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中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (03) : 301 -307. doi: 10.3877/cma.j.issn.1674-134X.2023.03.001

指南与应用

中国骨关节炎外用药物临床实践指南(2022年版)
中华医学会骨科学分会关节外科学组, 解放军联勤保障部队第九二〇医院   
  • 收稿日期:2022-11-21 出版日期:2023-06-01
  • 基金资助:
    国家自然科学基金面上项目(82072392); 云南省骨科与运动康复临床医学研究中心(202102AA310068); 云南省科技人才与平台计划项目(202105AD160027)

Chinese guideline for topical medicine of osteoarthritis (2022 edition)

Joint Surgery Group of Orthopaedic Branch of Chinese Medical Association, the 920th Hospital of Joint Service Force of PLA   

  • Received:2022-11-21 Published:2023-06-01
引用本文:

中华医学会骨科学分会关节外科学组, 解放军联勤保障部队第九二〇医院. 中国骨关节炎外用药物临床实践指南(2022年版)[J]. 中华关节外科杂志(电子版), 2023, 17(03): 301-307.

Joint Surgery Group of Orthopaedic Branch of Chinese Medical Association, the 920th Hospital of Joint Service Force of PLA. Chinese guideline for topical medicine of osteoarthritis (2022 edition)[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(03): 301-307.

骨关节炎(OA)是一种常见的关节退行性疾病,以疼痛、畸形、关节活动障碍等为特点,给患者个人、家庭和社会造成了沉重的负担。外用药物是一大类常用的治疗OA的干预措施,然而当前临床实践中存在各种不同类型、不同成分、不同作用机制、不同剂型的外用药物。目前在临床实施过程中缺少外用药物应用的共识。因此,如何有效、正确地选择外用药物是临床医生关注的问题。该指南由中华医学会骨科学分会关节外科学组发起,采用推荐意见分级的评估、制订及评价(GRADE)分级体系,科学性、透明性和适用性的评级工具(STAR)和指南研究与评价工具Ⅱ(AGREE Ⅱ)及国际实践指南报告规范(RIGHT)等方法,遴选出医生最为关注的9个临床问题,并最终形成9条循证医学推荐意见。本指南旨在提高医疗机构治疗OA过程中,外用药药物使用的科学性并最终提升以患者为中心的医疗服务质量。

Osteoarthritis (OA) is a highly prevalent degenerative joint disease, characterized by pain, deformity and limited function, which represents a substantial burden for affected individuals, families, and the society. Topical medicine is a large class of commonly used interventions for the treatment of OA. However, in current clinical practice, there are various types of topical medicine with different components, mechanisms of action and varied dosage forms. At present, there is no consensus on the application of topical medicine in clinical implementation. Therefore, how to choose topical medicine effectively and correctly is an issue that clinicians concern about. The present guideline was initiated by the Joint Surgery Branch of the Chinese Orthopaedic Association. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, the scientificity, transparency and applicability ranking tools (STAR), the Appraisal of Guidelines for Research and Evaluation (AGREE)Ⅱ, and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) were utilized to formulate nine evidence-based recommendations based on nine most concerned clinical questions from practitioners in primary clinics in China. This guideline intended to improve the scientificity of topical medicine for OA ultimately.

