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Licensed Unlicensed Requires Authentication Published by De Gruyter February 11, 2020

Analysis of effectiveness and drug related problems of pain reliever for knee osteoarthritis: weighing clinical risk and benefit

  • Junaidi Khotib EMAIL logo , Henny Utami Setiawan , Ahmad Dzulfikri Nurhan , Erreza Rahadiansyah , Chrismawan Ardianto and Mahardian Rahmadi



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.


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.


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%).


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.


The author thanks the Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas Airlangga and Universitas Airlangga Teaching Hospital for all supporting during research.

  1. 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.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. 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.


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Received: 2019-11-08
Accepted: 2019-11-28
Published Online: 2020-02-11

© 2019 Walter de Gruyter GmbH, Berlin/Boston

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