David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Curr Med Res Opin. 2010 Dec;26(12):2871-6. doi: 10.1185/03007995.2010.533650. Epub 2010 Nov 11.
Osteoarthritis (OA), the most common form of arthritis, often affects hands, hips, and knees and involves an estimated 26.9 million US adults. Women have a higher prevalence of OA, and the risk of developing OA increases with age, obesity, and joint malalignment. OA typically presents with pain and reduced function. Therapeutic programs are often multimodal and must take into account pharmaceutical toxicities and patient comorbidities. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with cardiovascular, gastrointestinal, and renal adverse events. Topical NSAIDs offer efficacy with reduced systemic drug exposure.
This is a review of current guideline recommendations regarding the use of topical NSAIDs in OA of the hand and knee. Articles were identified by PubMed search (January 1, 2000 to May 21, 2010).
Several current guidelines for management of OA recommend topical NSAIDs, indicating them as a safe and effective treatment. One guideline recommends that topical NSAIDs be considered as first-line pharmacologic therapy. A US guideline for knee OA recommends topical NSAIDs in older patients and in patients with increased gastrointestinal risk.
The consensus across US and European OA guidelines is that topical NSAIDs are a safe and effective treatment for OA. Because the research base on topical NSAIDs for OA is small, guidelines will continue to evolve.
骨关节炎（OA）是最常见的关节炎形式，常影响手、髋和膝关节，据估计，美国有 2690 万成年人患有 OA。女性 OA 的患病率更高，OA 的发病风险随着年龄增长、肥胖和关节错位而增加。OA 通常表现为疼痛和功能下降。治疗方案通常是多模式的，必须考虑药物毒性和患者合并症。例如，非甾体抗炎药（NSAIDs）与心血管、胃肠道和肾脏不良事件相关。局部 NSAIDs 可提供疗效，同时减少全身药物暴露。
这是对当前指南中关于局部 NSAIDs 在手部和膝部 OA 中应用的建议的综述。通过 PubMed 搜索（2000 年 1 月 1 日至 2010 年 5 月 21 日）确定了相关文章。
目前有几份 OA 管理指南推荐使用局部 NSAIDs，认为其安全有效。有一份指南建议将局部 NSAIDs 作为一线药物治疗。美国膝骨关节炎指南建议在老年患者和胃肠道风险增加的患者中使用局部 NSAIDs。
美国和欧洲 OA 指南的共识是，局部 NSAIDs 是 OA 的一种安全有效的治疗方法。由于 OA 局部 NSAIDs 的研究基础较小，指南将继续发展。
