Nees T A, Schiltenwolf M
Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 220a, 69118, Heidelberg, Deutschland.
Schmerz. 2019 Feb;33(1):30-48. doi: 10.1007/s00482-018-0286-6.
Joint pain due to osteoarthritis (OA) is often severe and disabling and affects a large proportion of the aging population impairing daily living and quality of life. Numerous pharmacological treatment approaches are available. Including major OA guidelines this review presents the current evidence of pharmacological therapies in OA-related pain and covers topical, oral and intraarticular treatment approaches. In patients with mild OA topical nonsteroidal antiinflammatory drugs (NSAIDs) can be recommended. Topical capsaicin can be used when other treatments are ineffective or contraindicated. In patients with moderate to severe OA oral NSAIDs are suggested at the lowest effective dose for the shortest possible duration to control symptoms. Importantly, drug-related side effects and gastrointestinal, cardiovascular and renal comorbidities need to be taken into account. In patients with multiple-joint OA and high risk of NSAID-induced adverse events duloxetine can be considered. The evidence of metamizole, symptomatic slow-acting drugs in osteoarthritis and other nutritional supplements in the treatment of OA pain is uncertain and the use of opioids is not routinely recommended. In patients suffering from severe OA-related pain intraarticular injections with glucocorticoids can be suggested to achieve short-term pain relief. Evidence for interventional approaches using hyaluronic acid or platelet-rich plasma is uncertain. Yet, the efficacy of pharmacological therapies in OA-related pain is often inconsistent and severe adverse events might occur. Thus, critical use of the different treatment options considering patient-related comorbidities and nonpharmacological therapies is of major importance.
骨关节炎（OA）所致的关节疼痛通常较为严重且会导致功能障碍，影响很大一部分老年人群，损害日常生活和生活质量。目前有多种药物治疗方法。本综述包括主要的OA指南，介绍了OA相关疼痛药物治疗的现有证据，涵盖局部、口服和关节内治疗方法。对于轻度OA患者，可推荐使用局部非甾体抗炎药（NSAIDs）。当其他治疗无效或禁忌时，可使用局部辣椒素。对于中度至重度OA患者，建议使用口服NSAIDs，以最低有效剂量并在尽可能短的时间内控制症状。重要的是，需要考虑药物相关副作用以及胃肠道、心血管和肾脏合并症。对于多关节OA且有NSAID诱发不良事件高风险的患者，可考虑使用度洛西汀。安乃近、骨关节炎症状性慢作用药物及其他营养补充剂治疗OA疼痛的证据尚不明确，不常规推荐使用阿片类药物。对于患有严重OA相关疼痛的患者，可建议关节内注射糖皮质激素以实现短期疼痛缓解。使用透明质酸或富血小板血浆的介入治疗方法的证据尚不明确。然而，OA相关疼痛的药物治疗效果往往不一致，且可能发生严重不良事件。因此，根据患者相关合并症和非药物治疗方法谨慎使用不同的治疗选择至关重要。
