Roemer F W, Hayes C W, Miller C G, Hoover K, Guermazi A
Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany.
Department of Radiology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Osteoarthritis Cartilage. 2015 Jan;23 Suppl 1:S59-68. doi: 10.1016/j.joca.2014.09.018.
Despite promising results, the U.S. Food and Drug Administration (FDA) put on hold trials assessing anti-nerve growth factor (a-NGF) compounds due to concerns over accelerated rates of OA progression. The mechanism of these events is unclear but joint adverse events were observed particularly in patients using a-NGFs in combination with non-steroidal anti-inflammatory drugs (NSAIDs), suggesting that the significantly greater analgesic effect of these separate classes of drugs prompted patients to permit increased joint load without experiencing the usual pain that would limit joint stress. Development of a-NGF drugs is continuing with stringent safety criteria included in future trials as a-NGF therapies offer potential as the first new class of analgesics in many years. Potential imaging joint safety findings and exclusionary criteria for eligibility for the large weight bearing joints were presented in parts I and II of this atlas. The shoulder as a non-weight bearing joint is likely to be less affected by increased loading due to efficacious pain reduction. However, it remains prone to degeneration especially due to concomitant rotator cuff pathology and previous trauma and inflammatory disorders. This third part of the atlas illustrates imaging findings relevant for eligibility and potential joint safety findings such as osteonecrosis, incidental findings such as large cystic lesions, inflammatory disorders, bone marrow disorders and metastases.
尽管取得了令人鼓舞的结果，但由于担心骨关节炎（OA）进展加速，美国食品药品监督管理局（FDA）暂停了评估抗神经生长因子（a-NGF）化合物的试验。这些事件的机制尚不清楚，但在联合使用a-NGF与非甾体抗炎药（NSAIDs）的患者中尤其观察到关节不良事件，这表明这两类药物显著更强的镇痛作用促使患者在没有经历通常会限制关节压力的疼痛的情况下增加关节负荷。a-NGF药物的研发仍在继续，未来试验将纳入严格的安全标准，因为a-NGF疗法有望成为多年来首个新型镇痛药物类别。本图谱的第一部分和第二部分介绍了潜在的成像关节安全发现以及大型负重关节合格性的排除标准。作为非负重关节，肩部可能因有效减轻疼痛而较少受到负荷增加的影响。然而，它仍然容易发生退变，特别是由于合并的肩袖病变以及既往创伤和炎症性疾病。本图谱的第三部分展示了与合格性相关的成像结果以及潜在的关节安全发现，如骨坏死、偶然发现的大囊性病变、炎症性疾病、骨髓疾病和转移瘤。
