Pavlicević Ivancica, Kuzmanić Marion, Rumboldt Mirjana, Rumboldt Zvonko
Katedra obiteljske medicine, Medicinskifakultet Sveucilista u Splitu, Hrvatska.
Acta Med Croatica. 2011 Mar;65(1):55-62.
Nonsteroidal anti-inflammatory drug (NSAID) side effects can impair quality of life in patients with osteoarthritis. Due to its particular mechanism of action, paracetamol might bypass these negative effects.
To determine both the role of paracetamol in the treatment of osteoarthritis patients and optimal combination of antihypertensives and antirheumatics for these patients.
A prospective clinical trial in a family practice included 110 treated hypertensives aged over 55 years: 50 controls and 60 also taking NSAIDs for osteoarthritis. This 3-month study compared two antihypertensives, lisinopril/hydrochlorothiazide fixed combination and amlodipine, with two NSAIDs, ibuprofen and piroxicam, and with paracetamol. Following clinical work-up and NSAID discontinuation for at least 3 days (run-in period of only 3-7 days), osteoarthritis subjects were randomized to 1-month periods of ibuprofen (400-600 mg t.i.d.) or piroxicam (10-20 mg o.d.) with one month of paracetamol (1000 mg t.i.d.) in the middle as a "wash-out" interval, continuing the prescribed amlodipine (5-10 mg o.d.) or lisinopril/hydrochlorothiazide fixed drug combination (10/6.25-20/12.5 mg o.d.), while control subjects (hypertensives with no osteoarthritis) were just keeping their antihypertensive therapy. Blood pressure was measured with standard mercury sphygmomanometer and with an automatic device, in standing, sitting and supine position. The intensity of arthritic pain (on a visual analogue scale from 1 to 10, where 0 means "no pain" and 10 "the worst pain you may imagine") and the patient's quality of life estimate (on a visual analogue scale from 1 to 10, where 0 means "general condition excellent" and 10 "the worst possible") were recorded.
Blood pressure control was unchanged in the amiodipine group across the study periods and impaired in the lisinopril/ hydrochlorothiazide group during either ibuprofen or piroxicam, but not during paracetamol. In the amlodipine +/- ibuprofen subgroup, the reduction of the average pain intensity score throughout the study was significant (chi2 = 8.250; df 3; P = 0.037). In the lisinopril/hydrochlorothiazide +/- piroxicam subgroup, the assessed quality of life differed significantly (chi2 = 9.716; df 3; P = 0.018), while in the amlodipine +/- ibuprofen and amlodipine +/- piroxicam subgroups the changes were marginal (chi2 = 6.936; df 3; P = 0.072 and chi2 = 7146; df 3; P = 0.065, respectively).
非甾体抗炎药（NSAID）的副作用会损害骨关节炎患者的生活质量。由于对乙酰氨基酚具有特殊的作用机制，它可能避免这些负面影响。
确定对乙酰氨基酚在骨关节炎患者治疗中的作用以及这些患者使用的降压药与抗风湿药的最佳组合。
一项在家庭医疗诊所进行的前瞻性临床试验纳入了110名年龄超过55岁的高血压患者：50名对照者和60名同时因骨关节炎服用NSAID的患者。这项为期3个月的研究将两种降压药赖诺普利/氢氯噻嗪固定复方制剂和氨氯地平，与两种NSAID布洛芬和吡罗昔康，以及与对乙酰氨基酚进行了比较。在进行临床检查并停用NSAID至少3天（仅3 - 7天的导入期）后，骨关节炎患者被随机分配接受为期1个月的布洛芬（400 - 600毫克，每日三次）或吡罗昔康（10 - 20毫克，每日一次）治疗，中间有1个月的对乙酰氨基酚（1000毫克，每日三次）作为“洗脱”期，同时继续服用规定剂量的氨氯地平（5 - 10毫克，每日一次）或赖诺普利/氢氯噻嗪固定复方制剂（10/6.25 - 20/12.5毫克，每日一次），而对照者（无骨关节炎的高血压患者）则继续其降压治疗。使用标准汞柱血压计和自动设备在站立、坐位和仰卧位测量血压。记录关节炎疼痛强度（采用1至10的视觉模拟评分，其中0表示“无疼痛”，10表示“你能想象到的最严重疼痛”）和患者生活质量评估（采用1至10的视觉模拟评分，其中0表示“总体状况极佳”，10表示“可能的最差状况”）。
在整个研究期间，氨氯地平组的血压控制情况未变，而赖诺普利/氢氯噻嗪组在服用布洛芬或吡罗昔康期间血压控制受损，但在服用对乙酰氨基酚期间未受损。在氨氯地平+/-布洛芬亚组中，整个研究期间平均疼痛强度评分的降低具有显著性（χ² = 8.250；自由度3；P = 0.037）。在赖诺普利/氢氯噻嗪+/-吡罗昔康亚组中，评估的生活质量有显著差异（χ² = 9.716；自由度3；P = 0.018），而在氨氯地平+/-布洛芬和氨氯地平+/-吡罗昔康亚组中变化不明显（χ²分别为6.936；自由度3；P = 0.072和χ² = 7.146；自由度3；P = 0.065）。
