【原】【晨读】骨关节炎药物治疗的选择过程是什么?（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Yu S P , Hunter D J . What is the selection process for osteoarthritis pharmacotherapy?[J]. Expert Opinion on Pharmacotherapy, 2020(9):1-5.

ABSTRACT

Osteoarthritis is the most prevalent joint condition that continues to increase with an ever-aging population and the rising tide of obesity. There are multiple recommendations/guidelines for the management of osteoarthritis. The basis of management should focus on self-management and education, lifestyle modifications, exercise and when appropriate, weight loss. Pharmacotherapy is targeted toward pain palliation with no agents available presently to target prevention and disease modification. The selection of pharmacotherapy should be tailored to the individual, taking into account of personal preferences and interactions with underlying co-morbidities. This editorial provides a guide to the selection process of presently available pharmacotherapy in osteoarthritis.

摘要

骨关节炎是最普遍的关节疾病，并随着人口老龄化和肥胖的增加而持续增加。有多种管理骨关节炎的建议/指南。管理的基础应该集中在自我管理和教育、生活方式的改变、适时锻炼以及减肥。药物治疗的目标是缓解疼痛，目前没有药物可用于预防和改变疾病。药物治疗的选择应针对个人，考虑到个人偏好和与潜在共病的相互作用。这篇社论为骨关节炎目前可用的药物治疗的选择过程提供了指南。

Introduction 

Osteoarthritis (OA) is the most prevailing joint condition. With the uprising trend in the number of individuals affected annually and the expectations that the numbers will continue to rise, it poses tremendous impact on the individuals affected along with substantial consequences on the health-care systems and wider socioeconomic systems

引言

骨关节炎(OA)是最常见的关节状况。每年受影响的个人数量呈上升趋势，预计人数将继续上升，这对受影响的个人造成巨大影响，并对卫生保健系统和更广泛的社会经济系统造成重大影响。

The pathophysiology of OA itself has migrated from traditional concepts of a degenerative process. Rather, it is a process of excessive mechanical stress that overwhelms the joints innate reparative potential applied in the setting of systemic susceptibility . It is a complex disease with whole joint involvement, that incorporates associated structural alterations of the articular cartilage, meniscus, synovial membrane, subchondral bone, ligaments, capsule and periarticular musculature. Osteoarthritis pain pathogenesis itself is an intricate biopsychosocial model that encompasses interactions between catabolic and inflammatory cytokines and sensitization of nociceptive pathways by the activation of primary afferent nerves in response to inflammation or tissue injury. Apart from nociceptive pain mechanisms, there is increasing recognition of neuropathic/central pain mechanisms in OA patients.

OA自身的病理生理学已经不是传统的退行性过程的概念。相反，这是一个过度的机械应力的过程，超过了系统易感性设定的的关节先天修复潜力。这是一种复杂的疾病，涉及整个关节，相关的结构改变包括关节软骨、半月板、滑膜、软骨下骨、韧带、关节囊和关节周围肌肉。骨关节炎疼痛的发病机制本身是一个复杂的生物心理社会模型，包括分解代谢和炎症细胞因子之间的相互作用，以及通过激活初级传入神经来应对炎症或组织损伤而使伤害性感受途径敏化。除了痛觉性疼痛机制外，人们越来越认识到OA患者的神经性/中枢性疼痛机制。