A comparative study of Therapeutic Effects of topical Diclofenac, Capsaicin and Wishca, in a patient with Knee Osteoarthritis

Background and Objective: Osteoarthritis (OA) is the most common joint disorder worldwide. There is no cure, but treatments are available to manage symptoms. Topical treatments of this disease have been considered due to having fewer side effects. We compared the effect of three common topical medications of OA in Iran, WishCa herbal cream, capsaicin 0.034% ointment and diclofenac 1% gel, on the complications of knee OA patients. Materials and Methods: In this comparative prospective study, by convenience sampling, 275 knee OA patients, who referred to the orthopaedic clinic of Imam Reza, 22 Bahman and Aria Hospitals of Mashhad, from October 2017 to March 2018, were assessed for eligibility. Knee OA was confirmed according to American Rheumatology Association criteria. Patients with other forms of diseases involving knees; knee arthroscopy, surgery or injections; or acute psychological illnesses were excluded. Eventually, 44 patients were enrolled; 20 patients were allocated to Diclofenac group, 21 to Capsaicin, and 30 to WishCa. With 95% CI, the statistical test power of 85 % was obtained. Patients were asked to apply 1 mL of ointment TID, topically on the osteoarthritic knee. We used the VAS (Visual Analogue Scale) and the Persian version of the KOOS questionnaire (Knee injury and Osteoarthritis Outcome Score), which has five subscales: Pain, Symptoms, Function in daily living (ADL), Function in Sport and Recreation (Sport/Rec), and knee-related Quality of Life (QOL), to collect patient-reported knee symptoms at the baseline, 1 week and 4 weeks after starting the treatment. Outcomes were then compared using SPSS version 18. All patients filled consent forms and the study was approved by the Research Ethics Committee. Findings: there were no significant differences between the groups in terms of sex, BMI, age, OA grade and baseline clinical characteristics. About half of the patients were in grade 2 OA (46.7%). The mean age was 53.65 ± 10.8 and the majority of participants were female (77.5%). VAS scores, pain and ADL subscales in the Diclofenac group; pain and Sport/Rec subscales in the Capsaicin group; and VAS scores, pain, and ADL subscales In the WishCa group, significantly improved at the end of the first and fourth weeks (p-value < 0.05). The results indicate that all three topical drugs improve patient complications, but their effects are not significantly different (p-value > 0.05). Also, the effects were significantly better in lower grade compared to higher grade OA patients (p-value < 0.05) except for symptoms subscale. Conclusion: All three drugs improve patient outcomes, but none of them has an advantage over others. Indeed, studies with larger sample sizes are needed to confirm these findings.

کلیدواژه ها:

Knee Osteoarthritis ، Wishca ، Capsaicin ، Diclofenac ، KOOS ، VAS