当前骨关节炎患者的治疗策略综述

D. Karateev, L. V. Luchikhina, E. Luchikhina, G. N. Golukhov
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摘要

骨关节炎(OA)患者的治疗策略至关重要。应该基于目前对OA发病机制作为炎症性疾病的认识。回顾目前OA患者治疗的临床指南,发现对药理学方法的评价存在显著差异,特别是对骨关节炎的症状性慢动作药物(SYSADOA)的评价,以及对非药理学方法(主要是运动、患者教育、体重控制、各种物理治疗方法、矫形器和按摩/手工治疗)的一定共识。还应考虑到国际上“以治疗为目标”的建议,其主要思想是仔细定期监测患者的病情,并根据对治疗的反应调整治疗策略。作者在分析文献资料和自身临床经验的基础上,制定了OA综合治疗策略的算法,包括以下步骤:1)疼痛控制(2-4周),2)炎症控制(4-6周);3)控制软骨退化(6周- 12个月)。对于每个阶段,提出了系统药物治疗(非甾体抗炎药,SYSADOA),糖皮质激素和透明质酸关节内给药,运动和磁疗(脉冲电磁场)的特定组合。OA患者的分期综合治疗策略应有助于控制症状,同时最小化NSAIDs的持续时间,避免多药,并进一步实现对结构进展的抑制。
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Current Management Strategy for Osteoarthritis Patients: a Review
A strategic approach is crucial to the management of patients with osteoarthritis (OA). It should be based on the current understanding of the pathogenesis of OA as an inflammatory disease. A review of current clinical guidelines for the management of patients with OA shows significant differences in the evaluation of pharmacological approach, especially the place of symptomatic slow-acting drugs for osteoarthritis, (SYSADOA) and a certain consensus in relation to non-pharmacological methods (primarily exercise, patient education, body weight control, various physiotherapy methods, orthotics and massage/manual therapy). It should also be taken into account the international “treat to target” recommendations, the main idea of which is careful regular monitoring of the patient’s condition and adaptation of treatment tactics depending on the response to treatment. Based on the analysis of literature data and their own clinical experience, the authors developed an algorithm for the strategy of complex therapy of OA, including the following steps: 1) pain control (2-4 weeks), 2) inflammation control (4-6 weeks); 3) control over cartilage degradation (6 weeks – 12 months). For each stage, a specific combination of systemic pharmacotherapy (non-steroidal anti-inflammatory drugs, SYSADOA), intra-articular administration of glucocorticoids and hyaluronic acid, exercises and magnetotherapy (pulsed electromagnetic field) was proposed. A staged comprehensive strategy for the treatment of patients with OA should help to achieve control over the symptoms, while minimizing the duration of NSAIDs and avoiding polypharmacy, and further achievement of inhibition of structural progression.
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