膝骨性关节炎的注射治疗：指南系统回顾（一）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Pavone V, Vescio A, Turchetta M, et al. Injection-Based Management of Osteoarthritis of the Knee: A Systematic Review of Guidelines. Front Pharmacol. 2021;12:661805.本次学习由林小雯副主任医师主讲。

Osteoarthritis (OA) is a leading cause of disability among older adults. Numerous pharmaceutical and nonpharmaceutical interventions have been described. Intraarticular injections are commonly the first line treatment. There are several articles, reporting the outcome of corticosteroids (CS), hyaluronic acid (HA) and platelet rich plasma (PRP). The aim of the study is to highlight the usefulness, indication and efficacy of the intra-articular injection of principal drugs. CSs have been shown to reduce the severity of pain, but care should be taken with repeated injections because of potential harm. HA reported good outcomes both for pain reduction and functional improvement. Different national societies guidelines do not recommend the PRP intraarticular injection in the management of knee OA for lack of evidence. In conclusion, the authors affirm that there is some evidence that intra-articular steroids are efficacious, but their benefit may be relatively short lived (<4 weeks). Most of the positive outcome were limited to the studies or part of the studies that considered the injection of high molecular weight as visco-supplementation, with a course of two to four injections a year.

Keywords: knee osteoarthritis, injection therapy, intra-articular injections, corticosteroids, hyaluronic acid, platelet-rich plasm

骨关节炎 （OA） 是老年人残疾的主要原因。指南推荐了很多药物和非药物干预措施。关节内注射通常是第一线治疗。许多文章报道了皮质类固醇（CS）、透明质酸（HA）和富含血小板血浆（PRP）的治疗结果。本研究的目的是强调药物关节内注射的作用、指征和有效性。CS已被证明可以减轻疼痛的严重程度，但是由于潜在的危害，反复注射应谨慎。HA对缓解疼痛和改善功能有良好疗效。不同国家的指南因缺乏证据不推荐PRP膝关节内注射。总之，有一些证据表明，关节内类固醇是有效的，但治疗效果维持时间可能较短（<4周）。大多数研究结果表明高分子量粘胶剂作为补充治疗，每年注射两到四次。

关键词：膝骨性关节炎，注射治疗，关节腔注射，皮质类固醇，透明质酸，富血小板血浆

INTRODUCTION

Osteoarthritis (OA) is the most common form of arthritis, affecting an estimated 302 million people worldwide, and is a leading cause of disability among older adults.

As OA spans decades of a patient’s life, patients with OA are likely to be treated with a number of different pharmaceutical and nonpharmaceutical interventions, often in combination.

Here, we conduct a systematic review of international guidelines of the efficacy of intra-articular injections (IAJ) of corticosteroids (CS), hyaluronic acid (HA) and platelet rich plasma (PRP). We have the pleasure to highlight the usefulness of bringing together a summary of international guidelines in one place, being more than one guideline on these important topics. It should help clinicians to review and appraise published guidelines systematically, and aid evidence-based clinical decision-making.

Currently, there is no critical appraisal of international guidelines that are synthetized, graded and comprehensively presented for injection-based therapy of knee OA.

The aim of the study is to highlight the usefulness, indication and efficacy of the intra-articular injection of principal drugs. Therefore, a systematic critical appraisal of international guidelines wasundertaken to comprehensively present the evidence-based recommendation on injection-based therapy of knee OA.

前言

骨关节炎（OA）是最常见的关节炎形式，影响全球约 3.02 亿人，是老年人残疾的主要原因。由于OA可伴随患者数十年的病程，OA患者可能会接受多种不同的药物和非药物干预治疗，多为联合疗法。

在这里，我们系统回顾了国际指南中关于关节内注射（IAJ）皮质类固醇（CS）、透明质酸（HA）和富含血小板血浆（PRP）的疗效。我们将指南进行汇总，进而帮助临床医生系统学习指南，为临床决策提供依据。

目前，尚无针对膝骨性关节炎的注射治疗的综合、分级和全面的国际指南进行客观性评价。

这项研究的目的是强调关节内药物注射的作用、指征和有效性。因此，我们对国际指南进行了系统的客观性评价，以全面提出膝骨性关节炎注射治疗的循证推荐。