玻璃酸钠联合双醋瑞因治疗膝骨关节炎临床观察

目的：探讨玻璃酸钠联合双醋瑞因治疗膝骨关节炎的疗效。方法：将82例膝骨关节炎患者随机分为2组,试验组膝关节腔内注入玻璃酸钠2．5mL,1次／周,联合服用双醋瑞因50mg,2;k／d;对照组膝关节腔内注入玻璃酸钠2．5mL,1次／周,均连续5周;治疗结束后1周比较2组疗效。结果：采用Lequesne评分方法进行比较,试验组在治疗前后的有效率较对照组高（68．3％vs58．5％,P〈0．05）。结论：玻璃酸钠联合双醋瑞因治疗膝骨关节炎在镇痛效果和改善关节活动度上较单用玻璃酸钠疗效更显著。     

双醋瑞因治疗膝骨关节炎的疗效与安全性多中心对照研究

目的评价双醋瑞因(安必丁)治疗膝骨关节炎(OA)患者的疗效和安全性。方法223例符合美国风湿病学院(ACR)膝OA标准的患者纳入随机、多中心、双氯酚酸钠对照、双模拟研究,双醋瑞因组100mg/d,双氯酚酸钠75mg/d,治疗12周,随访4周。结果经12周治疗,患者/医生评价两组总有效率分别是65.4%/61.6%和61.2%/61.2%(P>0.05)。双醋瑞因组和对照组在主要疗效指标(20m步行痛)和次要疗效指标(关节触痛、WOMAC骨关节炎指数和健康状况调查问卷SF-36)均较治疗前明显改善,随访期(停药1个月后),双醋瑞因能持续发挥药效,以上各项疗效参数较治疗结束时变化不大。但在对照组,随访期与治疗结束时相比,20m步行痛和关节触痛疼痛程度明显加重,WOMAC骨关节炎指数明显增加(P<0.05)。同时,随访期试验组对乙酰氨基酚用量明显低于对照组。出现可能与试验药物相关的不良事件的比例在双醋瑞因组和对照组分别为35.7%和45.1%(P>0.05)。主要为轻至中度的胃肠道反应。结论应用双醋瑞因治疗膝OA疗效与双氯酚酸钠基本相当,而且双醋瑞因的作用更持久,无严重不良反应发生,安全性好。     

双醋瑞因与美洛昔康治疗老年膝骨关节炎的疗效比较

骨关节炎(OA)是导致老年人行动障碍的最常见原因之一。2000年欧洲抗风湿病防治联盟(EULAR)制定的膝关节OA治疗指南中,药物治疗的一线药物为对乙酰氨基酚和非甾类抗炎药(NSAIDs),长期应用可引起严重的胃十二指肠和肾脏损害,某些药物还具有破坏软骨作用;二线药物则有益于关节组织损伤的修复,常见的有硫酸葡聚糖胺、硫酸软骨素、透明质酸等,而且治疗OA的新药陆续问世,双醋瑞因(Diacerein)作为白细胞介素1(IL-1)的抑制剂,可显著缓解OA症状和有效修正结构,是属于改变OA症状和病情的慢作用药物,国内有研究报道双醋瑞因对于膝OA的多中心…     

透明质酸钠治疗膝骨关节炎疗效观察

对46例65个膝关节炎(OA)采用透明质酸钠治疗,结果疼痛、晨僵、步行不适、步行距离均有明显改善。21.5％临床缓解,43.1％显效,29.2％有效,有效率达93.8％。除个别注射后关节红肿、痛外,未见其他毒副作用。注射后关节肿痛经NSAIDs治疗2天～3天缓解,且病情比注射前有所改善。透明质酸钠治疗膝OA,除缓解疼痛外,还可改善关节功能,疗效持续时间长,且无毒副作用。     

