Bobacz Klaus
Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Wien Med Wochenschr. 2013 May;163(9-10):236-42. doi: 10.1007/s10354-013-0203-7. Epub 2013 May 29.
Osteoarthritis (OA) is a joint disease of high prevalence and affects > 90 % of the population, depending on several risk factors. Symptomatic OA is less frequent, but requires an individually tailored therapeutic regimen consisting of non-pharmacological and pharmacological treatment modalities. Pharmacologic therapy, however, is mainly limited to analgetic and anti-inflammatory agents; structure modifying remedies do not exist. The therapeutic approach to hand-, knee- and hip-OA is basically similar and differs only at some minor points. Generally, topical agents or paracetamol are recommended as first-line agents. If unsuccessful oral non-steroidal anti-inflammatory drugs (NSAIDs) or COX-2-selctive inhibitors should be introduced. Tramadol is an option in the case patients will not respond satisfactorily to NSAIDs. Glucosamine and chondroitine sulphate are no longer recommended in knee and hip OA, but chondroitine might be efficient in treating hand OA. Oral NSAIDs should be prescribed with caution due to potential side effects. Opioids are not recommended as their benefits are outweighed by an increased risk for serious adverse events.
骨关节炎（OA）是一种高发性关节疾病，根据多种风险因素，其影响着超过90%的人群。有症状的OA较为少见，但需要由非药物和药物治疗方式组成的个体化治疗方案。然而，药物治疗主要限于止痛和抗炎药物；不存在结构改善药物。手部、膝部和髋部OA的治疗方法基本相似，仅在一些小方面有所不同。一般来说，局部用药或对乙酰氨基酚被推荐为一线药物。如果无效，应使用口服非甾体抗炎药（NSAIDs）或COX-2选择性抑制剂。如果患者对NSAIDs反应不佳，曲马多是一种选择。不再推荐在膝部和髋部OA中使用氨基葡萄糖和硫酸软骨素，但软骨素可能对治疗手部OA有效。由于潜在的副作用，口服NSAIDs应谨慎处方。不推荐使用阿片类药物，因为其严重不良事件风险增加，超过了其益处。
