The article presents an analysis of the therapeutic effect of the drug diacerein (D), which has been used in osteoarthritis (OA) for more than 20 years and is included in the clinical guidelines of the Association of Rheumatologists of Russia (2021) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal diseases (ESCEO, 2019) for the treatment of OA. The main pathogenic effect of D in OA is to suppress the synthesis of interleukin 1,

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... ate the production of articular cartilage proteoglycans, and slow down abnormal remodeling of the subchondral bone. The advantages of D in the treatment of patients with OA and comorbidities are presented – a prolonged anti-inflammatory and analgesic effect and good tolerability. These properties of D allow to control the symptoms of OA and improve the quality of life of patients. The structure-modifying effect of D is based on its ability to stimulate the synthesis of articular cartilage proteoglycans with long-term use and prevent abnormal remodeling of the subchondral bone, which leads to a decrease in the risk of OA progression and a delay in total joint arthroplasty. An important advantage of D is its positive metabolic effect in patients with type 2 diabetes mellitus and obesity, which is associated with the ability of D to reduce the level of glycated hemoglobin and body mass index. Data are presented on the absence of adverse cardiovascular effects when using D, which allows us to recommend its use in patients with OA who have comorbid cardiovascular diseases, as well as contraindications for non-steroidal anti-inflammatory drugs.