Evaluation of Change in Aceclofenac Usage Pattern in Knee Osteoarthritis Following Viscosupplementation: A Prospective Interventional Study

Abstract

Introduction: Osteoarthritis (OA) of knee is one of the most common musculoskeletal disorders affecting the elderly population in Asia-Pacific region. Array of diverse treatment options exist including analgesics, Non Steroidal Anti-Inflammatory Drugs (NSAIDs), opioids, physical therapy, orthotic devices, structure modifying drugs, Intra-articular viscosupplementation, corticosteroids or Platelet Rich Plasma (PRP) and surgery. Viscosupplementation {Hyaluronic acid (HA)} is said to exert an anti-inflammatory effect and has remained a modality under investigation for a longtime. Aim: To see the change in aceclofenac usage pattern in knee OA following viscosupplementation as a surrogate for efficacy of viscosupplementation related pain relief. Materials and Methods: This study was a prospective interventional study on 60 subjects over duration of 18 months (October 2015 to March 2017). The subjects who were prescribed viscosupplementation (single dose of Intra-articular Hyaluronic Acid (IAHA) High Molecular Weight (HMW) 90 mg/3 mL in the affected knee) were included after satisfying inclusion and exclusion criteria. All the patients were assessed at the baseline, 4, 8 and 12 weeks in terms of Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and quantity of aceclofenac intake post viscosupplementation. Data were entered and analysed in SPSS version 21. Categorical variables were presented in number and percentage while continuous variables were presented as mean±SD and compared using paired t-test across follow-ups. A p-value of ≤0.05 was considered statistically significant. Results: After viscosupplementation there was significant reduction in aceclofenac intake from 3.88±1.46 gm to 1.72±0.75 gm and p-value was <0.0001. There was also improvement in pain as VAS decreased from 6.88±0.98 to 3.97±0.86 (p-value <0.0001) over 12 weeks. Similarly there was functional improvement as WOMAC total score reduced from 46.2±8.45 to 27.53±5.67 after 12 weeks. The p-value was <0.0001 at all the follow-ups. Conclusion: Aceclofenac requirement is decreased and there is improvement in pain and function after viscosupplementation. Viscosupplementation reduces NSAIDs (aceclofenac) usage in OA knee while at the same time reducing pain and improving function.