AB0599 EFFICACY AND SAFETY OF COMBINATION THERAPY WITH NSAIDS AND ANTICONVULSANT, COMPARED WITH NSAID MONOTHERAPY FOR CHRONIC PAIN IN PATIENTS WITH OSTEOARTHRITIS OF THE KNEE JOINTS
Authors: E. Filatova, L. Alekseeva, E. Taskina, N. Kashevarova, A. Lila, E. Sharapova
Journal: Annals of the Rheumatic Diseases (2021)

Background: In 20-44% of patients with osteoarthritis of the knee joints neuroplastic changes occur due to central sensitization (1,2), which is the rationale for complex therapy, including centrally acting drugs, for more effective pain control. Objectives: To evaluate the efficacy and safety of combination therapy with NSAID and anticonvulsant in comparison with NSAID monotherapy in patients with osteoarthritis of the knee joints and signs of central sensitization or nocyplastic pain Methods: The study included 60 women with osteoarthritis of the knee joints (OAK) with signs of nocyplastic pain. Nocyplastic pain were revealed by neuropathic scales (DN4 questionnaire &gt; 4 points), subject to the absence of patients lesions of the somatosensory nervous system. All patients were randomized into two age- and sex-matched groups: group I (n=30) received combination therapy with aceclofenac and pregabalin, group II (n=30) - monotherapy with aceclofenac. The observation period was 42 days and included three visits. All patients underwent a clinical and neurological examination, we assessed the overall WOMAC index, pain intensity at rest with the visual analogue scale (VAS), nocyplastic pain (DN4 and Pain DETECT questionnaires), anxiety and depression (HADS questionnaire) and the quality of life (EQ-5D questionnaire). Results: The intensity of pain at rest according to VAS in patients of group I significantly decreased after 14 days (visit 2) and even further after 42 days (visit 3) (64.0 [50.0; 72.0] vs 49.0 [33.0; 55.0] vs 33.5 [22.0; 49.0] p = 0.006). In group II the intensity of pain at rest also decreased after 14 days (visit 2) (63.0 [41.0; 72.0] vs 48.0 [35.0; 58.0] p &lt;0.001), however, did not change significantly from visit 2 to 3 (48.0 [35.0; 58.0] vs 44.0 [35.0; 60.0]) (p = 0.57). The dynamics of neuropathic pain indicators according to the DN4 and Pain DETECT questionnaires was as follows: group I (visit 1-3) DN4 (6.0 [5.0; 7.0] vs 3.0[1.0; 4.0], p=0.001) and Pain DETECT (17.0 [16.0;20.0] vs 8.0 [5.0; 14.0], p=0.001). Group II DN4 (6.0[5.0;6.0] vs 5,0 [3,0; 6,0],p=0,05), Pain DETECT (17,0 [15,0; 19,0] vs 16.0 [14,0; 19,0],p=0,53). The overall WOMAC index decreased significantly in both groups. Significant positive dynamics in terms of the level of anxiety (9.0 [7.0;14.0] vs 7.0 [4.0;10.0], p=0.001), depression (8.0 [5.0;10.0] vs 6.5 [4.0;9.0], p= 0.03) and quality of life (0.52 [-0.02;0.52] vs 0.52 [0.52;0.59], p=0.01) was observed compared to baseline in group I but not in group II. Before the start of therapy, the groups were comparable in the studied parameters, however, after 42 days, anxiety (7.0 [4.0;10.0]vs 9.0 [7.0;12.0], p=0.02) and depression levels (6.5 [4.0;9.0] vs 8.0 [6.0;9.0], p=0.05) were statistically different. Moreover, the median anxiety and depression levels still exceeded 7 points in group II, indicating the presence of anxiety and depression. Conclusion: Combination therapy of chronic pain with signs of nocyplastic pain with pregabalin and aceclofenac in patients with knee osteoarthritis has been shown to be effective in terms of pain intensity, the presence of neuropathic descriptors and the severity of anxiety compared with aceclofenac alone. References: [1]Hochman JR, French MR, Bermingham SL, Hawker GA. The nerve of osteoarthritis pain. Arthritis Care Res (Hoboken). 2010;62:1019–23. [2]Hochman JR, Gagliese L, Davis AM, Hawker GA. Neuropathic pain symptoms in a community knee OA cohort. Osteoarthr Cartil. 2011;19:647–54. Disclosure of Interests: None declared.