【晨读】骨关节炎药物治疗的选择过程是什么?（五）
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Yu S P , Hunter D J . What is the selection process for osteoarthritis pharmacotherapy?[J]. Expert Opinion on Pharmacotherapy, 2020(9):1-5.
Development of disease-modifying osteoarthritis drugs are under development and trials that act on different aspects of the OA pathway, targeting inflammation, cartilage catabolism/anabolism and increasing cartiage repair. Some promising agents include Sprifermin, a fibroblast growth factor 18, Wnt/ β catenin signaling pathway inhibitors and Gene therapy (TissueGene-C) (allogeneic human chondrocytes modified to express transforming growth factor- β1) .
治疗疾病的骨关节炎药物正在开发和试验中，这些药物作用于OA通路的不同方面，靶点针对炎症、软骨分解/合成，以及增加软骨的修复能力。一些有前景的药物包括Sprifermin，一种成纤维细胞生长因子18,Wnt/ catenin信号通路抑制剂和基因治疗(组织基因- c)(修饰表达转化生长因子- case1的异体软骨细胞)。
3. Expert Opinion
Despite the rising prevalence of OA amongst society, there is no pharmacotherapy that can prevent, halt or reverse disease progression. Symptom control continues to be the goal of treatment in most circumstances; thus, it is imperative that management should incorporate treatment modalities other than pharmacological agents. Care of patients with OA should be patient-specific and tailored to their individual requirements and goals. Clinical algorithms are readily available to aid in OA guideline dissemination to help clinicians to make educated and appropriate decisions toward the care of OA patients . We echo the recommendations and guidelines of the different governing associations, starting with education/self manage-ment, weight loss, exercise and physical activity, followed by medications. The decision of medication takes onboard single versus multiple joints with OA symptoms and patient’s comor-bidities, with a preference toward topical anti-inflammatories, followed by oral anti-inflammatories with gastroprotection cover. Should anti-inflammatories be contra-indicated, consid-eration of less preferenced analgesics such as tramadol or intra-articular corticosteroids can be utilized.
3.专家意见
尽管在OA的发病率上升，但没有药物疗法可以预防，停止或逆转疾病的进展。在大多数情况下，控制症状仍然是治疗的目标;因此，必须在管理中纳入除药物之外的治疗模式。对OA患者的护理应针对患者具体情况，并根据其个人需求和目标进行调整。OA指南传播可帮助临床医生对OA患者做出教育和适当的护理决定。我们赞同不同管理协会的建议和指导方针，首先是教育/自我管理、减肥、锻炼和体育活动，然后是药物治疗。治疗方案需考虑单关节或者多关节症状的OA及合并症，优先选择局部抗炎药物，其次是有胃粘膜保护的口服非甾体药物。如果非甾体药被禁用，可以考虑使用不太受青睐的止痛剂，如曲马多或关节内皮质类固醇。
Ultimately, there needs to be a shared decision-making approach between the clinician and patient, especially with pharmacotherapy. Patients should be informed of the evi-dence of benefit in this context and the lack of high-quality clinical trials in many circumstances. Prioritization of patient safety is imperative, regardless of what pharmacotherapy is chosen and regular monitoring of patients’ responses will not only ascertain safety, but also check adherence, and encou-rage concurrent life-style modifications. Across the board, effective and evidence-proven lifestyle behavior modification strategies are underutilized , and this is multi-factorial due to lack of availability of service providers, government support or individual financial limitations.
最终，临床医生和患者之间需要有一个共同的决策方法，特别是在药物治疗方面。患者应该被告知在这种情况下益处的证据以及在许多情况下缺乏高质量的临床试验。无论选择何种药物疗法，都必须优先考虑患者的安全，定期监测患者反应不仅能确定安全性，还能检查患者的依从性，并鼓励同时改变生活方式。总体而言，没有充分利用有效且经证据证明的生活方式行为矫正策略，这是由于缺乏服务提供商、政府支持或个人财政限制等多重因素造成的。
OA is a chronic disease and should be viewed similar to other chronic pain conditions, where the recommended goals of treatment are aimed at limiting the use of analgesics and concentrating on the incorporation of a biopsychosocial plan to target different aspects of the condition.
OA是一种慢性疾病，应与其他慢性疼痛状况相似，建议治疗目标旨在限制止痛剂的使用，并专注于结合生物、心理、社会计划来针对不同方面的情况。
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