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[非甾体抗炎药、口服制剂及关节腔注射透明质酸钠在软骨损伤保守治疗中的作用]

[The role of nonsteroidal anti-inflammatory drugs, oral preparations, and viscosupplementation in conservative treatment of cartilage lesions].

作者信息

Müezzinoğlu Sefa, Buluç Levent

机构信息

Kocaeli Universitesi Tip Fakültesi Ortopedi ve Travmatoloji Anabilim Dali, Kocaeli, Turkey.

出版信息

Acta Orthop Traumatol Turc. 2007;41 Suppl 2:48-53.

Abstract

Osteoarthritis is one of the most common disabling conditions in elderly population. Its current treatment includes not only eliminating symptoms, but also slowing down the degenerative process and achieving functional improvement. When the patient does not benefit from nonpharmacologic measures such as loosing weight, drug therapy is needed, which includes analgesics, weak narcotic drugs, nonsteroidal anti-inflammatory drugs, COX-2 inhibitors, corticosteroids, viscosupplementation, and slow-acting drugs used in osteoarthritis. Among these, simple analgesics are first-line treatment option for osteoarthritis owing to successful relief of symptoms and negligible side effects. Nonsteroidal anti-inflammatory drugs, in spite of providing greater analgesic effect, have to be used carefully for their gastrointestinal and chondrodestructive adverse effects. COX-2 inhibitors are being reassessed for their cardiovascular adverse effects and research is in progress for further improvement. Although viscosupplementation is effective in the short-term, no long-term benefits have been observed. There is no convincing evidence for the efficacy of slow-acting drugs such as glucosamine and chondroitin sulphate given as nutritional support. Other treatment modalities currently evaluated are biphosphonates, hormones, metalloproteinase inhibitors, cytokines, nitric oxide, growth factors, and gene therapy.

摘要

骨关节炎是老年人群中最常见的致残性疾病之一。其目前的治疗不仅包括消除症状,还包括减缓退变过程并实现功能改善。当患者无法从诸如减肥等非药物措施中获益时,就需要药物治疗,这包括镇痛药、弱麻醉药、非甾体抗炎药、COX-2抑制剂、皮质类固醇、关节腔注射透明质酸钠以及用于骨关节炎的慢作用药物。其中,单纯镇痛药因能成功缓解症状且副作用可忽略不计,是骨关节炎的一线治疗选择。非甾体抗炎药尽管镇痛效果更佳,但因其胃肠道和软骨破坏等不良反应,必须谨慎使用。COX-2抑制剂正因其心血管不良反应而重新评估,相关研究正在进行以进一步改进。尽管关节腔注射透明质酸钠在短期内有效,但尚未观察到长期益处。没有令人信服的证据表明氨基葡萄糖和硫酸软骨素等作为营养支持的慢作用药物的疗效。目前正在评估的其他治疗方式包括双膦酸盐、激素、金属蛋白酶抑制剂、细胞因子、一氧化氮、生长因子和基因治疗。

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