Objective. To compare the efficacy and tolerability of etodolac versus etodolac in combination with eperisone in patients of Osteoarthritis knee. Patients and Methods. A prospective, randomized, open label, parallel group, comparative study was conducted in 60 patients of knee OA over a period of 2 months. Thirty patients received etodolac 600？mg once daily and 30 patients received eperisone 50？mg thrice daily in addition to etodolac 600？mg once daily for 8 weeks. Efficacy assessment was done on the basis of improvement in mean scores of spontaneous pain on Visual analog scale (VAS), pain on movement, functional capacity, joint tenderness, swelling, erythema on Likert scale, and patient's overall arthritic condition on a five-point investigator scale at the end of study period as compared with the baseline scores. Assessment of tolerability was done by recording the occurrence of adverse events. Data was analyzed using Chi square test and students t-test. Results. All the enrolled patients completed the study and were compliant to the treatment regimens that they were allocated to. Both the treatment groups showed a statistically significant improvement in all the efficacy parameters at the end of 8 weeks as compared to baseline ( ) with no statistically significant difference between the groups. Adverse events were few and mild in nature. Conclusion. Combination of etodolac and eperisone is as effective as etodolac alone in patients of OA knee. Thus, it is concluded that additional use of muscle relaxant has no adjuvant value in patients of OA knee and is not recommended. The study is registered with the Clinical Trial Registry of India vide registration number CTRI/2013/03/003442. 1. Introduction Osteoarthritis (OA) is the most common chronic joint disease with a prevalence of 22%–39% in India, accounting for 30% of all joint disorders [1]. Symptomatic OA, particularly of knee and hip, is the leading cause of disability between the fourth and fifth decades of life [2]. The disease is characterized by the degeneration of articular cartilage, subchondral sclerosis, cyst, and osteophyte formation. These result in joint pain and tenderness, limited movement, crepitus, effusion, and inflammation [3]. Treatment is aimed at reducing pain, maintaining mobility, and minimizing disability. Pain control is of paramount importance in order to maintain quality of life in such patients. There is, however, no single ideal pain medication for management of arthritic pain. The WHO analgesic ladder advocates a stepped approach to the use of analgesics from these
References
[1]
A. Chopra, J. Patil, V. Billempelly, J. Relwani, and H. S. Tandle, “Prevalence of rheumatic diseases in a rural population in western India: a WHO-ILAR COPCORD study,” The Journal of the Association of Physicians of India, vol. 49, pp. 240–246, 2001.
[2]
J. Lutzner, P. Kasten, K. P. Gunther, and S. Kirschner, “Surgical options for patients with osteoarthritis of the knee,” Nature Reviews Rheumatology, vol. 5, no. 6, pp. 309–316, 2009.
[3]
P. Creamer and M. C. Hochberg, “Osteoarthritis,” The Lancet, vol. 350, no. 9076, pp. 503–509, 1997.
[4]
T. Grosser and E. M. Smyth, “Antiinflammatory, antipyretic and analgesic agents,” in Goodman and Gilman’s the Pharmacological Basis of Therapeutics, L. Bruton, B. A. Chabner, and B. C. Knollmann, Eds., p. 985, McGraw-Hill, New York, NY, USA, 12th edition, 2011.
[5]
K. Inoue, A. Motonaga, J. Dainaka et al., “Effect of etodolac on prostaglandin E2 biosynthesis, active oxygen generation and bradykinin formation,” Prostaglandins Leukotrienes and Essential Fatty Acids, vol. 51, no. 6, pp. 457–462, 1994.
[6]
P. A. Bacon, “Etodolac: efficacy in osteoarthritis and effects on chondrocyte function,” Rheumatology International, vol. 10, pp. 3–7, 1990.
[7]
S. Ryder, I. Salom, G. Jacob, M. Sanda, and J. Huth, “The safety profile of a new structurally novel nonsteroidal anti-inflammatory drug,” Current Therapeutic Research, vol. 33, no. 6, pp. 948–965, 1983.
[8]
F. E. Silverstein, G. Faich, J. L. Goldstein et al., “Gastrointestinal toxicity with Celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and reumatoid arthritis: the CLASS study: a randomized controlled trial,” The Journal of the American Medical Association, vol. 284, no. 10, pp. 1247–1255, 2000.
[9]
G. A. FitzGerald and C. Patrono, “The coxibs, selective inhibitors of cyclooxygenase-2,” The New England Journal of Medicine, vol. 345, no. 6, pp. 433–442, 2001.
[10]
S. Iwase, T. Mano, M. Saito, and G. Ishida, “Effect of a centrally-acting muscle relaxant, eperisone hydrochloride, on muscle sympathetic nerve activity in humans,” Functional Neurology, vol. 7, no. 6, pp. 459–470, 1992.
[11]
K. Bose, “The efficacy and safety of eperisone in patients with cervical spondylosis: results of a randomized, double-blind, placebo-controlled trial,” Methods and Findings in Experimental and Clinical Pharmacology, vol. 21, no. 3, pp. 209–213, 1999.
[12]
K. D. Brandt, “Osteoarthritis,” in Harrison’s Principles of Internal Medicine, D. L. Kasper, A. S. Fauci, D. L. Longo, E. Braunwald, S. L. Hauser, and J. L. Jameson, Eds., p. 2039, McGraw-Hill, New York, NY, USA, 16th edition, 2005.
[13]
G. Majani, A. Giardini, and A. Scotti, “Subjective impact of osteoarthritis flare-ups on patients' quality of life,” Health and Quality of Life Outcomes, vol. 3, pp. 14–19, 2005.
[14]
J. A. Bolognese, T. J. Schnitzer, and E. W. Ehrich, “Response relationship of VAS and Likert scales in osteoarthritis efficacy measurement,” Osteoarthritis and Cartilage, vol. 11, no. 7, pp. 499–507, 2003.
[15]
G. Perpignano, A. Bogliolo, and L. Puccetti, “Double-blind comparison of the efficacy and safety of etodolac SR 600？mg U.I.D. and of tenoxicam 20？mg U.I.D. in elderly patients with osteoarthritis of the hip and of the knee,” International Journal of Clinical Pharmacology Research, vol. 14, no. 5-6, pp. 203–216, 1994.
[16]
H. Berry, S. P. Liyanage, R. A. Durance, J. D. Goode, and A. J. Swannell, “A double-blind study of benorylate and chlormezanone in musculoskeletal disease,” Rheumatology and Rehabilitation, vol. 20, no. 1, pp. 46–49, 1981.