[1]
Hallberg S, Rolfson O, Karppinen J, et al. Burden of disease and management of osteoarthritis and chronic low back pain: healthcare utilization and sick leave in Sweden, Norway, Finland and Denmark (BISCUITS): study design and patient characteristics of a real world data study[J]. Scand J Pain, 2023, 23(1): 126-138.
[2]
Long H, Liu Q, Yin H, et al. Prevalence trends of site-specific osteoarthritis from 1990 to 2019: findings from the global burden of disease study 2019[J]. Arthritis Rheumatol, 2022, 74(7):1172-1183.
[3]
Xing D, Xu Y, Liu Q, et al. Osteoarthritis and all-cause mortality in worldwide populations: grading the evidence from a meta-analysis[J/OL]. Sci Rep, 2016, 6: 24393. DOI: 10.1038/srep24393.
[4]
Hoveidaei AH, Nakhostin-Ansari A, Hosseini-Asl SH, et al. Increasing burden of hip osteoarthritis in the Middle East and North Africa (MENA): an epidemiological analysis from 1990 to 2019[J]. Arch Orthop Trauma Surg2023, 143(6): 3563-3573.
[5]
Tang X, Wang S, Zhan S, et al. The prevalence of symptomatic knee osteoarthritis in China: results from the China health and retirement longitudinal study[J]. Arthritis Rheumatol, 2016, 68(3): 648-653.
[6]
Yu H, Huang T, Lu WW, et al. Osteoarthritis pain[J/OL]. Int J Mol Sci, 202223(9): 4642. DOI: 10.3390/ijms23094642.
[7]
Berteau JP. Knee pain from osteoarthritis: pathogenesis, risk factors, and recent evidence on physical therapy interventions[J/OL]. J Clin Med, 2022, 11(12): 3252. DOI: 10.3390/jcm11123252.
[8]
Laires PA, Laíns J, Miranda LC, et al. Inadequate pain relief among patients with primary knee osteoarthritis[J]. Rev Bras Reumatol Engl Ed, 2017, 57(3): 229-237.
[9]
Maloney J, Pew S, Wie C, etal. Comprehensive review of topical analgesics for chronic pain[J/OL]. Curr Pain Headache Rep, 2021, 25(2): 7. DOI: 10.1007/s11916-020-00923-2.
[10]
World Health Organization. WHO Handbook for Guideline Development. Second edition. Geneva: WHO, 2014. ISBN: 978 9241548960.
[11]
Bourne RB, Chesworth BM, Davis AM, et al. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?[J].Clin Orthop Relat Res, 2010, 468(1): 57-63.
[12]
Xing D, Wang Q, Yang Z, et al. Evidence-based guidelines for intra-articular injection in knee osteoarthritis: formulating and evaluating research questions[J]. Int J Rheum Dis, 2018, 21(8): 1533-1542.
[13]
de Steiger RN, Graves SE. Orthopaedic registries: the Australian experience[J]. EFORT Open Rev, 2019, 4(6): 409-415.
[14]
Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials[J/OL]. BMJ, 2011, 343: d5928. DOI: 10.1136/bmj.d5928.
[15]
Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies[J]. Ann Intern Med, 2011, 155(8): 529-536.
[16]
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9): 603-605.
[17]
Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables[J]. J Clin Epidemiol, 2011, 64(4): 383-394.
[18]
陈耀龙,杨克虎,姚亮,等. GRADE系统方法学进展[J]. 中国循证儿科杂志2013, 8(1): 64-65.
[19]
Goh GSH, Liow MHL, Lim WSR, et al. Accelerometer-based navigation is as accurate as optical computer navigation in restoring the joint line and mechanical axis after total knee arthroplasty: aprospective matched study[J]. J Arthroplasty, 2016, 31(1): 92-97.
[20]
Jaeschke R, Guyatt GH, Dellinger P, et al. Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive[J/OL]. BMJ, 2008, 337: a744. DOI: 10.1136/bmj.a744.
[21]
Becker M, Neugebauer EA, Eikermann M. Partial updating of clinical practice guidelines often makes more sense than full updating: a systematic review on methods and the development of an updating procedure[J]. J Clin Epidemiol, 2014, 67(1): 33-45.
[22]
陈耀龙,王小琴,吴琼芳,等. 中国临床实践指南更新情况调查[J]. 中国循证医学杂志2014, 14(2): 178-183.
[23]
Rodriguez-Merchan EC. Topical therapies for knee osteoarthritis[J]. Postgrad Med, 2018, 130(7): 607-612.
[24]
Carnes D, Anwer Y, Underwood M, et al. Influences on older people’s decision making regarding choice of topical or oral NSAIDs for knee pain: qualitative study[J]. BMJ, 2008, 336(7636): 142-145.
