Felson D T, Lawrence R C, Hochberg M C, McAlindon T, Dieppe P A, Minor M A, Blair S N, Berman B M, Fries J F, Weinberger M, Lorig K R, Jacobs J J, Goldberg V
Boston University School of Medicine, 715 Albany Street, Room A203, Boston, MA 02118, USA.
Ann Intern Med. 2000 Nov 7;133(9):726-37. doi: 10.7326/0003-4819-133-9-200011070-00015.
Osteoarthritis is the most common form of arthritis, affecting millions of people in the United States. It is a complex disease whose etiology bridges biomechanics and biochemistry. Evidence is growing for the role of systemic factors, such as genetics, diet, estrogen use, and bone density, and local biomechanical factors, such as muscle weakness, obesity, and joint laxity. These risk factors are particularly important in the weight-bearing joints, and modifying them may help prevent osteoarthritis-related pain and disability. Major advances in management to reduce pain and disability are yielding a panoply of available treatments ranging from nutriceuticals to chondrocyte transplantation, new oral anti-inflammatory medications, and health education. This article is part 2 of a two-part summary of a National Institutes of Health conference that brought together experts in osteoarthritis from diverse backgrounds and provided a multidisciplinary and comprehensive summary of recent advances in the prevention of osteoarthritis onset, progression, and disability. Part 2 focuses on treatment approaches; evidence for the efficacy of commonly used oral therapies is reviewed and information on alternative therapies, including nutriceuticals and acupuncture, is presented. Biomechanical interventions, such as exercise and bracing, and behavioral interventions directed toward enhancing self-management are reviewed. Current surgical approaches are described and probable future biotechnology-oriented approaches to treatment are suggested.
骨关节炎是最常见的关节炎形式，在美国影响着数百万人。它是一种复杂的疾病，其病因涉及生物力学和生物化学。越来越多的证据表明，遗传、饮食、雌激素使用和骨密度等全身因素以及肌肉无力、肥胖和关节松弛等局部生物力学因素发挥着作用。这些风险因素在负重关节中尤为重要，改变这些因素可能有助于预防与骨关节炎相关的疼痛和残疾。在减轻疼痛和残疾方面的重大进展带来了一系列可用的治疗方法，从营养保健品到软骨细胞移植、新型口服抗炎药物以及健康教育。本文是美国国立卫生研究院一次会议两部分总结的第二部分，该会议汇聚了来自不同背景的骨关节炎专家，并对预防骨关节炎发作、进展和残疾的最新进展进行了多学科、全面的总结。第二部分重点关注治疗方法；回顾了常用口服疗法疗效的证据，并介绍了包括营养保健品和针灸在内的替代疗法的信息。对运动和支具等生物力学干预措施以及旨在加强自我管理的行为干预措施进行了综述。描述了当前的手术方法，并提出了未来可能的以生物技术为导向的治疗方法。
