Rashad S, Revell P, Hemingway A, Low F, Rainsford K, Walker F
West Middlesex University Hospital.
Lancet. 1989 Sep 2;2(8662):519-22. doi: 10.1016/s0140-6736(89)90651-x.
To test the hypothesis that non-steroidal anti-inflammatory drugs (NSAIDs) accelerate the progression of osteoarthritis by reducing synthesis of vasodilator prostaglandins, thereby diminishing joint perfusion, 105 osteoarthritis patients awaiting hip arthroplasty were treated prospectively with a strong or weak prostaglandin synthesis inhibitor, indomethacin or azapropazone, respectively. Pain and radiological joint space were monitored during the period up to arthroplasty and the condition of the excised femoral head was determined. As judged by radiological and histopathological data, the two treatment groups were at a similar pathophysiological end-point when they came to arthroplasty. In the indomethacin group the affected hips lost joint space more rapidly than did the contralateral hips, a difference not seen in the azapropazone group. The patients receiving azapropazone, who had higher concentrations of synovial vasodilator prostaglandins, took longer than the indomethacin group to reach the arthroplasty end-point. Potent inhibitors of prostaglandin synthesis may be inappropriate in the management of osteoarthritis of the hip.
为验证非甾体抗炎药（NSAIDs）通过减少血管舒张性前列腺素的合成从而加速骨关节炎进展，进而减少关节灌注这一假说，105例等待髋关节置换术的骨关节炎患者分别前瞻性地接受强效或弱效前列腺素合成抑制剂吲哚美辛或阿扎丙宗治疗。在直至进行置换术的期间内监测疼痛和放射学关节间隙，并确定切除股骨头的状况。根据放射学和组织病理学数据判断，两个治疗组在进行置换术时处于相似的病理生理终点。在吲哚美辛组中，患侧髋关节比对侧髋关节更快地丧失关节间隙，而在阿扎丙宗组中未见到这种差异。接受阿扎丙宗治疗的患者滑膜血管舒张性前列腺素浓度较高，比吲哚美辛组花费更长时间达到置换术终点。强效前列腺素合成抑制剂可能不适用于髋关节骨关节炎的治疗。
