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甲氨蝶呤可作为治疗症状性膝骨关节炎的选择

上一篇 / 下一篇  2014-04-20 10:59:08 / 个人分类:骨关节炎专题

译者:侯建文           校对:李玉翠          审核:张改连

      Abstract: OBJECTIVES: To assess the efficacy of methotrexate (MTX) in decreasing pain and inflammation in symptomatic knee osteoarthritis (OA). METHODS:One hundred and forty-four patients with primary knee OA were randomised in a 1:1 ratio to receive up to 25 mg/week oral MTX (n=72) or placebo (n=72) for 28 weeks. Outcome measures included reduction in pain and inflammation and improvements in physical function scores. Pain was assessed using the visual analogue pain scale, (VAS, 0-100 mm). Functional assessment was performed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and activities of daily living (ADL) scores. Synovitis was detected clinically and by ultrasound imaging at baseline and at the end of the study. RESULTS: There was a clinically relevant reduction in the intervention group compared with the placebo group for knee pain, physical function and ADL scores at 28 weeks. The mean difference between treatment arms (95% CI) was 11.4 (2.8 to 20.0), p=0.009; 9.5 (3.7 to 15.3) p=0.001 and 1.2 (0.1 to 2.3), p=0.032, respectively. Furthermore, a clinically relevant reduction in synovitis (both clinically and by ultrasound) was noted in the MTX group compared with the placebo group at 28 weeks. The proportion of patients who had a reduction in VAS of >20 mm was significantly higher in the MTX group (n=38) 53% than in the placebo group (n=17) 24%, p=0.018. CONCLUSIONS:MTX significantly reduced pain and improved synovitis. There was a significant improvement in physical function. MTX may be a therapeutic option in the treatment of pain and inflammation related to knee OA.

    

       目的:评估甲氨蝶呤(MTX)在减轻膝骨关节炎(OA)关节疼痛和炎症中的疗效。方法:144例原发性膝骨关节炎患者按1:1比例随机分为两组,即MTX72例)和安慰剂组(72例),治疗组口服MTX25mg/周,治疗28周后进行评估。对关节疼痛及炎症缓解和躯体功能改善进行评估。疼痛的评估采用视觉模拟评分法(VAS0-100毫米,分值越高,症状越重)。功能的评估采用西安大略和麦克马斯特大学骨关节炎指数(WOMAC)和日常生活活动能力(ADL)评分。在研究起始和终末通过临床表现和超声监测滑膜炎改善情况。结果:MTX组患者治疗28周时膝关节疼痛、躯体功能和ADL评分较安慰剂组明显改善。其评分的平均差值为分别为11.4[9  5%可信区间(CI)为2.820.0]p=0.0099.5[95% CI3.715.3]P = 0.0011.2[95% CI0.12.3]P = 0.032;此外,治疗28周后MTX组较安慰剂组滑膜炎症反应明显减轻。VAS评分>20mm的患者疼痛缓解率,MTX组(n=38,53%)明显高于安慰剂组(n=1724%),P=0.018结论:MTX可明显减轻关节疼痛及滑膜炎症反应,改善关节功能。MTX可作为治疗膝骨关节炎关节疼痛及炎症的选择。

    

       引自:Abou-Raya A1,Abou-Raya S,Khadrawe T. Methotrexate in the treatment of symptomatic knee osteoarthritis: randomised placebo-controlled trial.Ann Rheum Dis. 2014 Mar 27. 


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张莉芸的个人空间 引用 删除 张莉芸   /   2015-03-11 11:19:48
3
不符合,治疗骨关节炎不用甲氨蝶呤
引用 删除 Guest   /   2015-02-17 17:23:37
张教授您好 :我想问下甲氨蝶呤联合洛索洛芬治疗膝骨关节炎符合临床治疗原则吗?叩谢!
我来说两句

 
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