难以治疗的骨关节炎--采用多模式治疗策略的理由

A. Karateev
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引用次数: 0

摘要

有效控制疼痛是治疗骨关节炎(OA)最重要的临床任务。国际专家委员会在讨论将 "靶向治疗 "原则引入 OA 治疗的可能性时,认为 PASS(患者可接受的症状状态)指数是成功治疗该疾病的最合理标准。然而,根据多项人群研究发现,20%-30% 的患者无法获得明显的 OA 改善。导致 OA 治疗反应不充分的因素可能包括关节结构的严重变化、痛觉系统功能障碍(神经可塑性变化、中枢敏感化)、精神情绪障碍和合并病症。因此,对于有中度或重度疼痛的 OA 患者,治疗策略的选择应因人而异,并考虑到疾病的表型、临床情况的特点以及是否存在合并病症。OA 领域的权威专家认为,治疗这种疾病最合理的方法是多学科、多模式的治疗,包括非甾体抗炎药、局部注射疗法、骨关节炎症状慢作用药物(SYSADOA)和非药物疗法的综合使用。目前有大量证据证实了 SYSADOA(尤其是葡萄糖胺和软骨素的组合)的有效性和安全性。这使我们能够将 SYSADOA 作为治疗 OA 的必备成分,而不论其所处阶段、表型和伴随病理。治疗 OA 的一个新方向是使用原生(未变性)胶原蛋白制剂,其效果与形成对这种蛋白质自身抗原的免疫耐受和降低慢性关节炎症的严重程度有关。多项临床研究证实了原生胶原蛋白补充剂的有效性。一种含有原生胶原蛋白、氨基葡萄糖、软骨素、B 族维生素和生姜提取物的新型膳食补充剂的出现,扩大了为 OA 患者提供药物支持的可能性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Difficult-to-treat osteoarthritis – justification for multimodal treatment tactics
Effective pain control is the most important clinical task in the treatment of osteoarthritis (OA). The International Expert Council, which discussed the possibility of introducing the principle of "treatment to target" to OA treatment, recognized the PASS (patient acceptable symptoms state) index as the most reasonable criterion for the successful treatment of this disease. However, according to several population studies, it is not possible to achieve a significant improvement in OA in 20–30% of patients. Factors that may be responsible for an inadequate response to the treatment of OA are severe structural changes in the joints, dysfunction of the nociceptive system (neuroplastic changes, central sensitization), psychoemotional disorders and comorbid pathologies. Therefore, the choice of therapeutic tactics in patients with OA who have moderate or severe pain should be individualized and take into account the phenotype of the disease, the characteristics of the clinical situation and the presence of comorbid pathologies. Leading experts in OA believe that the most rational approach to the management of this disease is a multidisciplinary, multimodal treatment that includes the complex use of nonsteroidal anti-inflammatory drugs, local injection therapy, Symptomatic Slow Acting Drugs for Osteoarthritis (SYSADOA) and non-pharmacological approaches. There is currently a strong evidence base confirming the efficacy and safety of SYSADOA (particularly the combination of glucosamine and chondroitin). This allows us to consider SYSADOA as a mandatory component of OA treatment, regardless of stage, phenotype and concomitant pathology. A new direction of OA therapy is the use of native (undenatured) collagen preparations, the effect of which is associated with the formation of immunological tolerance to autoantigens of this protein and a reduction in the severity of chronic joint inflammation. Several clinical studies have confirmed the effectiveness of native collagen supplements. The appearance of a new dietary supplement containing native collagen, glucosamine, chondroitin, B vitamins and ginger extract expands the possibilities of pharmaconutraceutical support for patients with OA.
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