). Proinfl ammatory mediators, especially interleukin-1β (IL-1β), play a signifi cant role in the occurrence of joint infl ammation, which lead to pain and limitation of daily activities. As an anti–IL-1β, diacerein is therefore have potency to reduce pain and improve functional status of OA patients.

Objective: To evaluate the role of diacerein in pain intensity and functional status of knee OA patients. Methods: This is a pre-post study without control group using consecutive sampling conducted at rheumatology outpatient clinic at the Cipto Mangunkusumo General Hospital, Jakarta from January until May 2006. At the fi rst visit, all patients underwent
assessment of pain intensity (using visual analog scale (VAS)) and functional status (Lequesne algofunctional index) to obtain baseline data. We also performed knee
radiograph examination to evaluate joint damage basedon the Kellgren-Lawrence classifi cation. Measurement of IL-1β level in synovial fl uid was performed using enzyme-linked immunosorbent assay, with a minimum detectable value of 3.9 pg/mL. Diacerein was
administered with a dose of 50 mg, given orally twice a day for 2 months. Follow-ups were done in the fi rst, second, and eighth week after the administration of diacerein. In the eighth week we repeated the measurement of IL-1β level.

Results: Thirty three patients were enrolled in this study, most (78.8%) of them were female. The majority (81.8%) belong to the 50- to 70-year-old age group. More than half of the patients (54.5%) had detectable IL-1β level. The median baseline VAS score was 65.00 (range 25–100) while the median baseline Lequesne score was 11.00 (range 1.5–21.0). The statistical analysis showed a signifi cant decrease in VAS at the fi rst (p = 0.000), second
(p = 0.000), and eighth week (p = 0.000). Lequesne index score was also decrease signifi cantly at the fi rst (p =0.000), second (p = 0.000), and eighth week (p = 0.000)
of treatment. We found no signifi cant correlation of IL-1β level with VAS and Lequesne algofunctional index scores.

Conclusions: Among the patients in this study, there were signifi cant decrease in pain intensity and disabilityafter the administration of diacerein.

Article Details

How to Cite
Kasjmir, Y. I., Imelda, F., & Erawati, L. (2018). Role of diacerein in pain intensity and functional status in patients with knee osteoarthritis. Indonesian Journal of Rheumatology, 2(2). https://doi.org/10.37275/ijr.v2i3.78

