Bijlsma Johannes W J
Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
Am J Ther. 2002 May-Jun;9(3):189-97. doi: 10.1097/00045391-200205000-00004.
Osteoarthritis is the most common form of arthritis, its prevalence increasing with age: as much as 80% of the population over 75 years show radiologic signs of the condition. Symptoms include pain, stiffness, and functional impairment; however, not all patients are symptomatic. Management starts with nonpharmacologic interventions, followed by pharmacologic means, and ultimately by surgical intervention. The management is multidisciplinary and is tailored to the needs of the individual patient. It is, therefore, a good model of collaborative care: multidisciplinary management of a chronic condition for which the patients themselves coordinate the use of the management options, with information and guidance from health care professionals and written materials, as needed. Guidelines for the management of osteoarthritis have been developed and are applied in different continents. These guidelines are based on searches of the literature and evidence-based interpretation, in combination with expert opinion. Pharmacologic management guidelines state that based on its overall efficacy, toxicity profile, and cost, paracetamol-acetaminophen should be tried first and, if successful, should be used as the preferred long-term analgesic. In patients who do not experience adequate symptomatic relief with paracetamol-acetaminophen, alternative or additional pharmacologic agents should be considered, especially nonsteroidal anti-inflammatory drugs (NSAIDs). When the combination of paracetamol-acetaminophen with NSAIDs fails, tramadol may be given. Most patients with osteoarthritis are able, after discussion with their physician, to manage their symptoms themselves. They make use of educational occupational, and physical advisers, and they use their medication on demand. The basis of this self-administered pharmacologic management is paracetamol-acetaminophen, sometimes in combination with NSAIDs. A promising option for the future is the development of symptomatic slow-acting drugs for osteoarthritis that possess structure-modifying properties.
骨关节炎是最常见的关节炎形式，其患病率随年龄增长而增加：75岁以上人群中高达80%有该病症的放射学迹象。症状包括疼痛、僵硬和功能障碍；然而，并非所有患者都有症状。治疗首先从非药物干预开始，接着是药物治疗手段，最终是手术干预。治疗是多学科的，并根据个体患者的需求进行调整。因此，它是协作护理的一个良好模式：对慢性病进行多学科管理，患者在医疗保健专业人员的信息和指导以及所需书面材料的帮助下，自行协调使用管理方案。已经制定了骨关节炎管理指南并在不同大陆应用。这些指南基于文献检索和循证解读，并结合专家意见。药物治疗管理指南指出，基于其总体疗效、毒性特征和成本，应首先尝试使用对乙酰氨基酚，若成功，应将其用作首选的长期镇痛药。对于使用对乙酰氨基酚后症状缓解不充分的患者，应考虑使用替代或额外的药物，尤其是非甾体抗炎药（NSAIDs）。当对乙酰氨基酚与NSAIDs联合使用无效时，可给予曲马多。大多数骨关节炎患者在与医生讨论后能够自行管理症状。他们利用教育、职业和身体方面的建议，并按需使用药物。这种自我药物管理的基础是对乙酰氨基酚，有时会与NSAIDs联合使用。未来一个有前景的选择是开发具有结构改变特性的骨关节炎症状性慢作用药物。
