A Comparative Prospective Observational Study On The Efficacy And Safety Of Diacerein, Diclofenac, And Their Combination In The Management Of Osteoarthritis

Background: Osteoarthritis (OA) is a chronic joint disease requiring long-term treatment that is both effective and safe. Diclofenac, a strong NSAID, provides quick symptomatic relief but comes with high GI and cardiovascular risks. Diacerein, an interleukin-1β inhibitor, gives delayed but long-standing relief from symptoms with a possible disease-modifying action. This research compared the clinical efficacy and safety of Diacerein monotherapy, Diclofenac monotherapy, and their combination in OA patients.
Methods: A six-month prospective, observational study was performed within the inpatient orthopedics unit of a tertiary care center. 109 patients with OA were recruited and divided into three groups: Diacerein (n=36), Diclofenac (n=36), and Combination therapy (n=37). The primary outcomes were the changes in inflammatory markers (Erythrocyte Sedimentation Rate - ESR, C-Reactive Protein - CRP) and pain severity (Visual Analog Scale - VAS). Secondary endpoints were improvement in function (Activities of Daily Living - ADL scale) and the frequency of adverse drug reactions (ADRs).
Results: All treatment groups had a statistically significant decline in ESR, CRP, and pain scores (p<0.001). The combination therapy group had the largest improvement: ESR decreased from 26.49 to 15.08, CRP decreased from 15.41 to 4.82, and pain scores decreased from 5.11 to 1.57. Only the combination group had a statistically significant increase in ADL scores (p<0.001). Safety analysis indicated that the combination group experienced the highest proportion of patients (72.9%) showing no adverse effects compared to Diclofenac monotherapy (52.8%) and Diacerein monotherapy (50%). A higher rate of stomach ulcers was reported for Diclofenac (25%).
Conclusion: The combination of Diacerein and Diclofenac much more effective than either drug alone in the prevention of inflammation, pain relief, and improvement in functional ability in osteoarthritis and with a better safety profile. Such synergy offers a rational basis for optimizing OA treatment by capitalizing on the fast onset action of an NSAID with the sustained action of a disease-modifying drug.
KEYWORDS: Osteoarthritis, Diacerein, Diclofenac, Combination Therapy, Anthraquinones, NSAIDs, Inflammation, Pain Management.