Griffin M R, Brandt K D, Liang M H, Pincus T, Ray W A
Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tenn., USA.
Arch Fam Med. 1995 Dec;4(12):1049-55. doi: 10.1001/archfami.4.12.1049.
Pharmacotherapy should play an adjunctive role to nonpharmacologic measures in the overall management of patients with symptoms due to osteoarthritis. Patients should be instructed in how to rest or unload involved joints; protect them through appropriate manipulation of their environment and appropriate methods of lifting and bending; and maintain and improve muscle strength and flexibility to ensure joint stability and prevent contractures. In most patients, acetaminophen in doses of up to 4 g/d is preferable to nonsteroidal anti-inflammatory drugs (NSAIDs) as a first-choice agent because of its lower toxicity. If NSAIDs are used, they should be prescribed initially in lower (analgesic) doses. Ibuprofen may be the preferred initial NSAID because it can be given in low doses for short durations, has been associated with lower rates of gastrointestinal tract side effects, and is inexpensive.
在骨关节炎所致症状患者的整体管理中，药物治疗应作为非药物措施的辅助手段。应指导患者如何休息或减轻受累关节的负荷；通过适当调整环境以及采用合适的 lifting 和弯曲方法来保护关节；并维持和提高肌肉力量及灵活性，以确保关节稳定性并预防挛缩。在大多数患者中，由于对乙酰氨基酚毒性较低，每日剂量高达 4 g 时比非甾体抗炎药（NSAIDs）更适合作为首选药物。如果使用 NSAIDs，最初应以较低（止痛）剂量开具。布洛芬可能是首选的初始 NSAID，因为它可以低剂量短期给药，胃肠道副作用发生率较低，且价格便宜。