双醋瑞因在骨性关节炎治疗中的应用

目的探讨双醋瑞因在骨性关节炎（OA）治疗中的应用效果。方法将60例OA患者随机分为两组,均予盐酸利多卡因加醋酸强的松龙痛点封闭及玻璃酸钠关节内注射治疗,观察组加用双醋瑞因。观察两组治疗1 a后20 m步行痛（VAS评分）减少值,WOMAC骨关节炎评分增加值,AKS膝关节评分及功能评分增加值。结果观察组20 m步行痛（VAS评分）减少值,WOMAC骨关节炎评分增加值,AKS膝关节评分及功能评分增加值均高于对照组,P均〈0.05。结论双醋瑞因与封闭、玻璃酸钠联合使用可明显提高OA的治疗效果。     

透明质酸钠治疗膝骨关节炎疗效观察

目的观察透明质酸钠(SHP)对膝骨关节炎(OA)的疗效。方法选择348例膝OA,580个膝关节进行关节腔内注射SHP,每周1次,连用3周为1个疗程,比较治疗前与治疗后临床症状(关节疼痛、关节肿胀,上下楼及下蹲有无困难)及实验室检查[血沉(ESR)、C反应蛋白(CRP)、白细胞]结果变化的人数。结果注射治疗后病人的关节肿胀、疼痛、活动受限缓解的人数与治疗前相比差异有显著性,P<0.05或P<0.01;同时治疗后ESR、CRP、白细胞正常化的关节个数与治疗前相比差异有显著性(P<0.05或P<0.01)。结论SHP缓解关节疼痛,减轻关节肿胀,减少关节功能障碍,是治疗膝OA的有效药物。     

双醋瑞因治疗疼痛性膝骨关节炎的疗效和安全性研究

目的评价双醋瑞因胶囊治疗疼痛性膝骨关节炎的疗效和安全性。方法通过随机、双肓、双模拟、阳性药(双氯芬酸钠)平行对照方法,观察双醋瑞因和双氯芬酸钠治疗42例疼痛性膝骨关节炎患者的疗效和安全性。结果双醋瑞因胶囊治疗组和双氯芬酸钠对照组均能明显改善20 m步行痛、关节触痛症状、WOMAC骨关节炎指数、健康状况、关节肿胀指数。两组治疗前后比较差异均有统计学意义,两组间比较差异无统计学意义,两者疗效相当。同时两组间的患者和医生对疗效和耐受性的总体评价相当；安全性亦相仿,主要是一过性胃肠道不良反应。结论双醋瑞因是一种新型的治疗疼痛性膝骨关节炎的有效和安全的药物。     

透明质酸钠治疗膝骨关节炎临床观察

为探讨SH对我国OA患者的疗效及耐受性,应用施沛特或Artz关节腔注射治疗膝OA患者133例共167个膝关节(施沛特组112膝,Artz组55膝)。施沛特组临床缓解率25.0％,总有效率93.8％,轻、中及重度患者有效率分别为100％、96.2％及83.3％;Artz组临床缓解率27.3％,总有效率96.4％,轻、中及重度患者有效率分别为100％、100％及81.8％。经统计学检验,两组无显著性差异(p>0.05)。二组治疗后各种症状均有明显改善,但以疼痛和肿胀改善最为显著;给药前三次(周),症状改善明显,后二次虽有改善,但程度小。患者对SH制剂耐受性好,未见有明显的毒、副反应。本文提示,施沛特治疗OA疗效确切、安全,同Artz相比较无显著性差异。     

透明质酸钠治疗膝骨关节为疗效观察

对４６例６５个膝关节炎（ＯＡ）采用透明质酸钠治疗，结果疼痛、晨僵、步行不适、步行距离均有明显改善。２１．５％临床缓解，４３．１％显效，２９．２％有效，有效率达９３．８％。除个别注射后关节红肿、痛外，未见其他毒副作用。注射后关节肿痛经ＮＳＡＩＤｓ治疗２天￣３天缓解，且病情比注射前有所改善。透明质酸钠治疗膝ＯＡ，除缓解疼痛外，还可改善关节功能，疗效持续时间长，且无毒副作用。     

