Evaluation of the Structural Modification Effect of Diacerein (Artrodar®) in Knee Osteoarthritic Patients

Inclusion criteria

• Patients aged between 40 and 65 years who diagnosed with primary OA knee (medial tibiofemoral compartment) according to ACR criteria
• Grade II-III OA severity that classified by the Kellgren-Lawrence classification
• Varus malalignment ≤ 15°
• Body mass index (BMI) ≤ 30 kg/m2
• Pain on walking at 15 metres ≥ 30 mm using 100 mm visual analogue pain score (VAPS)
• Evidence of adequate contraceptive methods in women of childbearing age

Exclusion criteria

• Accompanying osteoarthritis of the hip of sufficient severity to interfere with the functional assessment of the knee
• Intra-articular treatment with any product (corticosteroids in the last 3 months, glycosaminoglycans, hyaluronic acid in the last 6 months, etc.), joint lavage or arthroscopic procedures within 6 months before the start of the study
• Oral corticosteroids, oral symptomatic slow acting drug for OA (SYSADOA) treatment (chondroitin sulfate, glucosamine sulfate, piascledin, diacerein) within last 3 months
• Current treatment with anti-depressants, tranquilisers, antacids or antibiotics
• Poor general health or other conditions which would make regular hospital attendance difficult
• Primary inflammatory painful conditions of the knee (e.g. rheumatoid arthritis, psoriatic arthropathy, pseudo-gout)
• Painful knee conditions other than osteoarthritis (e.g. Sudeck's atrophy, intra-articular neoplasm, villonodular synovitis)
• Evolving arthritis requiring surgery within the coming year;
• Persistent diarrhoea (\> 3 stools /24 h) or laxative use (any laxative use is to be stopped before inclusion in the trial)
• Severe gastrointestinal disorders, indications or history of severe gastrointestinal disorders (e.g. gastric or duodenal ulcers, ulcerative colitis, Crohn's syndrome, diverticulitis, recurrent pancreatitis)
• Renal insufficiency (estimate glomerular filtration rate ≤ 60 ml/min/1.73 m2)
• Hepatic disease (transaminases \> 2.5 x upper limit of normal values (ULN) or total bilirubin \> 2 x ULN) or history of alcoholism and liver disease
• Severe parenchymal organ disease
• History of heart attack or stroke, or have had serious diseases of the heart such as congestive heart failure, or taking clopidogrel.
• Patient with diabetes mellitus (DM) who has heamoglobin A1c level \> 8%
• Patient with hypertension who has systolic blood pressure \> 150 mmHg or diastolic Blood pressure \> 95 mmHg
• Pregnancy or lactation
• Participation in a drug clinical trial within the 3 months before the start of the study;
• Ascertained hypersensitivity to the active ingredient diacerein, to similar compounds, to the excipients or to paracetamol, naproxen, and omeprazole
• Contraindications for magnetic resonance imaging (MRI) assessment such as heart pacemaker, aneurysm clip or claustrophobia
• Knee size measured at lower thigh \> 50 cm