JAMA:激素在治疗关节炎上的错误

2017-08-02 zhuliee 来宝网

据发表于JAMA杂志上的研究报道,每3个月进行关节腔激素注射治疗的骨关节炎患者,当注射时间超过两年后,会发生更多的软骨总量的丢失,而病人的膝关节的疼痛和接受安慰剂注射的患者没有显著差异。



关节腔注射激素治疗被推翻】据发表于JAMA杂志上的研究报道,每3个月进行关节腔激素注射治疗的骨关节炎患者,当注射时间超过两年后,会发生更多的软骨总量的丢失,而病人的膝关节的疼痛和接受安慰剂注射的患者没有显着差异。

骨关节炎是危害中老年健康的重要疾病,早在2005年,美国的骨关节炎患者就已经达到了900万人口,骨关节炎是导致残疾和医药花费增加的一项重要内容。

在治疗方面,目前对骨关节炎的治疗以缓解症状为主要目的,还没有已知的可以影响骨和软骨结构增长的有效干预。

滑膜炎在膝骨关节炎中很常见,且和骨关节炎中的结构进展相关。关节腔内注射激素可以减少滑膜炎导致的软骨损伤,但是可能对软和骨组织本身的结构具有负面的影响。

来自波士顿,塔夫茨医学中心的Timothy E将140例患有症状性膝关节炎的患者进行随机分组,其中70例患者接受关节腔注射类固醇激素,70例患者关节腔注射盐水,每12周注射一次,共注射2年。

研究结果发现,注射激素的患者关节软骨的体积丢失多余注射生理盐水的患者,且在缓解疼痛方面,和对照之间没有明显差异。

另外,在副反应方面,接受激素治疗的患者的副反应有5项,而接受生理盐水治疗的患者只有3项。

原始出处:

Timothy E. McAlindon, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis. JAMA. 2017;317(19):1967-1975. doi:10.1001/jama.2017.5283.

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    2017-08-04 lmm397
  2. [GetPortalCommentsPageByObjectIdResponse(id=1265483, encodeId=998012654835e, content=<a href='/topic/show?id=57a53011364' target=_blank style='color:#2F92EE;'>#关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30113, encryptionId=57a53011364, topicName=关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f90281, createdName=lmm397, createdTime=Fri Aug 04 02:26:00 CST 2017, time=2017-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=229435, encodeId=ae0b229435d1, content=学习了,学习了学习了学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuIjZYTAgkEia1SFuoeAByVaQC8uXegibpJEV2Q7SqhpDINJicNiaU5pYicYmy5WsI8l5hDribViac2A1BQ9/0, createdBy=c36f1724608, createdName=hfuym10906, createdTime=Thu Aug 03 07:14:04 CST 2017, time=2017-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=229210, encodeId=7c2222921034, content=学习了受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Wed Aug 02 15:30:57 CST 2017, time=2017-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=229192, encodeId=568722919297, content=谢谢分享,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Wed Aug 02 14:18:53 CST 2017, time=2017-08-02, status=1, ipAttribution=)]
    2017-08-03 hfuym10906

    学习了,学习了学习了学习了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1265483, encodeId=998012654835e, content=<a href='/topic/show?id=57a53011364' target=_blank style='color:#2F92EE;'>#关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30113, encryptionId=57a53011364, topicName=关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f90281, createdName=lmm397, createdTime=Fri Aug 04 02:26:00 CST 2017, time=2017-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=229435, encodeId=ae0b229435d1, content=学习了,学习了学习了学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuIjZYTAgkEia1SFuoeAByVaQC8uXegibpJEV2Q7SqhpDINJicNiaU5pYicYmy5WsI8l5hDribViac2A1BQ9/0, createdBy=c36f1724608, createdName=hfuym10906, createdTime=Thu Aug 03 07:14:04 CST 2017, time=2017-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=229210, encodeId=7c2222921034, content=学习了受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Wed Aug 02 15:30:57 CST 2017, time=2017-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=229192, encodeId=568722919297, content=谢谢分享,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Wed Aug 02 14:18:53 CST 2017, time=2017-08-02, status=1, ipAttribution=)]
    2017-08-02 131****1460

    学习了受益匪浅。

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1265483, encodeId=998012654835e, content=<a href='/topic/show?id=57a53011364' target=_blank style='color:#2F92EE;'>#关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30113, encryptionId=57a53011364, topicName=关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f90281, createdName=lmm397, createdTime=Fri Aug 04 02:26:00 CST 2017, time=2017-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=229435, encodeId=ae0b229435d1, content=学习了,学习了学习了学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuIjZYTAgkEia1SFuoeAByVaQC8uXegibpJEV2Q7SqhpDINJicNiaU5pYicYmy5WsI8l5hDribViac2A1BQ9/0, createdBy=c36f1724608, createdName=hfuym10906, createdTime=Thu Aug 03 07:14:04 CST 2017, time=2017-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=229210, encodeId=7c2222921034, content=学习了受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Wed Aug 02 15:30:57 CST 2017, time=2017-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=229192, encodeId=568722919297, content=谢谢分享,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Wed Aug 02 14:18:53 CST 2017, time=2017-08-02, status=1, ipAttribution=)]
    2017-08-02 清风拂面

    谢谢分享,学习了

    0

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