Abstract
Background
Osteoarthritis (OA) is a chronic degenerative joint disease, characterized by physiological disorders, such as cartilage degradation, bone remodeling, osteophyte formation, and joint inflammation, which results in pain. Several studies have reported problems with the use of pain medications in OA, such as the use of a combination of many drugs and their long-term use. Therefore, this study was designed to evaluate the use of pain medications in OA patients. The study focused on the analysis of effectiveness and drug related problems (DRPs) with the category of drug interactions and adverse drug events (ADEs) in knee OA patients in Orthopedic and Traumatology Clinic, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia.
Methods
The study used a retrospective approach through tracking and recording of the medical data from the period of 1st January to 30th June, 2018. The potential of drug interactions was determined by analyzing data based on literature. The actual side effects of the drug were identified based on the patient’s medical record through clinical data, laboratory data, and therapeutic data received by the patient. The study involved 143 subjects who met the inclusion criteria of 871 visits to the hospital.
Results
The results showed that women as much as 80.42% with an age distribution of at most 46–65 years are the most affected by OA cases. The predominant history of illness and comorbidities in OA patients was hypertension in 58.74% of patients. The use of analgesic meloxicam had a percentage of 26.06%, sodium diclofenac 20.21%, mefenamic acid 4.36% and paracetamol 4.25%. The effectiveness of the use of pain reliever was characterized by a decrease in VAS in each patient at the beginning and at the end of the study, where a decrease in pain intensity occurred in 79.72% of patients who received pain medications. Based on drug interactions, we were able to identify pharmacodynamic interactions of 43 events (4.94%) and onine events of pharmacokinetic interactions (1.03%), with a minor severity of 7 events (0.80%),44 moderate events (5.05%), and one major event (0.11%). Mostly identified side effects of the drugs were those due to the use of non-steroid anti inflammatory drugs, which occurred in 42 events (4.82%).
Conclusions
It can be concluded that OA therapy with a number of pain relievers shows an adequate therapeutic response with some side effects and interactions both pharmacokinetically and pharmacodynamically.
Acknowledgments
The author thanks the Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas Airlangga and Universitas Airlangga Teaching Hospital for all supporting during research.
Research funding: This research was funded by the Ministri of Research, Technology and Higher Education, Republic of Indonesia through a scheme of PDUPT Research Grant.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Ethical approval: This research was carried out in the Universitas Airlangga Teaching Hospital in accordance with guidance for good clinical practice procedures issued by the Ministry of Health Republic of Indonesia in 2015. The protocol of this research was approved by the Universitas Airlangga Teaching Hospital Ethics Committee.
References
[1] Sinusas K. Osteoarthritis: diagnosis and treatment. Amer Fam Phys 2012;85:49–56.Search in Google Scholar
[2] Osteoarthritis Research Society International. Osteoarthritis: a serious disease. Submitted to the US Food and Drug Administration, 2016:1–5.Search in Google Scholar
[3] Wittenauer R, Smith L, Aden K. Priority medicines for Europe and the world “A Public Health Approach to Innovation” Ostheoarthritis 2013;6–36.Search in Google Scholar
[4] Fransen M, Bridgett L, March L, Hoy D, Penserga E, Brooks P. The epidemiology of osteoarthritis in Asia. Inter J Rheum Dis 2011;14:113–21.10.1111/j.1756-185X.2011.01608.xSearch in Google Scholar PubMed
[5] Soeryadi A, Gesal J, Sengkey LS. Gambaran Faktor Risiko Penderita Osteoartritis Lutut di Instalasi Rehabilitasi Medik RSUP Prof Dr RD Kandou Manado Januari-Juni 2017. Jurnal E-Clinic (ECL) 2017;5:267–73.Search in Google Scholar