References

  1. Woolf AD, Pfl eger B. Burden of major musculoskeletal conditions. [Online].Geneva: World Health Organization; 2003. [cited 2005 Sep 12]. Availablefrom: URL: ttp://www.who.int/bulletin/volumes/81/9/Woolf.pdf.
  2. Smith MD, Triantafi llou S, Parker A, Youssef PP, Coleman M. Synovial membrane infl ammation and cytokine production in patients with early osteoarthritis. J Rheumatol 1997;24:365–71.
  3. Pelletier JP, Caron JP, Evans C. In vivo suppression of early experimentalosteoarthritis by interleukin-1–receptor antagonist using gene therapy.Arthritis Rheum 1997;40:1012–9.
  4. Pelletier JP, Martel-Pelletier J, Abramson SB. Osteoarthritis, an inflammatory disease: potential implication for the selection of new therapeutic targets. Arthritis Rheum 2001;44:1237–47.
  5. Firestein GS, Berger AE, Tracey DE, Chosay JG, Chapman DL, Paine MM, et al. IL-1 receptor antagonist protein production and gene expression in rheumatoid arthritis and osteoarthritis synovium. J Immunol 1992;149:1054–62.
  6. Martel-Pelletier J. Pathophysiology of osteoarhritis. Osteoarthritis Cart 2004;12:S31-3.
  7. McCarberg BL, Herr KA. Osteoarhritis: How to manage pain and improvepatient function. Geriatrics 2001;56(10):14–24.
  8. Sumariyono. Structure and composition of joint cartilage [Struktur dan komposisi rawan sendi]. In: Kertia N, editor. Report of the 6th national congress of Indonesian Rheumatism Association [Naskah lengkap kongres nasional dan pertemuan Ikatan Reumatologi Indonesia VI]. Yogyakarta: University of Gadjah Mada; 2005. p. 64–73.
  9. Wahono CS, Yuliasih, Kalim H. Role of markers of joint cartilage destructionin the diagnosis of osteoarthritis [Peranan petanda kerusakan rawan sendipada diagnosis osteoarthritis]. In: Setiyohadi B, Kasjmir YI, Mahfudzoh S, editors. Report of the rheumatology scientifi c meeting 2003 [Naskah lengkap temu ilmiah reumatologi 2003]. Jakarta: Indonesian Rheumatism Association; 2003. p. 192–8.
  10. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classifi cation and reporting of osteoarthritis: classifi cation of osteoarthritis of the knee. Arthritis Rheum 1986;29:1039–49.
  11. Ligren L. The Bone and Joint Decade and the global economic and healthcare burden of musculoskeletal disease. J Rheumatol Suppl 2003:67:4–5.
  12. Fraenkel L, Roubenoff R, La Valley M, McAlindon T, Chaisson C, Evans S, et al. The association of peripheral monocyte-derived interleukin-1ï¢ (IL-1ï¢), IL-1–receptor antagonist and tumor necrosis factor ï¡ with osteoarthritis in the elderly. J Rheumatol 1998;25:1820–6.
  13. Cameron ML, Fu FH, Paessler HH, Schneider M, Evans H. Synovial fl uidcytokine concentrations as possible prognostic indicators in the ACLdeficient knee. Knee Surg, Sports Traumatol, Arthroscopy 1994;2:38–44.
  14. Kubota E, Imamura H, Kubota T. Interleukin-1β and stromelysin (MMP3)activity of synovial fl uid as possible markers of osteoarthritis in thetemporomandibular joint. J Oral Maxillofac Surg 1997;55:20–7.
  15. Kubota E, Matsumoto J, Kubota T. Synovial fl uid cytokines and proteinasesas markers of temporomandibular joint disease. J Oral Maxillofac Surg1998;56:192–8.
  16. Borderie D, Hilliquin P. Nitric oxide synthase is expressed in the lymphomononuclear cells of synovial fl uid in patients with rheumatoid arthritis. J Rheumatology 1999;26:2083–5.
  17. Pelletier JP, Jovanovic D, Fernandes J, Manning P, Connor JR, Currie MG, et al. Reduced progression of experimental osteoarthritis in vivo by selective inhibition of inducible nitric oxide synthase. Arthritis Rheum 1998:1275–86.
  18. Kirkham B. Interleukin-1, immune activation pathways, and different mechanisms in osteoarthritis and rheumatoid arthritis. Ann Rheum Dis1991;50:395–40.
  19. Effector mechanism of immune responses. In: Abbas A, Lichtman A,
  20. editors. Cellular and molecular immunology. 5th ed. Philladelphia: ElsevierScience; 2003. p. 243–54.
  21. Chrousos GP. Hypothalamic-pituitary-adrenal Axis and immune-mediatedinfl ammation. N Engl J Med 1995;332:1351-62.
  22. Nguyen M, Dougados M, Berdah L, Amor B. Diacerhein in the treatment of osteoarthritis of the hip. Arthritis Rheum 1994;37:529–536.
  23. Dougados M, Nguyen M, Berdah L, Maziéres B, Vignon E, Lequesne M, et al. Evaluation of the structure-modifying effects of diacerein in hip osteoarthritis: ECHODIAH, a three-year, placebo-controlled trial. Evaluation of the Chondromodulating Effect of Diacerein in OA of the Hip.Arthritis Rheum 2001;44:2539–47.
  24. Kertia N, Khomimiah. Role of infl ammation in pain and disease progression in osteoarthritis [Peran infl amasi terhadap nyeri dan progresivitas osteoartritis]. In: Setyohadi B, Kasjmir YI, editors. Report of the rheumatology scientifi c meeting 2005 [Naskah lengkap temu ilmiah reumatologi 2005]. Jakarta: Indonesian Rheumatism Association; 2005.p. 44–7.
  25. Meliala L. Neurobiology and mechanism of pain [Neurobiologi nyeri danmekanisme nyeri]. In: Rational therapy of pain: review on neuropathicpain [Terapi rasional nyeri: tinjauan khusus nyeri neuropatik]. Yogyakarta:Aditya Media; 2004. p. 3–47.
  26. Ranitya R. Correlation of serum hyaluronic acid level with functional status of knee osteoarthritis patients [Korelasi kadar asam hyaluronat serum dengan status fungsional pasien osteoartritis lutut] [specialist tesis]. [Jakarta]: University of Indonesia School of Medicine; 2005.
  27. Garnero P, Piperno M, Gineyts E, Christgau S, Delmas PD, Vignon E.Cross-sectional evaluation of biochemical markers of bone, cartilage, and synovial tissue metabolism in patients with knee osteoarthritis: relations with disease activity and joint damage. Ann Rheum Dis 2001;60:619–26.
  28. Brenner S, Klotz U, Alscher DM. Osteoarthritis of the knee—clinical assessments and infl ammatory markers. Osteoarthritis Cart2004;12:469–75.