膝骨性关节炎的注射治疗：指南系统回顾（三）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Pavone V, Vescio A, Turchetta M, et al. Injection-Based Management of Osteoarthritis of the Knee: A Systematic Review of Guidelines. Front Pharmacol. 2021;12:661805.本次学习由林小雯副主任医师主讲。

RESULTS 

Corticosteroid Injections

In 1953, Dr. Hollander and collegues from University of Pennsylvania were first authors who described interarticular corticosteroid injections for patients with rheumatoid arthritis. Subsequently, have become a commonly utilized technique of managing pain in KOA affected patients as well, and previous reviews on the topic has generally found them to be an effective treatment. IAJ for knee OA have been demonstrated to decrease the pain gravity.

The 2019 Osteoarthritis Research Society International (OARSI) international guidelines conditionally recommended (recommended with caution) the use of intra-articular corticosteroids knee OA affected patients in all groups. A Good Clinical Practice Statement utilizing to intra-articular (IA) treatments for all comorbidity subgroups was added, noting that intra-articular corticosteroid (IACS) may provide short term pain relief.

结果

皮质类固醇注射

1953年，来自宾夕法尼亚大学的霍兰德博士和其团队首先将皮质醇关节内注射用于类风湿性关节炎患者。随后，该技术也成为KOA患者疼痛管理的常用技术，而以往研究发现，这是一种有效的治疗方法。膝关节腔内注射已被证明可以减轻疼痛。

2019年国际骨关节炎研究协会（OARSI）国际指南建议（谨慎推荐）使用关节内皮质类固醇治疗膝骨性关节炎患者。一项临床研究表明，关节内皮质类固醇(IACS)可能提供短期疼痛缓解。

In the latest international guidelines, the American Academy of Orthopedic Surgeons (AAOS) does not currently have recommendations for or against the use (unsupported) of IACS injection of the knee and advises that practitioners should be alert for emerging evidence that clarifies or helps determine the balance between benefits and potential harm: “We are unable to recommend for or against the use of intraarticular (IA) corticosteroids for patients with symptomatic osteoarthritis of the knee”.

2020 European League Against Rheumatism (EULAR) recommendations for the management of knee osteoarthritis claims that “Intra-articular injection of long acting steroid is indicated for acute exacerbation of knee pain, especially if accompanied by effusion” (recommended) .

在最新的国际指南中，美国骨科外科医师学会（AAOS）目前不建议或反对使用（不受支持）膝关节腔内注射治疗皮质醇，并建议从业者应注意疗效和潜在危害之间的平衡："我们不建议或反对膝关节腔内注射皮质醇用于治疗有症状的膝骨关节炎患者" 。

2020年欧洲反风湿病联盟（EULAR）关于膝盖骨关节炎管理的建议声称：“关节注射长效类固醇可用于治疗急性期关节炎，尤其是伴有滑膜炎的患者”（推荐）。

The Royal Australian College of General Practitioners (RACGP) in its Guidelines for the management of knee and hip osteoarthritis published in 2018 assert that “Corticosteroid injections could be offered for short-term symptom relief for some people with knee OA, but care should be taken with repeated injections because of potential harm”, giving to the physician a conditional recommendation for the intervention (recommended with caution).

American College of Rheumatology/Arthritis Foundation (ACR) in the society guideline highlighted that “The Intraarticular glucocorticoid injections are strongly recommended for patients with knee and/or hip OA”, due to the good short-term outcome, even if the main disadvantage of cartilage loss is caused by specific steroid preparations with a certain frequency of injections.

澳大利亚皇家全科医师学院（RACGP）在其 2018 年发布的《膝和髋骨关节炎管理指南》中声称，"OA 患者皮质类固醇注射短期症状缓解，但因潜在的风险，应谨慎进行反复注射"（谨慎建议）。

美国风湿病学会/关节炎基金会（ACR）在协会指南中强调：“关节内糖皮质激素注射强烈推荐用于膝关节和/或髋关节OA患者”，即便频繁注射可能造成软骨损伤，但可以取得良好的短期结果。