Hochberg M C, Altman R D, Brandt K D, Clark B M, Dieppe P A, Griffin M R, Moskowitz R W, Schnitzer T J
University of Maryland School of Medicine, USA.
Arthritis Rheum. 1995 Nov;38(11):1541-6. doi: 10.1002/art.1780381104.
Treatment of patients with OA of the knee should be individualized and tailored to the severity of the symptoms. In individuals with mild symptomatic OA, treatment may be limited to patient education, physical and occupational therapy and other nonpharmacologic modalities, and pharmacologic therapy including non-opioid oral and topical analgesics. In patients who are unresponsive to this treatment regimen, the use of NSAIDs in addition to nonpharmacologic therapy is appropriate unless medically contraindicated. Judicious use of intraarticular steroid injections has a role either as monotherapy or an adjunct to systemic therapy in patients with knee OA who have symptomatic effusions. The role of joint lavage and arthroscopic debridement in patients with OA of the knee who are unresponsive to conservative medical therapy needs further study, and these procedures cannot be routinely recommended for all patients at this time. Patients with severe symptomatic OA of the knee require an aggressive approach to decreasing pain, increasing mobility, and decreasing functional impairment; such patients may benefit from orthopedic consultation and evaluation for osteotomy or total joint arthroplasty.
膝关节骨关节炎患者的治疗应个体化，并根据症状的严重程度进行调整。对于症状较轻的骨关节炎患者，治疗可能仅限于患者教育、物理和职业治疗以及其他非药物治疗方法，以及包括非阿片类口服和外用镇痛药在内的药物治疗。对于对这种治疗方案无反应的患者，除非有医学禁忌，在非药物治疗的基础上加用非甾体抗炎药是合适的。对于有症状性积液的膝关节骨关节炎患者，谨慎使用关节内类固醇注射可作为单一疗法或全身治疗的辅助手段。关节灌洗和关节镜清创术在对保守药物治疗无反应的膝关节骨关节炎患者中的作用需要进一步研究，目前不能常规推荐所有患者采用这些手术。重度症状性膝关节骨关节炎患者需要积极采取措施减轻疼痛、增加活动能力并减少功能障碍；这类患者可能受益于骨科会诊以及截骨术或全关节置换术的评估。
