Reijman M, Bierma-Zeinstra S M A, Pols H A P, Koes B W, Stricker B H C, Hazes J M W
Department of Orthopedics, Erasmus MC, Rotterdam, The Netherlands.
Arthritis Rheum. 2005 Oct;52(10):3137-42. doi: 10.1002/art.21357.
To investigate the influence of the use of various types of nonsteroidal antiinflammatory drugs (NSAIDs) on progression of osteoarthritis (OA) of the hip and knee.
In 1,695 subjects (2,514 hips) and 635 subjects (874 knees) ages 55 years and older from the Rotterdam Study, radiographs of the hip and knee at baseline and followup (mean followup time 6.6 years) were evaluated. Radiologic OA (ROA) progression was defined as a minimum increase of 1 in the Kellgren/Lawrence grade or incident joint replacement at followup. The associations between the different types of NSAIDs and progression of ROA were assessed using multivariate logistic regression analysis.
Those subjects who were receiving diclofenac >180 days had a 2.4-fold increased risk (95% confidence interval [95% CI] 1.0-6.2) of progression of hip ROA and a 3.2-fold increased risk (95% CI 1.0-9.9) of knee ROA, compared with those considered short-term users (diclofenac for 1-30 days). These associations were adjusted for age, sex, body mass index, baseline ROA, followup time, and defined daily dosage.
These data suggest that diclofenac may induce accelerated progression of hip and knee ROA. Whether this occurs because of a true deleterious effect on cartilage or because of excessive mechanical loading on a hip following pain relief remains to be investigated.
研究使用各类非甾体抗炎药（NSAIDs）对髋和膝骨关节炎（OA）进展的影响。
对鹿特丹研究中年龄在55岁及以上的1695名受试者（2514个髋关节）和635名受试者（874个膝关节）进行研究，评估其基线和随访时（平均随访时间6.6年）髋和膝的X线片。放射学骨关节炎（ROA）进展定义为随访时Kellgren/Lawrence分级至少增加1级或发生关节置换。使用多因素逻辑回归分析评估不同类型NSAIDs与ROA进展之间的关联。
与短期使用者（双氯芬酸使用1 - 30天）相比，接受双氯芬酸治疗超过180天的受试者髋ROA进展风险增加2.4倍（95%置信区间[95%CI]1.0 - 6.2），膝ROA进展风险增加3.2倍（95%CI 1.0 - 9.9）。这些关联已根据年龄、性别、体重指数、基线ROA、随访时间和规定日剂量进行了校正。
这些数据表明双氯芬酸可能会加速髋和膝ROA的进展。这是由于对软骨产生真正的有害作用，还是因为疼痛缓解后髋部承受过多机械负荷，仍有待研究。