[25]
Schubert T, Kern KU, Schneider S, et al. Oral or topical pain therapy-how would patients decide? A discrete choice experiment in patients with peripheral neuropathic pain[J]. Pain Pract, 2021, 21(5): 536-546.
[26]
Jorge LL, Feres CC, Teles VE. Topical preparations for pain relief: efficacy and patient adherence[J]. J Pain Res, 2010, 4: 11-24.
[27]
Jiang S, Tang M. Allergy to local anesthetics is a rarity: review of diagnostics and strategies for clinical management[J]. Clin Rev Allergy Immunol2023, 64(2): 193-205.
[28]
Zeng C, Wei J, Persson MSM, et al. Relative efficacy and safety of topical non-steroidal anti-inflammatory drugs for osteoarthritis: a systematic review and network meta-analysis of randomised controlled trials and observational studies[J]. Br J Sports Med, 2018, 52(10): 642-650.
[29]
Derry S, Wiffen PJ, Kalso EA, et al. Topical analgesics for acute and chronic pain in adults-an overview of Cochrane Reviews[J/OL]. Cochrane Database Syst Rev, 20175(5): CD008609. DOI: 10.1002/14651858.CD008609.pub2.
[30]
Derry S, Conaghan P, Da Silva JA, et al. Topical NSAIDs for chronic musculoskeletal pain in adults[J/OL]. Cochrane Database Syst Rev, 2016, 4(4):CD007400. DOI: 10.1002/14651858.CD007400.pub3.
[31]
da Costa BR, Pereira TV, Saadat P, et al. Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis: network meta-analysis[J/OL]. BMJ, 2021, 375: n2321. DOI:10.1136/bmj.n2321 pmid:34642179
[32]
Sardana V, Burzynski J, Zalzal P. Safety and efficacy of topical ketoprofen in transfersome gel in knee osteoarthritis: a systematic review[J]. Musculoskeletal Care, 2017, 15(2):114-121.
[33]
Mu R, Bao CD, Chen ZW, etal. Efficacy and safety of loxoprofen hydrogel patch versus loxoprofen tablet in patients with knee osteoarthritis: a randomized controlled non-inferiority trial[J]. Clin Rheumatol, 2016, 35(1): 165-173.
[34]
Greig SL, Garnock-Jones KP. Loxoprofen: areview in pain and inflammation[J]. Clin Drug Investig, 2016, 36(9): 771-781.
[35]
中华医学会骨科学分会关节外科学组,中国医师协会骨科医师分会骨关节炎学组,国家老年疾病临床医学研究中心湘雅医院,等. 中国骨关节炎诊疗指南(2021年版)[J]. 中华骨科杂志2021(18): 1291-1314.
[36]
《白脉软膏临床应用专家意见》课题工作组,陈薇,詹红生,等. 白脉软膏临床应用专家意见[J]. 中国中药杂志202247(5): 1403-1408.
[37]
郑昱新,詹红生,张琥,等. 奇正青鹏膏剂治疗膝骨关节炎的随机对照临床研究[J]. 中国骨伤2006, 19(5): 316-317.
[38]
Banerjee S, McCormack S. CADTH Rapid Response Reports. Capsaicin for Acute or Chronic Non-Cancer Pain: A Review of Guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health Copyright? 2020 Canadian Agency for Drugs and Technologies in Health., 2020.
[39]
Persson MSM, Stocks J, Walsh DA, et al. The relative efficacy of topical non-steroidal anti-inflammatory drugs and capsaicin in osteoarthritis: a network meta-analysis of randomised controlled trials[J]. Osteoarthritis Cartilage, 2018, 26(12): 1575-1582.
[40]
Guedes V, Castro JP, Brito I. Topical capsaicin for pain in osteoarthritis: a literature review[J]. Reumatol Clin, 2018, 14(1): 40-45.
[41]
Pergolizzi JV, Paladini A, Varrassi G, et al. Change pain: ever evolving-an update for 2016[J]. Pain Ther, 2016, 5(2): 127-133.
[42]
Manchikanti L, Kaye AM, Knezevic NN, et al. Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American society of interventional pain physicians (ASIPP) guidelines[J]. Pain Physician, 2017, 20(2S): S3-S92.
[43]
Attal N, Cruccu G, Baron R, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision[J]. Eur J Neurol, 2010, 17(9): 1113-e88.
[44]
Derry S, Wiffen PJ, Moore RA, et al. Topical lidocaine for neuropathic pain in adults[J/OL]. Cochrane Database Syst Rev, 2014, 2014(7): CD010958. DOI: 10.1002/14651858.CD010958.pub2.
[45]
Voute M, Morel V, Pickering G. Topical lidocaine for chronic pain treatment[J]. Drug Des Devel Ther, 2021, 15: 4091-4103.
[46]
Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis[J]. Lancet Neurol, 2015, 14(2): 162-173.
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