Arboleya Luis R, de la Figuera Enrique, Soledad García María, Aragón Belén
Rheumatology Section, Hospital de Cabueñes, Gijón, Spain.
Curr Med Res Opin. 2003;19(4):278-87. doi: 10.1185/030079903125001712.
To investigate the use of traditional non-steroidal anti-inflammatory drugs (tNSAIDs) in the management of osteoarthritis (OA) in primary care in Spain and to quantify patient and physician satisfaction with tNSAID therapy.
A 6-month retrospective, observational study conducted in 29 Spanish primary-care centres shortly before the first introduction of selective COX-2 inhibitors (Coxibs).
A total of 897 patients with a mean age 66 +/- 9 years and radiologically documented OA were included: most (76%) were women. Three-quarters of the patients had primary generalised OA, with the knees (> 60% of cases) and lumbar spine (> 50% of cases) being the sites most commonly affected. Pain was an almost universal feature of the clinical presentation. More than 96% of patients had been prescribed tNSAIDs during the observation period, predominantly for pain relief. The most commonly prescribed agents were diclofenac, aceclofenac and piroxicam. Twenty-six per cent of discontinuations of tNSAIDs during the observation period were due to limited effectiveness of these drugs, making this the largest single cause of discontinuation apart from prescription expiry. Almost half of patients and physicians (46% in both categories) were not satisfied with OA treatment and only one patient in six regarded their overall health status during tNSAID therapy as satisfactory. Gastroprotective medications (GPMs) were prescribed for just over half the participating patients (51%), but use of these drugs appeared haphazard: 25% of those who received GPMs had no compelling indications for this therapy whereas more than half of the patients at high risk for gastrointestinal complications on the basis of clinical criteria were not receiving GPMs.
There is a high level of dissatisfaction with tNSAID therapy of OA, arising in large part from a perception among many patients and physicians that these drugs are not always adequately effective in relieving the symptoms of this disease. These findings, together with the low patient perceptions of general health, indicate the need for new therapeutic approaches to OA.
调查西班牙基层医疗中传统非甾体抗炎药（tNSAIDs）在骨关节炎（OA）管理中的使用情况，并量化患者和医生对tNSAID治疗的满意度。
在首次引入选择性COX-2抑制剂（昔布类药物）前不久，于29个西班牙基层医疗中心开展了一项为期6个月的回顾性观察研究。
共纳入897例平均年龄为66±9岁且经放射学证实患有OA的患者，其中大多数（76%）为女性。四分之三的患者患有原发性全身性OA，膝关节（>60%的病例）和腰椎（>50%的病例）是最常受累的部位。疼痛几乎是临床表现的普遍特征。在观察期内，超过96%的患者曾被处方tNSAIDs，主要用于缓解疼痛。最常处方的药物是双氯芬酸、醋氯芬酸和吡罗昔康。观察期内tNSAIDs停药的26%是由于这些药物疗效有限，这使其成为除处方到期外停药的最大单一原因。几乎一半的患者和医生（两类人群中均为46%）对OA治疗不满意，在tNSAID治疗期间，每六名患者中只有一名认为其总体健康状况令人满意。略多于一半的参与患者（51%）被处方了胃保护药物（GPMs），但这些药物的使用似乎很随意：接受GPMs的患者中有25%没有使用该治疗的紧迫指征，而根据临床标准有胃肠道并发症高风险的患者中，超过一半没有接受GPMs。
对OA的tNSAID治疗存在高度不满，这在很大程度上源于许多患者和医生认为这些药物在缓解该疾病症状方面并不总是足够有效的看法。这些发现，连同患者对总体健康的低认知度，表明需要针对OA的新治疗方法。
