Meng Zengdong, Huang Rongzhong
Department of Orthopaedics, First People's Hospital of YunNan Province, Kunming, YunNan, P.R. China.
Department of Gerontology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China.
Am J Med Sci. 2018 Jan;355(1):6-12. doi: 10.1016/j.amjms.2017.06.006. Epub 2017 Jun 15.
This article reviews topical management strategies for degenerative osteoarthritis (OA) of the knee. A search of Pubmed, Embase and the Cochrane library using MeSH terms including "topical," "treatment," "knee" and "osteoarthritis" was carried out. Original research and review articles on the effectiveness and safety, recommendations from international published guidelines and acceptability studies of topical preparations were included. Current topical treatments included for the management of knee OA include topical nonsteroidal anti-inflammatory drugs, capsaicin, salicylates and physical treatments such as hot or cold therapy. Current treatment guidelines recommend topical nonsteroidal anti-inflammatory drugs as an alternative and even first-line therapy for OA management, especially among elderly patients. Guidelines on other topical treatments vary, from recommendations against their use, to in favor as alternative or simultaneous therapy, especially for patients with contraindications to other analgesics. Although often well-tolerated and preferred by many patients, clinical care still lags in the adoption of topical treatments. Aspects of efficacy, safety and patient quality of life data require further research.
本文综述了膝关节退行性骨关节炎（OA）的局部治疗策略。利用包括“局部的”“治疗”“膝关节”和“骨关节炎”等医学主题词（MeSH）在PubMed、Embase和Cochrane图书馆进行了检索。纳入了关于有效性和安全性的原始研究及综述文章、国际已发表指南的推荐意见以及局部制剂的可接受性研究。目前用于膝关节OA管理的局部治疗包括局部非甾体抗炎药、辣椒素、水杨酸盐以及热疗或冷疗等物理治疗。当前的治疗指南推荐局部非甾体抗炎药作为OA管理的替代甚至一线治疗方法，尤其是在老年患者中。关于其他局部治疗的指南各不相同，从反对使用到支持作为替代或联合治疗，特别是对于有其他镇痛药禁忌证的患者。尽管局部治疗通常耐受性良好且为许多患者所偏爱，但在临床实践中采用局部治疗仍存在滞后情况。疗效、安全性和患者生活质量数据等方面需要进一步研究。
