From the Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Dr. Jevsevar), American Academy of Orthopaedic Surgeons, Rosemont, IL (Mr. Shores, Mr. Mullen, Ms. Schulte, and Dr. Cummins), and Franciscan Orthopedic Associates, Tacoma, WA (Dr. Brown).
J Am Acad Orthop Surg. 2018 May 1;26(9):325-336. doi: 10.5435/JAAOS-D-17-00318.
Knee osteoarthritis (KOA) is a significant health problem with lifetime risk of development estimated to be 45%. Effective nonsurgical treatments are needed for the management of symptoms.
We designed a network meta-analysis to determine clinically relevant effectiveness of nonsteroidal anti-inflammatory drugs, acetaminophen, intra-articular (IA) corticosteroids, IA platelet-rich plasma, and IA hyaluronic acid compared with each other as well as with oral and IA placebos. We used PubMed, EMBASE, and Cochrane Central Register of Controlled Trials to perform a systematic search of KOA treatments with no date limits and last search on October 7, 2015. Article inclusion criteria considered the following: target population, randomized controlled study design, English language, human subjects, treatments and outcomes of interest, ≥30 patients per group, and consistent follow-up. Using the best available evidence, two abstractors independently extracted pain and function data at or near the most common follow-up time.
For pain, all active treatments showed significance over oral placebo, with IA corticosteroids having the largest magnitude of effect and significant difference only over IA placebo. For function, no IA treatments showed significance compared with either placebo, and naproxen was the only treatment showing clinical significance compared with oral placebo. Cumulative probabilities showed naproxen to be the most effective individual treatment, and when combined with IA corticosteroids, it is the most probable to improve pain and function.
Naproxen ranked most effective among conservative treatments of KOA and should be considered when treating pain and function because of its relative safety and low cost. The best available evidence was analyzed, but there were instances of inconsistency in the design and duration among articles, potentially affecting uniform data inclusion.
膝关节骨关节炎（KOA）是一个严重的健康问题，其终生发病风险估计为 45%。需要有效的非手术治疗来缓解症状。
我们设计了一个网络荟萃分析，以确定非甾体抗炎药、对乙酰氨基酚、关节内（IA）皮质类固醇、IA 富血小板血浆和 IA 透明质酸与彼此以及口服和 IA 安慰剂相比的临床相关疗效。我们使用 PubMed、EMBASE 和 Cochrane 对照试验中心注册库进行了无日期限制的 KOA 治疗系统搜索，并于 2015 年 10 月 7 日进行了最后一次搜索。文章纳入标准考虑了以下因素：目标人群、随机对照研究设计、英语、人体、治疗和感兴趣的结局、每组≥30 例患者，以及一致的随访。使用最佳现有证据，两名摘要员独立提取最常见随访时间点或接近该时间点的疼痛和功能数据。
在疼痛方面，所有积极治疗均显著优于口服安慰剂，其中 IA 皮质类固醇的效果最大，且仅显著优于 IA 安慰剂。在功能方面，与任何一种安慰剂相比，IA 治疗均无显著差异，而萘普生是唯一与口服安慰剂相比具有临床意义的治疗方法。累积概率显示萘普生是最有效的单一治疗方法，当与 IA 皮质类固醇联合使用时，它最有可能改善疼痛和功能。
萘普生在 KOA 的保守治疗中是最有效的药物之一，由于其相对安全和低成本，在治疗疼痛和功能时应予以考虑。虽然分析了最佳现有证据，但文章的设计和持续时间存在不一致的情况，这可能会影响数据的统一纳入。