硫酸氨基葡萄糖与双氯芬酸治疗膝骨关节炎的临床对照研究

骨关节炎 (osteoarthritis,OA)是一种常见的难治性骨关节疾患 ,以关节软骨破坏为主要特点。膝关节作为负重关节是最易受累的关节之一。OA的传统治疗方法是非甾体抗炎药 (NSAIDs)和局部使用麻醉药物以及体疗等 ,近年来改善软骨代谢的药物受到国内外学者的普遍重视。本文报道具有改善软骨代谢作用的治疗OA慢作用药物硫酸氨基葡萄糖治疗膝关节OA患者 5 1例 ,并与双氯芬酸进行对照 ,以观察两组病人的疗效和药物耐受性。1　资料与方法1 1　病例选择 :10 8例临床确诊为膝OA的患者 ,分为两个治疗组 ,硫酸氨基葡萄糖 (GS)组 5 1例 ,双氯芬酸 …     

双醋瑞因治疗老年人痛性膝骨关节炎的疗效和安全性

目的 观察双醋瑞因治疗老年人痛性膝骨性关节炎的疗效及安全性.方法 选择门诊老年痛性膝骨关节炎患者57例,采用随机、阳性药硫酸氨基葡萄糖(维固力)平行对照方法,将57例患者分为双醋瑞因治疗组和维固力对照组,利用100 mm视觉模拟评分表(VAS)评价20 m步行痛积分,骨关节炎指数(WOMAC)评定两组用药前后临床症状改善情况;受试者和医生对总体疗效的评价采用5级评定法,并观察药物不良反应.结果 20 m步行痛积分治疗前、后双醋瑞因组为53.10±17.31和16.73±18.88,维固力组为51.52±18.12和17.33±20.73;WOMAC指数治疗前、后双醋瑞因组为41.13±18.60和18.40±15.70,维固力组为42.81±17.73和21.14±15.60.两组治疗前后比较,差异均有统计学意义(P＜0.05);两组间治疗后比较差异无统计学意义(P＞0.05).受试者对综合有效率评价(5级评定法中:非常好+好+中等):双醋瑞因组为90.0%,维固力组为92.6%;两组患者和医生对疗效的总体评价差异无统计学意义.两组不良反应主要是胃肠道反应,发生率差异无统计学意义.结论 双醋瑞因是治疗老年人痛性膝骨关节炎的有效药物,且具有良好的安全性.     

Hepatotoxicity associated with glucosamine and chondroitin sulfate in patients with chronic liver disease

Glucosamine and chondroitin sulfate are molecules involved in the formation of articular cartilage and are frequently used for symptom relief in patients with arthrosis.These molecules are well tolerated with scarce secondary effects.Very few cases of possible hepatotoxicity due to these substances have been described.The aim of this paper is to report the frequency of presumed glucosamine hepatotoxicity in patients with liver disease.A questionnaire was given to 151 consecutive patients with chronic liver disease of different etiology(mean age 59 years,56.9%women)attended in an outpatient clinic with the aim of evaluating the frequency of consumption of these drugs and determine whether their use coincided with a worsening in liver function test results.Twenty-three patients(15.2%)recognized having taken products containing glucosamine or chondroitin sulfate previously or at the time of the questionnaire.Review of the clinical records and liver function tests identified 2 patients presenting an elevation in aminotransferase values temporarily associated with glucosamine treatment;one of the cases simultaneously presented a skin rash attributed to the drug.Review of these two patients and the cases described in the literature suggest toxicity of glucosamine and chondroitin sulfate.The clinical spectrum is variable,and the mechanism of toxicity is not clear but may involve reactions of hypersensitivity.The consumption of products containing glucosamine and/or chondroitin sulfate is frequent among patients with chronic liver diseases and should be taken into account on the appearance of alterations in liver function tests not explained by the underlying disease.     

