Abstract

EVALUATION OF TREATMENT RESPONSE TO PAINS OF RHEUMATIC DISEASES’ ORIGIN AND CLINICAL OUTCOME OF DRUG COMBINATIONS USED FOR PAIN MANAGEMENT IN A TEACHING HOSPITAL IN NIGERIA

John David Ohieku* and Zainab Alkali Jime

Abstract

Background: Musculoskeletal diseases causing pain are common and increasing in frequency as well as causing a considerable burden to the individual and society. It is desirable to evaluate the various treatment options to identify optimal therapy that improve pain alleviation in order to guide their clinical and rational uses in the region. Aim and Objectives: The objectives of this study are to assess the status of arthritis pains in patients receiving drug therapy between clinic visits and to determine the optimal therapy or therapies for pain management with various drug combinations. Methods: The retrospective study reviewed 121 patients with various types of arthritis on regular clinic attendance. Pain status of patients on various drug combinations were assessed in-between clinic visits which cumulatively sum up to 372 visits and covering a period of 5 years. Results: The proportion of the male subjects was 36.4% compared to 63.6% of the female subjects. Osteoarthritis was the highest form of arthritis (being 65.3%) while rheumatoid arthritis was observed in 22.3% cases. Other forms are gouty arthritis (9.1%), juvenile arthritis (0.8%), and septic arthritis (0.8%). Pain regression occurred in 64.5% cases but was exacerbated in 5.1% cases. No changes in pain status were observed in 6.5% patients while in 22.6% of patients, there were complete alleviations with various drug combinations. However, in 1.1% proportion, resurged pain episode was observed. About 73 (62.9%) of patients placed on NSAIDs as lone agent had pain regression with 21 (18.1%) having complete pain resolution between clinic visits and while 3(2.6%) experienced resurged pain, 8 (6.9%) had pain exacerbation and 11(9.5%) had no change in pain status. There were marginal increases in patients who experienced pain regression and resolution when NSAID was combined with chondroitin/glucosamine (being 65.3% and 21.4% respectively), and with steroids (being 68.0% and 24.0% respectively), but DMARD and steroid combinations gave a very high proportion of patients with pain regression (92.3%). Conclusion: The treatment outcomes resulting from various drug combinations used in the management of arthritis pains varies with high proportion of patients experiencing pain regression but while a few others experienced no change in pain status, pain exacerbation occurred in minority. Complete pain remission also occurred in minority of patients. The combination of NSAIDS with other agents gave rise to various changes in pain status.

Keywords: Pain regression, Arthritis, NSAIDs, Rheumatoid arthritis, Osteoarthritis.