Chondroprotection and the Prevention of Osteoarthritis Progression of the Knee A Systematic Review of Treatment Agents
Chondroprotection and the Prevention of Osteoarthritis Progression of the Knee A Systematic Review of Treatment Agents
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DOI：
10.1177/0363546514533777
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发表时间：
2015-03-01
影响因子：
4.8
通讯作者：
Freedman, Kevin B.
中科院分区：
文献类型：
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作者：
Gallagher, Brian;Tjoumakaris, Fotios P.;Freedman, Kevin B.
背景：结构改变药物或营养保健品可能是骨关节炎的有效治疗方法。这项研究确定了 12 种可能具有软骨保护特性的治疗方法：口服葡萄糖胺；软骨素；非甾体抗炎药（NSAID）；多不饱和脂肪酸； S-腺苷甲硫氨酸；鳄梨和大豆不皂化物；甲磺酰甲烷；维生素 C、D 和 E；关节内注射透明质酸；目的：对随机对照试验进行系统评价，了解每种药物在保护膝关节软骨和延缓骨关节炎进展方面的有效性。证据水平，2.方法：使用 PubMed、EMBASE 和 Cochrane 对照试验中心注册库进行文献检索。使用治疗、骨关节炎和膝盖作为关键词进行搜索。选择标准包括为期 12 个月的随机对照试验，采用安慰剂对照，测量关节间隙宽度、软骨体积的放射学变化或骨关节炎的放射学进展。主要结果是关节完整性指标的变化。结果：初步检索共确定了 3514 项研究，其中 13 项符合纳入标准。在 4 项研究中，有 3 项表明，与安慰剂相比，硫酸软骨素治疗可显着减少软骨损失。确定的 3 项氨基葡萄糖试验中的 2 项也报告了相对于安慰剂的显着结构效应。在 3 项研究中，只有 1 项与安慰剂相比，关节内注射透明质酸能有效降低软骨损失率。在针对非甾体抗炎药、维生素 E 和维生素 D 进行的 6 项研究中，与安慰剂相比，没有一项研究显示出任何结构效应。没有发现符合多不饱和脂肪酸、S-腺苷甲硫氨酸、鳄梨和大豆不皂化物、甲磺酰甲烷、维生素 C 或 PRP 纳入标准的研究。结论：对于骨关节炎患者或有骨关节炎风险的患者，使用葡萄糖胺和硫酸软骨素可以作为保护关节软骨和延缓骨关节炎进展的非手术手段。透明质酸注射显示出不同的疗效，而非甾体抗炎药以及维生素 E 和 D 对骨关节炎的进展没有影响。评估的其他药物在文献中没有证据支持或反驳它们用于软骨保护的用途。
Background: Structure-modifying medications or nutraceuticals may be an effective treatment for osteoarthritis. This study identified 12 treatments that may possess chondroprotective properties: oral glucosamine; chondroitin; nonsteroidal anti-inflammatory drugs (NSAIDs); polyunsaturated fatty acids; S-adenosylmethionine; avocado and soybean unsaponifiable fractions; methylsulfonylmethane; vitamins C, D, and E; intra-articular injections of hyaluronic acid; and platelet-rich plasma (PRP).Purpose: To perform a systematic review of randomized controlled trials for the effectiveness of each agent in preserving articular cartilage of the knee and delaying the progression of osteoarthritis.Study Design: Systematic review; Level of evidence, 2.Methods: A literature search was performed using PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Searches were performed using treatment, osteoarthritis, and knee as keywords. Selection criteria included randomized controlled trials of 12 months, with a placebo control, measuring radiographic changes in joint space width, cartilage volume, or radiographic progression of osteoarthritis. The primary outcome was changes in joint integrity measures.Results: A total of 3514 studies were identified from the initial search, 13 of which met inclusion criteria. Treatment with chondroitin sulfate showed a significant reduction in cartilage loss in 3 of 4 studies identified compared with placebo. Two of 3 trials identified for glucosamine also reported significant structural effects relative to placebo. Intra-articular hyaluronic acid was effective in lowering the rate of cartilage loss in only 1 of 3 studies identified versus placebo. Of the 6 studies identified for NSAIDs, vitamin E, and vitamin D, none showed any structural effect compared with placebo. No studies were found that met the inclusion criteria for polyunsaturated fatty acids, S-adenosylmethionine, avocado and soybean unsaponifiable fractions, methylsulfonylmethane, vitamin C, or PRP.Conclusion: For patients with or at risk for osteoarthritis, the use of glucosamine and chondroitin sulfate may serve as a nonoperative means to protect joint cartilage and delay osteoarthritis progression. Hyaluronic acid injections showed variable efficacy, while NSAIDs and vitamins E and D showed no effect on osteoarthritis progression. The other agents evaluated had no evidence in the literature to support or refute their use for chondroprotection.