Start therapy of pain at gonarthrosis in patients with diabetes mellitus

Abstract

Introduction.Among phenotypic variants of osteoarthritis (OA), a special place is occupied by OA with a comorbidity. A therapy of a pain in OA patients with the comorbid for diabetes mellitus type 2 (DM2) should be carried out with account for its effectiveness and safety.Objective.Perform comparative analysis of the clinical and laboratory characteristics of gonarthrosis and their therapeutic dynamics in moderate comorbid risk groups.Methods.The clinical and laboratory characteristics of gonarthrosis were studied in 386 women (mean age 61.3 ± 7.8 years), of which 162 ones had DM2. We evaluated several characteristics of the pain, which were summarized in the rating of pain (R_P). The level of C-reactive protein (CRP) in the blood serum was determined. An analysis of 75 samples of a synovial fluid (SF) obtained by a puncture of knee joints (KJ) in patients with severe synovitis was performed. An open-label controlled short-term trial of the analgesic and anti-inflammatory activity of diclofenac sodium in gonarthrosis was performed in 30 people in the euglycemic group and in the comorbid one according to DM2.Results.R_P for concomitant DM2 was 22.2% (p = 0.0001) lower than for isolated gonarthrosis, but the concentration of CRP in serum and SF did not differ between groups. The glucose level in the SF with concomitant DM2 was 46.6% (p = 0.0001) higher. NSAIDs were used according to the needs of more than 75% of patients, but women with concomitant diabetes mellitus type 2 used non-selective drugs 1.9 times (p = 0.008) more often. The efficacy and safety of the drug containing diclofenac sodium was comparable in the euglycemic group and in the concomitant diabetes mellitus type 2 group, but patients with comorbid DM2 achieved an effect of 23% less quantity NSAIDs.Conclusions.The use of drugs containing diclofenac sodium in 87% of patients provides an analgesic and anti-inflammatory effect with the satisfactory tolerance and the low drug demand, including in patients comorbid for type 2 diabetes.