Disease-modifying drugs are known treatment options for rheumatoid arthritis and other inflammatory types of arthritis. Are there treatments that can modify osteoarthritis (slow progression of the disease, slow joint damage, decrease the chance of disability)?
Usual Osteoarthritis Treatments Don't Slow Disease Progression
Usual recommended non-drug treatments for knee osteoarthritis and hip osteoarthritis -- two of the joints most affected by osteoarthritis -- include weight loss, exercise, and avoidance of weight-bearing activities that increase stress to the joints.
Drugs and supplements used to treat osteoarthritis include adequate vitamin D intake; analgesics such as Tylenol; NSAIDs (nonsteroidal anti-inflammatory drugs) such as naproxen and ibuprofen; supplements such as glucosamine sulfate; and joint injections. Alternative therapies are also among popular treatment options. Other than weight loss, there has been no conclusive evidence that these treatment regimens slow down or prevent osteoarthritis.
Diacerein Is Being Studied as Disease-Modifier for Osteoarthritis
Diacerein has been studied to treat osteoarthritis of the knees and hips. Diacerein is an anti-inflammatory medication that works differently from the typical NSAIDS. Diacerein blocks interleukin-1, as opposed to inhibiting the cyclooxygenase (COX) pathway as NSAIDs do.
In studies, diacerein was typically prescribed at a dose of 50 mg twice a day. A review of 7 clinical studies involving diacerein, which included 2,069 patients, was published by The Cochrane Collaboration. It concluded that diacerein had a small effect in improving pain and slowing progression of osteoarthritis compared to standard treatment with NSAIDs or placebo. The most common side effect associated with diacerein was diarrhea.
More Studies Needed for Diacerein
We asked rheumatologist Scott J. Zashin, MD about diacerein for osteoarthritis. Dr. Zashin said, "At this time, there is no definitive evidence that diacerein produces significant results as a disease-modifying drug for osteoarthritis. Further study is needed to establish the short and long-term safety and effectiveness of diacerein for osteoarthritis."
The drug is not available in the United States, Canada, Britain, or Australia. It is available in a few countries including India, Thailand, Argentina, Brazil, and Portugal. Clinicaltrials.gov lists 3 studies for diacerein. Currently, one is completed, one is active, and the third is recruiting.
Diacerein for Osteoarthritis. Fidelix TSA et al. Cochrane Review. January 25, 2006.
Scott J. Zashin MD is clinical assistant professor at University of Texas Southwestern Medical School and an attending physician at Presbyterian Hospitals of Dallas and Plano. Dr. Zashin is author of Arthritis Without Pain - The Miracle of TNF Blockers. The book is useful for anyone on one of the biologic drugs or considering the biologic drugs.