关节内注射治疗髋关节骨关节炎:透明质酸与糖皮质激素-一项系统综述。

IF 1 4区 医学 Q4 RHEUMATOLOGY
Acta reumatologica portuguesa Pub Date : 2020-04-01
Filipa Vilabril, Jorge Rocha-Melo, José Vítor Gonçalves, José Vilaça-Costa, Iva Brito
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引用次数: 0

摘要

目的:比较关节内注射糖皮质激素(GC)和透明质酸(HA)对髋关节骨关节炎(HO)所致疼痛和残疾的影响。材料和方法:在MEDLINE(通过PubMed)、Web of Science、Scopus和Cochrane Central Register of Controlled Trials (Central)数据库中对相关文献进行系统综述,检索关键词为:“髋关节骨关节炎”、“糖皮质激素”、“皮质类固醇”、“皮质激素”、“透明质酸”和“粘质补充剂”。两位独立作者应用纳入和排除标准,选择随机临床试验,直接比较HO患者关节内注射GC和HA。结果:在初始搜索中发现157篇文章。应用排除标准后,阅读36篇文献,最终选择3项随机临床试验(n = 484)。两项研究将这些产品的使用与安慰剂(生理盐水)进行了比较,一项研究还将其与第四组仅接受物理治疗的患者进行了比较。Qvistgaard等人在4周时与安慰剂相比,证明了GC(中度临床获益)和HA(边际临床获益)在疼痛方面的临床优势;然而,在12周的随访中,GC和HA之间没有统计学上的显著差异。Atchia等人报道了GC治疗8周后患者疼痛和功能的统计学显著改善。Spitzer等人在整个研究过程中证明了两组患者的总体临床反应,其中GC治疗组的反应更快。然而,作者强调,在26周的中度HO病例中,HA与GC相比在所有结局指标上都具有优势。讨论:很少有研究直接比较骨髓瘤患者关节内注射GC与HA的临床效果,在人群类型、给药次数、HA的配制、随访时间等方面存在异质性。所分析的研究随访时间较短。所获得的结果似乎表明,与HA相比,GC在治疗疼痛方面具有优势,即在临床反应速度方面。然而,Spitzer等人证明了HA在中度HO患者中的总体优势,这表明患者的最佳选择仍有待确定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Hip osteoarthritis treatment with intra-articular injections: hyaluronic acid versus glucocorticoid - a systematic review.

Objective: To compare the effects of intra-articular injection of glucocorticoid (GC) and hyaluronic acid (HA) on pain and disability caused by hip osteoarthritis (HO).

Materials and methods: A systematic review of the literature was carried out within MEDLINE (via PubMed), Web of Science, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) databases, using the keywords (MeSH words): "hip osteoarthritis", "glucocorticoid", "corticosteroid", "corticoid", "hyaluronic acid" and "viscosupplementation". Two independent authors applied inclusion and exclusion criteria, selecting randomized clinical trials with direct comparison between intra-articular injection of GC and HA in patients with HO.

Results: 157 articles were found in the initial search. After applying the exclusion criteria, 36 articles were read, with final selection of 3 randomized clinical trials (n = 484). Two studies compared the administration of these products with placebo (saline) - and one also compared it with a fourth group of patients undergoing only physical therapy. Qvistgaard et al. demonstrated clinical superiority of GC (moderate clinical benefit) and HA (marginal clinical benefit) in pain, at 4 weeks, both compared to placebo; however, there was no statistically significant difference between GC and HA during the 12-week follow-up. Atchia et al. reported a statistically significant improvement in pain and function in patients treated with GC during 8 weeks. Spitzer et al. demonstrated an overall clinical response in patients in both groups throughout the study, with a faster response for those treated with GC. However, the authors highlight the superiority in all outcome measures of HA compared to GC in cases of moderate HO, at 26 weeks.

Discussion: Few studies directly compare the clinical effect between intra-articular injections of GC and HA in HO, showing heterogeneity in the type of population, number of administrations, formulation of HA and follow-up period. The analyzed studies had a short follow-up time. The results obtained seem to demonstrate a superiority of GC compared to HA in managing pain, namely in the speed of clinical response. However, Spitzer et al. demonstrated an overall superiority of HA in patients with moderate HO, which suggests that optimal selection of patients remains to be defined.

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来源期刊
Acta reumatologica portuguesa
Acta reumatologica portuguesa 医学-风湿病学
自引率
0.00%
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0
审稿时长
>12 weeks
期刊介绍: Acta Reumatólogica Portuguesa is a scientific peer reviewed journal covering all aspects of rheumatic diseases and related to Rheumatology. The journal publishes original articles, reviews, clinical cases, images in rheumatology, letters to the editor and clinical teaching (e.g. guidelines and clinical protocols). Published since 1973, Acta Reumatológica Portuguesa is the official scientific publication of the Portuguese Society of Rheumatology, a non-profit organization that promotes the knowledge and investigation of rheumatic diseases and the development of Rheumatology.
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