Efficacy and safety of diacerein in early knee osteoarthritis: a randomized placebo-controlled trial

The objective of this study was to evaluate the efficacy and safety of diacerein in early, symptomatic knee osteoarthritis in Indian population. Sixty-four patients of knee osteoarthritis fulfilling American College of Rheumatology Criteria were randomized to receive either diacerein or placebo for 8 weeks, followed by 4 weeks “treatment-free” follow-up in this single-blind, parallel group, post-marketing trial. Primary efficacy variable was visual analogue scale (VAS) assessment of pain on movement; secondary efficacy variables included Western Ontario and Mc Master Universities Osteoarthritis Index (WOMAC) subscores for stiffness and physical function, rescue medication use and physician's clinical global impression (CGI). Compared to placebo, diacerein showed highly significant (p < 0.01) reductions in VAS pain scores, significant (p < 0.05) reductions in WOMAC physical function scores, significantly lower requirement for rescue medication, and significantly better CGI grades. Incidence of adverse events were significantly (p < 0.01) higher in diacerein arm with urine discoloration and soft stool being the most common ones. However, most events were of mild to moderate intensity. In Indian patients with knee osteoarthritis, diacerein effectively reduces pain and improves physical function, and despite frequent adverse events, overall tolerability seemed to be good.     

关节腔内注射联合康复训练治疗膝关节骨性关节炎临床观察

目的 观察关节腔内注射透明质酸钠联合康复训练治疗膝关节骨性关节炎(KOA)的临床疗效及对血浆β-内啡肽和P物质含量的影响.方法 将106例膝关节骨性关节炎患者分为治疗组及对照组,治疗组给予关节腔内注射透明质酸钠及康复训练治疗,对照组仅给予康复训练治疗.于治疗前、治疗6周后及随访3个月、6个月时采用Lysholm功能评分对2组患者膝关节功能进行评定,同时对2组患者血浆β-内啡肽及P物质含量进行检测.结果 治疗6周后及随访3个月、6个月时,2组患者膝关节功能评分均较治疗前明显改善(P＜0.01),且均以治疗组的改善幅度较显著,与对照组比较,组间差异均有统计学意义(P＜0.01).2组患者治疗后,其血浆β-内啡肽含量均明显增高,P物质含量均显著降低,并以治疗组的变化幅度较显著,与对照组间差异有统计学意义(P＜0.01).结论 关节腔内注射透明质酸钠联合康复训练治疗膝关节骨性关节炎,能有效改善膝关节功能,且疗效持久,同时能显著提高KOA患者血浆β-内啡肽活性,降低P物质含量,对缓解疼痛、提高膝关节活动功能具有重要意义.

Abstract：

Objective To observe the clinical effect of intra-articular injection of sodium hyaluronate combined with rehabilitation training in treatment of knee osteoarthritis, and their effects on β endorphin and substance P levels in plasma. Methods All 106 cases with knee osteoarthritis were divided into treatment group and control group. Treatment group were treated by intra-articular injection of sodium hyaluronate combined with rehabilitation training, and control group underwent rehabilitation training only. Knee joint function was evaluated using Lysholm scores before and six weeks after treatment, and at 3-month and 6-month follow-up. Meanwhile, the concentrations of β endorphin and substance P in plasma were tested in the two groups. Results Compared with pre- treatment, the Lysholm scores were obviously increased after 6-week treatment, at 3-month and 6-month follow-up in both groups, with more obvious increase in treatment versus control group (P＜0.01). The Lysholm scores were higher in treatment group than in control group (P＜0.01). The concentration of β endorphin in plasma was significantly increased, and the substance P concentration in plasma was decreased after treatment in both groups. There were also significant differences in concentrations of β endorphin and substance P in plasma between treatment group and control group (P＜0.01). Conclusions Intra-articular injection of sodium hyaluronate combined with rehabilitation training is effective in improving knee joint function in elderly patients, in relieving pain and in enhancing joint movement.     

