Do NSAIDs Affect Longitudinal Changes in Knee Cartilage Volume and Knee Cartilage Defects in Older Adults?
Do NSAIDs Affect Longitudinal Changes in Knee Cartilage Volume and Knee Cartilage Defects in Older Adults?
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DOI：
10.1016/j.amjmed.2009.03.022
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发表时间：
2009-09-01
影响因子：
5.9
通讯作者：
Jones, Graeme
中科院分区：
文献类型：
--
作者：
Ding, Changhai;Cicuttini, Flavia M.;Jones, Graeme
背景：非甾体类抗炎药（NSAID）对膝骨关节炎进展的影响尚不清楚。这项纵向研究的目的是确定使用非甾体类抗炎药与膝关节软骨体积变化和膝关节软骨缺损之间的相关性超过2.9年。随机选取395名受试者，进行右膝T-1加权脂肪抑制磁共振成像（平均年龄62岁，范围51-80岁，50%为女性），以评估基线和2.9年后胫骨部位的膝关节软骨体积和膝关节软骨缺损（0-4量表）。通过问卷调查记录患者最近一个月的用药情况。与非NSAID使用者（n = 334）相比，环氧合酶（考克斯）-2抑制剂使用者（n = 40）减少了内侧胫股间室膝关节软骨缺损的发展（比值比[OR] 0.4，95%置信区间[CI]，0.2-0.99），而传统非甾体抗炎药使用者（n = 21）双侧内侧膝关节软骨缺损发育增加（OR 3.1，95% CI，1.0-9.1）和外侧（OR 2.6，95% CI，1.0-6.7）胫股间室。使用考克斯-2抑制剂者与使用传统NSAID者相比，后者膝关节软骨体积损失更大（胫骨内侧-5.3% vs -3.1%，胫骨外侧-3.6% vs -1.1%，P均<0.05）。所有协会调整潜在的混杂因素，包括膝关节疼痛和放射性骨关节炎。结论：这项研究表明，非选择性NSAID可能有有害的影响，而选择性考克斯-2抑制剂可能对膝关节软骨有益的影响。随机对照试验检查膝关节结构，以证实这一发现是必要的。皇冠版权所有（C）2009由爱思唯尔公司出版。All rights reserved.美国医学杂志（2009）122，836-842
BACKGROUND: The effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on knee osteoarthritis progression are unclear. The aim of this longitudinal study was to determine the associations between use of NSAIDs and changes in knee cartilage volume and knee cartilage defects over 2.9 years in older adults.METHODS: T-1-weighted fat-suppressed magnetic resonance imaging on the right knee was performed in a total of 395 randomly selected subjects (mean age 62 years, range 51-80 years, and 50% female) to assess knee cartilage volume at tibial sites and knee cartilage defects (0-4 scale) at baseline and 2.9 years later. Medication use in the last month was recorded by questionnaire.RESULTS: Compared with nonusers of NSAIDs (n = 334), users of cyclooxygenase (COX)-2 inhibitors (n = 40) had decreased knee cartilage defect development in the medial tibiofemoral compartment (odds ratio [OR] 0.4, 95% confidence interval [CI], 0.2-0.99), whereas users of conventional NSAIDs (n = 21) had increased knee cartilage defect development in both medial (OR 3.1, 95% CI, 1.0-9.1) and lateral (OR 2.6, 95% CI, 1.0-6.7) tibiofemoral compartments. Comparing users of COX-2 inhibitors with users of conventional NSAIDs, the latter had higher knee cartilage volume loss (-5.3% vs -3.1% at medial tibia and -3.6% vs -1.1% at lateral tibia; all P < .05). All associations were adjusted for potential confounders including knee pain and radiographic osteoarthritis.CONCLUSIONS: This study suggests that nonselective NSAIDs may have deleterious effects, while selective COX-2 inhibitors might have beneficial effects on knee cartilage. Randomized controlled trials examining knee structure to confirm this finding are warranted. Crown Copyright (C) 2009 Published by Elsevier Inc. All rights reserved. The American Journal of Medicine (2009) 122, 836-842