Bradley J D, Brandt K D, Katz B P, Kalasinski L A, Ryan S I
Rheumatology Division, Indiana University School of Medicine, Indianapolis 46202-5103.
N Engl J Med. 1991 Jul 11;325(2):87-91. doi: 10.1056/NEJM199107113250203.
The optimal short-term, symptomatic therapy for osteoarthritis of the knee has not been fully determined. Accordingly, we compared the efficacy of a nonsteroidal antiinflammatory drug, ibuprofen, given in either an antiinflammatory dose (high dose) or an analgesic dose (low dose), with that of acetaminophen, a pure analgesic.
In a randomized, double-blind trial, 184 patients with chronic knee pain due to osteoarthritis were given either 2400 or 1200 mg of ibuprofen per day or 4000 mg of acetaminophen per day. They were evaluated after a washout period of three to seven days before the beginning of the study, and again after four weeks of treatment. The major measures of outcome included scores on the pain and disability scales of the Stanford Health Assessment Questionnaire (range of possible scores, 0 to 3), scores on the visual-analogue scales for pain at rest and pain while walking, the time needed to walk 50 ft (15 m), and the physician's global assessment of the patient's arthritis.
Seventy-eight percent of the patients completed four weeks of therapy. No significant differences were noted among the three treatment groups with respect to failure to complete the trial because of noncompliance or adverse events. All three groups had improvement in all major outcome variables, and the groups did not differ significantly in the magnitude of improvement in most variables. The mean improvement (change) in the scores on the pain scale of the Health Assessment Questionnaire was 0.33 with acetaminophen (95 percent confidence interval, 0.14 to 0.52), 0.30 with the low dose of ibuprofen (95 percent confidence interval, 0.09 to 0.51), and 0.35 with the high dose of ibuprofen (95 percent confidence interval, 0.13 to 0.57). Side effects were minor and similar in all three groups.
In short-term, symptomatic treatment of osteoarthritis of the knee, the efficacy of acetaminophen was similar to that of ibuprofen, whether the latter was administered in an analgesic or an antiinflammatory dose.
膝骨关节炎的最佳短期对症治疗方法尚未完全确定。因此，我们比较了非甾体抗炎药布洛芬以抗炎剂量（高剂量）或镇痛剂量（低剂量）给药与单纯镇痛药对乙酰氨基酚的疗效。
在一项随机双盲试验中，184例因骨关节炎导致慢性膝关节疼痛的患者，分别给予每日2400毫克或1200毫克布洛芬或每日4000毫克对乙酰氨基酚。在研究开始前经过三到七天的洗脱期后对他们进行评估，治疗四周后再次评估。主要结局指标包括斯坦福健康评估问卷疼痛和残疾量表的评分（可能的评分范围为0至3）、静息时疼痛和行走时疼痛的视觉模拟量表评分、行走50英尺（15米）所需时间以及医生对患者关节炎的整体评估。
78%的患者完成了四周治疗。在三个治疗组中，因不依从或不良事件而未完成试验的情况无显著差异。所有三个组在所有主要结局变量上均有改善，且在大多数变量的改善程度上组间无显著差异。健康评估问卷疼痛量表评分的平均改善（变化），对乙酰氨基酚组为0.33（95%置信区间为0.14至0.52），低剂量布洛芬组为0.30（95%置信区间为0.09至0.51），高剂量布洛芬组为0.35（95%置信区间为0.13至0.57）。三组的副作用均较小且相似。
在膝骨关节炎的短期对症治疗中，对乙酰氨基酚的疗效与布洛芬相似，无论布洛芬是以镇痛剂量还是抗炎剂量给药。
