Objective. To determine whether the efficacy of diacerein persists at 2 months after the end of a 3-month treatment period, compared with placebo, in patients with painful knee osteoarthritis (OA).Methods. After a 1-week nonsteroidal antiinflammatory drug washout period, patients received either diacerein or placebo for 3 months, followed by an off-treatment period of 3 months to determine the carryover effects of the drug. Although patients were followed up through month 6, the primary efficacy end point was the percent change from baseline in pain (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] A) at month 5 (i.e., 2 months after the end of treatment) compared with placebo. The co-primary efficacy end point was the percent change from baseline in the total WOMAC score, also at month 5 versus placebo.Results. Two hundred three patients were screened, and 168 patients with painful knee OA were randomized. One hundred sixty-five patients were analyzed in an intent-to-treat analysis. At month 5, diacerein showed statistically significant superiority versus placebo as assessed with both the WOMAC A (P < 0.0001) and the total WOMAC (P < 0.0001), demonstrating the carryover effect of the drug. This superiority was already evident from month 2 for pain (P ؍ 0.001) and month 1 for total WOMAC (P ؍ 0.0021). Diacerein was safe and well tolerated. No serious or previously undocumented adverse events were observed during the study.Conclusion. This is the first published study of a symptomatic slow-acting OA drug in which the time of assessment of the primary outcome end points was 2 months after the end of a 3-month treatment period. The results show that diacerein is safe and effective for the treatment of knee OA and has a long carryover effect.Osteoarthritis (OA) is a disease affecting synovial joints and is characterized by degradation and loss of articular cartilage with subchondral bone remodeling, osteophyte formation, and synovial membrane inflammation (1,2). Clinical signs include fluctuating joint pain, swelling, stiffness, and loss of mobility, which increase in severity as the disease progresses. In the absence of a curative agent, the main objectives of OA management are to reduce symptoms, minimize functional disability, and limit the progression of structural changes, with the ultimate goal of delaying or avoiding arthroplasty.
The purpose of the study was to assess the long-term behavior and incorporation of the bioactive oxyhydroxyapatite glass-ceramic used to fill defects of long bones after curettage of bone cysts in 17 patients. The method of evaluation was a three-phase bone scintigraphy combined with radiographic and clinical evaluation. At a mean follow-up of 7 years, the glass-ceramic material had been completely incorporated. Mean uptake ratio was 1.31+/-0.25 after implantation of glass-ceramic in the metaphyseal region and 2.07+/-0.62 after implantation of glass-ceramic in the diaphyseal region (P<0.05). Mean uptake ratio was 1.40+/-0.30 in patients without persistent pain and 2.07+/-0.69 in patients who complained of pain in the area of synthetic filling (P<0.05). The bioactive glass-ceramic can be implanted into the metaphyseal defects of long bones, but this material is not suitable for filling the diaphyseal defects.
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