[6] Schwinghammer TL, DiPiro CV, Wells BG, dan DiPiro JT. Pharmacotherapy handbook, 9th ed. New York: McGraw-Hill, 2015:9–16.Search in Google Scholar
[7] Hansen KE, Elliot ME. Osteoarthritis. In: Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, editors. Pharmacopy, A pathophysiological approach, 6th ed. Stamford: Appeton & Lange, 2005:1685–700.Search in Google Scholar
[8] Thomas S, Brown H, Mobasheri A, Rayman MP. What is the evidence for a role for diet and nutrition. Osteoarth Rheum 2018;57:61–74.Search in Google Scholar
[9] Abari IS. ACR revised criteria for early diagnosis of knee osteoarthritis. AutoimmunDis Therap Appr 2016;3:1–5.Search in Google Scholar
[10] Braun HJ, Gold GE. Diagnosis of osteoarthritis: imaging. Bone 2012;51:278–88.10.1016/j.bone.2011.11.019Search in Google Scholar PubMed PubMed Central
[11] McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage 2014;22:363–88.10.1016/j.joca.2014.01.003Search in Google Scholar PubMed
[12] Perkins C, Whiting B, Lee P. Steroids and osteoarthritis. J Arth 2017;6:1–3.10.4172/2167-7921.1000e115Search in Google Scholar
[13] Adusumilli and Adepu. Drug related problems: an over view of various classificaton systems. Asian J Pharm Clin Res 2014;7:7–10.Search in Google Scholar
[14] PCNE. Classification of drug related problems. The PCNE Classn 2017;8:1–10.Search in Google Scholar
[15] Van Mil JW, Westerlund LO, Hersberger KE, Schaefer MA. Drug-related problem classification systems. Ann Pharm 2004;38:859–67.10.1345/aph.1D182Search in Google Scholar PubMed
[16] Roman-Blas JA, Castañeda S, Largo R, Herrero-Beaumont G. Osteoarthritis associated with estrogen deficiency. Arth Res Ther 2009;11:1–14.10.1186/ar2791Search in Google Scholar PubMed PubMed Central
[17] Nebeker JR, Barach P, Samore MH. Clarifying adverse drug events: a clinician’s guide to terminology, documentation, and reporting. Ann Inter Med 2004;140:795–801.10.7326/0003-4819-140-10-200405180-00009Search in Google Scholar PubMed
[18] Beaumont H, Roman-Blas JA. Osteoarthritis pathophysiology: similarities and dissimilarities with other rheumatological diseases and the role of subchondral bone. Medicographia 2013;35:21–28.Search in Google Scholar
[19] Depkes RI. Profil Kesehatan Indonesia Tahun 2009. Kementerian Kesehatan Republik Indonesia, Pusat Data dan Surveilans Epidemiologi. Indonesia: Jakarta, 2009:148–9.Search in Google Scholar
[20] Bortoluzzi A, Furini F, Scirè CA. Osteoarthritis and its management – epidemiology, nutritional aspects and environmental factors. Autoimm Rev 2018;17:1097–104.10.1016/j.autrev.2018.06.002Search in Google Scholar PubMed
[21] Nugraha AS, Widyatmoko S, Jatmiko SW. Hubungan obesitas dengan terjadinya osteoartritis lutut pada lansia kecamatan laweyan surakarta. Biomedika 2015;7:15–18.10.23917/biomedika.v7i1.1587Search in Google Scholar
[22] Hayashi D, Roemer FW, Guermazi A. Imaging for osteoarthritis. Ann Phys Rehab Med 2016;59:161–9.10.1007/978-3-642-35579-0_5Search in Google Scholar
[23] Richette P, Latourte A, Frazier A. Safety and efficacy of paracetamol and NSAIDs in osteoarthritis: which drug to recommend? Exp Opin Drug Saf 2015;14:1259–68.10.1517/14740338.2015.1056776Search in Google Scholar PubMed
[24] Valderas JM, Starfield B, Sibbald B, Chris S, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med 2009;7:357–63.10.1370/afm.983Search in Google Scholar PubMed PubMed Central
[25] Baxter K. Stockley’s drug interactions, 8th ed. London UK: Pharmaceutical Press, 2008:1–3.Search in Google Scholar
[26] Tatro DS. Drug interaction facts 2009: the authority on drug interaction. Europe: Lippincott Williams and Wilkins, 2009:70–105.Search in Google Scholar
[27] Baxter K. Stokley’s drug interaction, 8th ed. London: Pharmaceutical Press, 2008:1–87.Search in Google Scholar
[28] Katzung BG, Masters SB dan Trevor AJ. Farmakologi dasar & klinik. Vol.2, Edisi 12, Editor Bahasa Indonesia Ricky Soeharsono et al., Jakarta: Penerbit Buku Kedokteran EGC, 2014:640–700.Search in Google Scholar
© 2019 Walter de Gruyter GmbH, Berlin/Boston
