【省立疼痛英语晨读】骨关节炎药物治疗的选择过程是什么?（二）
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.
Despite individuals experiencing a wide range of clinical symptoms including a reduction in physical function, range of movement restrictions, joint stiffness, joint instability and bony enlargements, joint pain is still the hallmark feature that promotes individuals to seek healthcare intervention. Similarly, pain is the main factor upon which clinical decisions are made in the healthcare setting.
尽管骨关节炎的临床表现多样，包括身体功能减少、活动范围受限、关节僵硬、关节不稳定和骨骼增大，但是关节疼痛仍然是促使个体寻求医疗干预的标志性特征。同样，在医疗环境中，疼痛也是做出临床决策的主要因素。
This editorial aims to discuss the currently available pharmacological therapies for OA and the selection progress behind these agents.
这篇文章的目的是讨论目前可用的OA药物治疗和这些药物的选择过程。
Pharmacotherapy for Osteoarthritis
Currently, available management therapies focus on pain alleviation and are regarded as palliative, given the current lack of preventative or curative treatments. Surgery should be regarded as the end of line therapy after failure of response to appropriate, conservative options. The National Institute for Health and Care Excellence (NICE), American Academy of Orthopedic Surgeons (AAOS) and the recently updated Osteoarthritis Society International (OARSI), European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and American College of Rheumatology/Arthritis Foundation guidelines recommend that first-line therapy for OA, whether it is for knees, hip, or polyarticular OA, to focus on conservative therapy with an emphasis toward education, lifestyle modifications with weight loss (in overweight/obese persons), water and land-based exercise, strength training and instilling self-management skills for a chronic disease process. The utilization of aids such as orthoses and braces are possible adjuncts to the above strategies in addition to recommended pharmacotherapies (Table 1).
骨关节炎的药物治疗
现有的OA治疗侧重于减轻疼痛，并被视为姑息性治疗，目前尚缺乏预防或治愈治疗。在对适当的、保守的治疗失败后，手术应被视为治疗的终点。卓越国家健康护理研究所 (NICE),美国骨外科医生学会(AAOS)和最近更新的骨关节炎国际协会 (OARSI),欧洲骨质疏松症，骨关节炎和肌肉骨骼疾病(ESCEO)的临床和经济学会,和美国风湿病学会上述学术机构，指南建议的一线治疗，无论是膝关节，髋关节还是多关节的OA,重点在于强调教育、生活方式改变如通过减肥(超重/肥胖人群)、水中和陆上运动、力量训练和慢性疾病过程中自我管理技能等保守治疗。除了推荐的药物疗法外，使用矫正器和支具等辅助手段也是上述策略的可能辅助手段(表1)。
Pharmacotherapy mainly targets pain with no apparent favorable effect on disease progression. Topical and oral nonsteroidal anti-inflammatory drugs (NSAIDs) or Coxibs have taken over from paracetamol as first-line medications and are strongly recommended over other available oral medications. Even though NSAIDs/Coxibs are thought to exert effects on some of the inflammatory processes in OA, there are associated potential concerns regarding cardiovascular, gastrointestinal and renal side effects that may limit its use in the OA population, where a substantial proportion of people have multiple health comorbidities. Therefore, it is imperative that risk reduction is taken into consideration in the prescription of these medications, whether it be using the lowest dose for the shortest duration possible, or considering other alternatives if there are contraindications.
药物治疗主要针对疼痛，对疾病进展没有明显的有利作用。局部和口服非甾体抗炎药(NSAIDs)或昔布类已取代扑热息痛作为一线药物，与其他可用的口服药物相比，强烈推荐使用这些药物。尽管非甾体抗炎药/ 昔布类在OA中有一些抗炎作用,但是心血管,胃肠道和肾脏的副作用可能会限制其使用,相当一部分OA患者有多个健康并发症。处方这些药物是必须考虑降低风险，即使使用最低的剂量和最短的持续时间，在有禁忌症时考虑其他的替代品。
Whilst paracetamol/acetaminophen is not recommended as first-line treatment given minimal benefit is seen from meta-analysis in OA, it is likely that majority of symptomatic OA patients will have trialed the medication in the context of it being readily available over-the-counter and its perceived safety of use. Actual symptomatic relief and possible hepatotoxicity in the individual must be taken account of with ongoing regular usage.
不推荐扑热息痛/对乙酰氨基酚作为OA的一线治疗，荟萃分析显示其益处很小,多数有症状的OA患者就医前已经使用对乙酰氨基酚，因为其非处方药物易获得且较安全。持续的常规使用中必须考虑实际的症状缓解和的肝毒性。