Cadet Christian, Maheu Emmanuel
Medical Practice, 4, Place Martin Nadaud, PARIS, 75020, France.
Hospital Saint-Antoine, Paris, Île-de-France, France.
Ther Adv Musculoskelet Dis. 2021 Jun 18;13:1759720X211022149. doi: 10.1177/1759720X211022149. eCollection 2021.
Osteoarthritis (OA) is the most common form of arthritis worldwide, and ranges in the top 5-10 most disabling diseases. Contrary to common opinion, this disease is severe, often symptomatic, and may lead to loss of mobility and independence, as well as being responsible for increased frailty and excess mortality [standardized ratio: 1.55 (95% confidence interval, CI: 1.41-1.70)]. The incidence of OA increases dramatically with age in an increasingly ageing world. Therefore, practitioners involved in the management of OA often have to manage very old patients, aged 75-80 years and above, as part of their daily practice. Treatment options are limited. In addition to education and physical treatments, which are at the forefront of all treatment recommendations but require a low level of symptoms to be implemented, many pharmacological options are proposed. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used as a second-line treatment but with great caution. However, the precise incidence of cardiovascular, renal, and gastrointestinal adverse events in very elderly patients is unclear. All of these risks are increased in the elderly. The relative risks can be extrapolated from various studies. However, what is the absolute risk according to age categorization? The answer to this question is important because NSAIDs should be used in very elderly patients with OA only if full information has been provided and the decision to prescribe this treatment is shared between the patient and their doctor. This article reviews the risks and currently available recommendations, and proposes practical options and warnings to allow for a responsible and limited use of NSAIDs in the very old.
Osteoarthritis (OA) in the very old is a serious disease leading to loss of independence, frailty, and excess mortality. Quantitative data from clinical trials and population-based observational studies on the risk of NSAID-related side effects allow the prescriber to provide more accurate information to each patient. If there is no contraindication, the decision to initiate NSAID therapy in a very old OA patient should be made in a shared manner, with the patient fully informed of the risks.
骨关节炎（OA）是全球最常见的关节炎形式，位列致残程度最高的5至10种疾病之中。与普遍看法相反，这种疾病很严重，常常有症状，可能导致行动能力丧失和生活不能自理，还会导致身体虚弱加剧和死亡率上升[标准化比率：1.55（95%置信区间，CI：1.41 - 1.70）]。在世界老龄化日益严重的情况下，OA的发病率随年龄急剧上升。因此，参与OA治疗的从业者在日常工作中常常需要治疗75岁及以上的高龄患者。治疗选择有限。除了教育和物理治疗（这些是所有治疗建议的首要措施，但实施时要求症状较轻）之外，还提出了许多药物治疗方案。非甾体抗炎药（NSAIDs）可作为二线治疗药物，但需极为谨慎使用。然而，高龄患者中心血管、肾脏和胃肠道不良事件的确切发生率尚不清楚。所有这些风险在老年人中都会增加。相对风险可从各种研究中推断出来。但是，根据年龄分类的绝对风险是多少呢？这个问题的答案很重要，因为只有在充分提供信息且患者与其医生共同做出开这种药的决定时，NSAIDs才应在高龄OA患者中使用。
高龄患者的骨关节炎（OA）是一种严重疾病，会导致生活不能自理、身体虚弱和死亡率上升。来自临床试验和基于人群的观察性研究的关于NSAID相关副作用风险的定量数据，使开处方者能够向每位患者提供更准确的信息。如果没有禁忌证，在高龄OA患者中启动NSAID治疗的决定应以共同参与的方式做出，要让患者充分了解风险。