Efficacy of intra-articular sodium hyaluronate in the treatment of knee osteoarthritis

 To assess the efficacy of intra-articular hyaluronic acid in patients with knee osteoarthritis, sixty female patients with knee osteoarthritis were randomised to three weekly intra-articular injections of 30 mg sodium hyaluronate (Na HA) with a high molecular weight (1.0 to 2.9 million Da) or 40 mg 6-methylprednisolone acetate (6-MPA). The clinical assessments included pain at rest, at weight-bearing and on walking, Lequesne Index and active range of knee flexion. Assessments were done at baseline, at week 4, and at months 3 and 6. A significant decrease in VAS scores for pain at rest, at weight-bearing and pain on walking, and in Lequesne index was found in both groups at week 4 when compared to baseline and there was no significant differences between the two groups. However, at 3^rd month improvement in all pain scores and Lequesne index was found in favour of hyaluronic acid. At 6^th, no significant difference was found between the treatment groups. Improvement in pain was accompanied by an increase in joint flexion at week 4 and at month 3 in both groups. Both treatments were well-tolerated. The results showed that both intra-articular hyaluronic acid and 6-MPA treatments provide clinically significant improvement and demonstrated that Na HA has a long-term beneficial effect in patients with knee osteoarthritis. Received: 13 May 2002 / Accepted: 21 November 2002     

硫酸氨基葡萄糖对白细胞介素1β诱导人骨关节炎软骨细胞合成前列腺素E2的影响

目的探讨硫酸氨基葡萄糖(glucosamine sulfate,GS)对白细胞介素1β(IL-1β)诱导体外培养的人骨关节炎软骨细胞(human osteoarthritic chondrocyte,HOC)合成前列腺素E_2 (prostaglandin E_2,PGE_2)的影响及其作用机制。方法取10例骨关节炎患者行全膝关节置换术的股骨髁和胫骨平台软骨标本,酶消化法获取软骨细胞进行体外培养。在原代或第二代的HOC培养液中加入IL-1β(5×10~(-3)μg/L)和不同浓度的GS(0.2、2和20 mmol/L)作用24 h(对照组不加IL-1β和GS),首先应用ELISA法检测GS对IL-1β诱导HOC合成PGE_2的影响,然后采用RT-PCR法和Western蛋白印迹法分别检测其对IL-1β诱导HOC表达COX-2 mRNA和蛋白的影响。结果对照组HOC培养液中PGE_2浓度为(109.46±17.48)pg/ml,IL-1β刺激后软骨细胞合成PGE_2为(3607.22±239.34)pg/ml,其差异有统计学意义(P<0.01)。0.2、2和20 mmol/L GS以浓度依赖的方式抑制IL-1β诱导HOC合成PGE_2(P<0.05),其浓度分别为(2594.23±185.18)、(1057.53±126.81)和(565.43±52.79)pg/ml;单独使用20 mmol/L GS时软骨细胞合成PGE_2为(169.94±30.03)pg/ml,与对照差异无统计学意义(P>0.05)。IL-1β刺激后,HOC表达COX-2 mRNA和蛋白上调(P<0.01),GS能以浓度依赖的方式抑制IL-1β诱导HOC表达COX-2 mRNA和蛋白上调(P<0.01)。结论GS抑制HOC在IL-1β诱导下分泌炎性介质PGE_2,其机制是下调调控它们表达的COX-2 mRNA和蛋白的表达;这可能是GS既能缓解症状和又能保护软骨的机制之一。     

Acupotomy combined with intra-articular injection of sodium hyaluronate in the treatment of knee osteoarthritis

This retrospective study aimed to compare the effects of acupotomy combined with intra-articular injection of sodium hyaluronate (IA-SH) for the treatment of knee osteoarthritis (KOA). Eighty electronic medical records of patients with KOA were retrospectively analyzed. The patients were divided into an intervention group (n = 40, acupotomy plus IA-SH) and a control group (n = 40, IA-SH). Outcome measures included the visual analog scale, the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and adverse events. Outcome data were collected and analyzed before and after treatment. The results of this study showed that there was a greater reduction in the visual analog scale (P < .01) and WOMAC scores (pain, P < .01; stiffness, P < .01; function, P < .01; total, P < .01) in the intervention group than in the control group. In addition, there were no significant differences in adverse events between the 2 groups. In this study, the effects of acupotomy plus IA-SH were superior to those of IA-SH alone for the treatment of patients with KOA. Further prospective studies are required to confirm these findings.