Operative Unit of Rheumatology, S. Pietro Fatebenefratelli Hospital, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2011 Jan;15(1):25-34.
Non-steroidal anti-inflammatory drugs (NSAIDs) consumption is strictly related to a high gastrointestinal and cardiovascular mortality and morbidity rate. Osteoarthritis Research Society International (OARSI) recommendations in patients with symptomatic hip or knee OA stated that NSAIDs should be used at the lowest effective dose but their long-term use should be avoided if possible. OARSI guidelines for the treatment of the hip OA include the use of viscosupplementation, which aims to restore physiological and rheological features of the synovial fluid.
Aim of this multicentric, open and retrospective study is to investigate if NSAID consumption may be reduced by the use of ultrasound-guided intra-articular injection of several hyaluronic acid (HA) products in hip joint administered in patients affected by symptomatic hip OA.
Patients affected by mono or bilateral symptomatic hip OA according to American Rheumatology Association (ARA) criteria, radiological OA graded II-IV (Kellgren and Lawrence) entered the study and were administered with ultrasound-guided intra-articular injection of hyaluronic acid products. As a primary endpoint, consumption of NSAIDs was evaluated by recording the number of days a month (range 0-30) the patient had used NSAID during the previous month, reported at each visit during the 24 months follow-up period. Secondary endpoints included further analysis for subgroups of patients categorized for Lequesne index score, Kellgren-Lawrence score, pain visual analogue scale (VAS) score, ultrasound pattern, age, hyaluronic acid used.
2343 patients entered the study. Regarding primary endpoint, the consumption of NSAIDs was reduced of 48.2% at the third month when compared with baseline values. This sparing effect increased at 12th and 24th month with a reduction respectively of 50% and 61% in comparison to baseline values. These differences were statistically significant.
These data point out that intraarticular hyaluronan preparations provide OA pain relief and reduce NSAIDs consumption in a large cohort of patients for a long period of follow-up. Multiple courses of viscosupplementation (vs) are required to maintain low dose of NSAID consumption over time. NSAIDs consumption is strictly related to an high gastrointestinal and cardiovascular mortality and morbidity rate, instead HA intra-articular treatment is well tolerated and is associated with a low incidence of adverse effects. For these reasons further studies evaluating cost-effectiveness and cost-utility of VS in the management of hip OA are required.
非甾体抗炎药（NSAIDs）的使用与较高的胃肠道和心血管发病率和死亡率密切相关。国际骨关节炎研究协会（OARSI）建议，对于有症状的髋或膝关节骨关节炎患者，应使用最低有效剂量的 NSAIDs，但如果可能，应避免长期使用。OARSI 髋关节骨关节炎治疗指南包括使用黏弹性补充剂，旨在恢复滑液的生理和流变学特性。
本多中心、开放和回顾性研究旨在探讨在患有症状性髋关节炎的患者中，使用超声引导下关节内注射多种透明质酸（HA）产品是否可以减少 NSAIDs 的使用。
符合美国风湿病学会（ARA）标准的单侧或双侧症状性髋关节炎患者，影像学 OA 分级 II-IV（Kellgren 和 Lawrence），接受超声引导下关节内注射透明质酸产品。主要终点为通过记录患者在前一个月中每天使用 NSAID 的天数（范围 0-30）来评估 NSAIDs 的使用情况，在 24 个月的随访期间，每次就诊时报告。次要终点包括根据 Lequesne 指数评分、Kellgren-Lawrence 评分、疼痛视觉模拟评分（VAS）评分、超声模式、年龄、使用的透明质酸对患者进行亚组分析。
2343 名患者进入研究。关于主要终点，与基线值相比，第 3 个月时 NSAIDs 的使用减少了 48.2%。这种节省效果在第 12 个月和第 24 个月时增加，与基线值相比，分别减少了 50%和 61%。这些差异具有统计学意义。
这些数据表明，关节内透明质酸钠制剂可缓解 OA 疼痛，并在较长的随访时间内减少 NSAIDs 的使用。需要多次进行黏弹性补充治疗（vs），以维持 NSAIDs 的低剂量使用。NSAIDs 的使用与较高的胃肠道和心血管发病率和死亡率密切相关，而 HA 关节内治疗具有良好的耐受性，并与较低的不良反应发生率相关。因此，需要进一步研究评估在髋关节炎管理中使用 VS 的成本效益和成本效用。
