A review of the benefits and risks of nonsteroidal anti-inflammatory drugs in the management of mild-to-moderate osteoarthritis.
A review of the benefits and risks of nonsteroidal anti-inflammatory drugs in the management of mild-to-moderate osteoarthritis.
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DOI：
10.1186/1750-4732-3-1
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发表时间：
2009-01-06
期刊：
影响因子：
--
通讯作者：
Greenberg, Bruce P
中科院分区：
文献类型：
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作者：
Fendrick, A Mark;Greenberg, Bruce P
本综述旨在为医生提供与使用非甾体抗炎药（NSAID）治疗轻中度骨关节炎（OA）患者相关的获益和风险概述。关于OA炎症成分和环氧合酶（考克斯）-2特异性抑制剂相关的心血管（CV）风险的新信息促使人们努力修订目前使用NSAID治疗OA患者的建议。临床研究表明，萘普生和布洛芬在减轻OA疼痛方面比传统的一线治疗药物对乙酰氨基酚更有效，对乙酰氨基酚在关节中没有明显的抗炎活性。考克斯-2特异性抑制剂在降低胃肠道（GI）毒性方面的理论优势已被临床研究所证实。胃肠道并发症可以通过使用较低剂量的NSAID持续时间最短或与质子泵抑制剂合并使用来减少。所有处方NSAID都带有关于CV风险的黑框警告;这些风险因NSAID而异。虽然布洛芬和双氯芬酸与CV风险增加相关，但与安慰剂相比，萘普生与中性CV风险相关。阿司匹林的抗血小板作用会减弱，但萘普生不会。在选择NSAID时，了解风险和益处很重要。使用“布洛芬”、“萘普生”、“考克斯-2特异性NSAID”、“非特异性NSAID”、“低剂量阿司匹林”和“非处方剂量”等词对1990年以来的医学文献进行了详尽的检索。检索的数据库包括MEDLINE、EMBASE和SCISEBASE。本文为初级保健医生提供了所需的信息，以帮助他们在管理轻度至中度OA疼痛患者时做出更明智的决定。
This review is intended to provide physicians with an overview of the benefits and risks associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the management of their patients with mild-to-moderate osteoarthritis (OA). New information on the inflammatory component of OA and the cardiovascular (CV) risk associated with cyclooxygenase (COX)-2-specific inhibitors has prompted efforts to revise the current recommendations for the use of NSAIDs in the treatment of patients with OA. Clinical studies have shown that naproxen and ibuprofen are significantly more effective at reducing OA pain than is acetaminophen, the traditional first-line therapy, which has no apparent anti-inflammatory activity in the joints. The theoretical advantage of COX-2-specific inhibitors in reducing gastrointestinal (GI) toxicity has been demonstrated by clinical studies. GI complications can be reduced by using lower NSAID doses for the shortest duration or with a concomitant proton-pump inhibitor. All prescription NSAIDs carry a black box warning regarding CV risks; these risks vary among the NSAIDs. While ibuprofen and diclofenac are associated with an increased CV risk, naproxen was associated with a neutral CV risk relative to placebo. Ibuprofen, but not naproxen, attenuates the antiplatelet effects of aspirin. An understanding of the risks and benefits is important when choosing an NSAID. An exhaustive search of the medical literature since 1990 was conducted using the words "ibuprofen," "naproxen," "COX-2-specific NSAIDs," "nonspecific NSAIDs," "low-dose aspirin," and "nonprescription dosage." Databases searched included MEDLINE, EMBASE, and SCISEARCH. This article provides primary care physicians with the information needed to assist them in making more informed decisions in managing patients experiencing mild-to-moderate OA pain.