van Herwaarden Noortje, van den Elsen Geke A H, de Jong Ingrid C A, Kramers C Kees, Kloppenburg Margreet, van den Bemt Bart J F
Radboudumc, Nijmegen. Afd. Reumatische Ziekten.
Contact: Noortje van Herwaarden (
Ned Tijdschr Geneeskd. 2021 May 19;165:D5317.
Topical NSAIDs are currently recommended in several national and international guidelines for knee osteoarthritis, hand osteoarthritis and acute musculoskeletal pain. However, there is still widespread skepticism about the effectiveness of this treatment. This article discusses different reasons for this skepticism, a short summary of the pharmacokinetics and pharmacodynamics of topical NSAIDs and an overview of available evidence regarding efficacy and safety. Based on this evidence topical NSAIDs have a clear place in the treatment of knee and hand osteoarthritis and acute musculoskeletal pain. Due to less systemic side effects they should be recommended before an oral NSAID is considered. Topical NSAIDs might even be an option for patients with contra-indications for oral NSAIDs. There is a large variety of available topical NSAIDs. Of the available topical NSAIDs in the Netherlands, diclofenac gel seems the most sensible choice.
目前，多种国内外指南推荐使用外用非甾体抗炎药治疗膝关节骨关节炎、手部骨关节炎和急性肌肉骨骼疼痛。然而，对于这种治疗方法的有效性仍普遍存在怀疑。本文讨论了产生这种怀疑的不同原因，简要总结了外用非甾体抗炎药的药代动力学和药效学，并概述了有关其疗效和安全性的现有证据。基于这些证据，外用非甾体抗炎药在治疗膝关节和手部骨关节炎以及急性肌肉骨骼疼痛方面具有明确的地位。由于其全身副作用较少，在考虑使用口服非甾体抗炎药之前应推荐使用外用非甾体抗炎药。对于有口服非甾体抗炎药禁忌证的患者，外用非甾体抗炎药甚至可能是一种选择。市面上有多种外用非甾体抗炎药可供选择。在荷兰现有的外用非甾体抗炎药中，双氯芬酸凝胶似乎是最合理的选择。
