Wollheim F A
Department of Rheumatology, Lund University Hospital, Sweden.
Drugs. 1996;52 Suppl 3:27-38. doi: 10.2165/00003495-199600523-00006.
In this overview, the currently available symptomatic treatments of osteoarthritis from the published literature are evaluated. Paracetamol attracts growing interest as a less toxic yet potent alternative to NSAIDs. These latter agents are, however, used more widely than paracetamol, although adverse reactions associated with their use are of increasing concern among both patients and physicians. New NSAIDs are still under development. While there is not much evidence of important differences between NSAIDs in overall efficacy, they do vary with regard to toxicity. The cytoprotective effect of misoprostol in at-risk patients on NSAIDs is established but the cost-effectiveness is unclear. Furthermore, percutaneous administration of NSAIDs, capsaicin, and other substances may have some merit. Opioids, such as dextropropoxyphene, are used in combination with paracetamol in patients intolerant to NSAIDs or when pain is not controlled with NSAIDs. Locally administered glucocorticoids may have a disease-modifying effect and are of symptomatic use in certain situations. The role, if any, of hyaluronan therapy remains to be established. Although this agent appears to have a good safety profile, it is expensive. Chondroprotection is an interesting field for future research, although there is no good evidence supporting its existence in clinical medicine as practised now.
在本综述中，对已发表文献中目前可用的骨关节炎症状性治疗方法进行了评估。对乙酰氨基酚作为一种毒性较小但效力较强的非甾体抗炎药替代药物，正吸引着越来越多的关注。然而，尽管与使用非甾体抗炎药相关的不良反应在患者和医生中越来越受到关注，但这些药物的使用比扑热息痛更为广泛。新型非甾体抗炎药仍在研发中。虽然没有太多证据表明非甾体抗炎药在总体疗效上有重要差异，但它们在毒性方面确实有所不同。米索前列醇对有风险的非甾体抗炎药患者的细胞保护作用已得到证实，但成本效益尚不清楚。此外，非甾体抗炎药、辣椒素和其他物质的经皮给药可能有一定优点。阿片类药物，如右丙氧芬，在对非甾体抗炎药不耐受或非甾体抗炎药无法控制疼痛的患者中，与对乙酰氨基酚联合使用。局部应用糖皮质激素可能具有改善病情的作用，在某些情况下可缓解症状。透明质酸治疗的作用（如果有的话）仍有待确定。尽管这种药物似乎具有良好的安全性，但价格昂贵。软骨保护是未来研究的一个有趣领域，尽管目前没有充分证据支持其在临床医学中的存在。
