骨关节炎患者用药治疗现状的全国多中心大样本现场调查
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摘要
目的:目的:评估骨关节炎在我国患病及用药现况,并进行疾病评估。方法:采用流行病学现场调查的研究方法,对2017年4—10月全国40家医院1 066例骨关节炎患者的一般资料、患病情况、用药情况以及关节功能进行评估。数据采用SPSS 19. 0软件进行统计学处理,采用t检验、Mann-Whitney U检验、卡方检验对数据进行分析。结果:本组1 066例患者中,男、女比例为1∶3. 6,平均年龄(61. 9±11. 0)岁,年龄分布于36~94岁。膝骨关节炎、髋骨关节炎、手骨关节炎患病人数分别是873例(81. 9%)、150例(14. 1%)、387例(36. 3%),其中合并两个部位的患者242例(22. 7%),3个部位均受累关节炎患者为51例(4. 8%)。56. 6%(603/1 066)患者应用过1种及以上非甾体抗炎药,28. 9%(308/1 066)患者应用1种及以上止痛药物。61. 2%(652/1 066)应用1种及以上改善病情骨关节炎药,包括氨基葡萄糖(400/1 066,37. 5%)、硫酸软骨素(21/1 066,2. 0%)、双醋瑞因(63/1 066,5. 9%)或联合应用2种以上改善病情骨关节炎药(168/1 066,15. 8%)。92例(8. 6%)患者应用止痛药控制症状,未进一步使用抗炎及保护关节药物。232例(21. 8%)患者应用关节腔穿刺注射药物,应用玻璃酸钠或糖皮质激素分别为98例(9. 2%)和48例(4. 5%),而将二者联合应用达86例(8. 1%)。应用局部外用药物患者占26. 5%(283/1 066),理疗占15. 8%(168/1 066)。与膝关节受累患者相比,髋关节受累患者的病情明显更加严重,两组患者按照美国西部安大略和麦克马斯特大学(the Western Ontario and McMaster Universities,WOMAC)骨关节炎指数评分评估疼痛(Z=-7. 625,P <0. 001)、僵硬感(Z=-6. 229,P <0. 001)、关节功能(Z=-6. 777,P <0. 001),差异均有统计学意义,并且髋骨关节炎患者更多应用止痛药物(χ2=24. 838,P <0. 001)。结论:我国骨关节炎患者以口服非甾体抗炎药及改善病情骨关节炎药为主要治疗方式,但存在药物使用不规范情况;与膝骨关节炎相比,髋骨关节炎患者病情更为严重,需引起重视,并积极治疗。
Objective: To investigate the clinical characteristics,the medicine application and to evaluate the disease activity in patients with osteoarthritis( OA) in China. Methods: This was a cross-sectional study. Totally 1 066 cases of OA from 40 hospitals in China from April to October 2017 were retrospectively enrolled. Demographic characteristics,clinical data,medicine application,and joint function were evaluated. All the data were analyzed by SPSS software 19. 0. t test,Mann-Whitney U test and chi-square test were used for statistical analysis. Results: In the 1 066 cases,the male-to-female ratio was 1 ∶ 3. 6 and the average age was( 61. 9 ± 11. 0) years,with an age range from 36 to 94 years.The incidence of knee OA,hip OA,and hand OA were respectively 81. 9%( 873/1 066),14. 1%( 150/1 066),and 36. 3%( 387/1 066). In the study,242( 22. 7%) cases had two kinds of joint areas involved and three joint areas were involved in 51 cases( 4. 8%),and 56. 6%( 603/1 066) of the patients used more than one kind of non-steroid anti-inflammatory drugs( NSAIDs) while 61. 2%( 652/1 066) used disease modifying osteoarthritis drugs( DMOADs),including glucosamine( 37. 5%,400/1 066),chondroitin sulfate( 2. 0%,21/1 066),diacetate( 5. 9%,63/1 066),and the combination of these drugs( 15. 8%,168/1 066). 8. 6%( 92/1 066) patients only took analgesics to relieve the pain,not using any kind of NSAIDs or DMOADs. And 232 patients( 21. 7%) had intra-articular injections,including 9. 2%( 98/1 066) sodium hyaluronate,4. 5%( 48/1 066) glucocorticoid,and 8. 1%( 86/1 066) combination of the two drugs. The proportion of the patients taking topical drugs accounted for26. 5%( 283/1 066) and physical therapy accounted for 15. 8%( 168/1 066). Compared with those who suffered from knee OA,the patients who suffered from hip OA had more severe disease assessment.Moreover,there were significant differences in pain( Z =-7. 625,P < 0. 001),morning stiffness( Z =-6. 229,P < 0. 001),and joint function( Z =-6. 777,P < 0. 001) between the two groups of the patients who suffered from knee or hip OA with The Western Ontario and McMaster Universities( WOMAC)osteoarthritis index. Furthermore,patients with hip OA took more analgesics( χ~2= 24. 838,P < 0. 001).Conclusion: Oral NSAIDs and DMOADs are wildly used in patients with OA in China. However,the treatment of some patients still need to be improved. Patients with hip OA are more seriously ill and require aggressive treatment.
Objective: To investigate the clinical characteristics,the medicine application and to evaluate the disease activity in patients with osteoarthritis( OA) in China. Methods: This was a cross-sectional study. Totally 1 066 cases of OA from 40 hospitals in China from April to October 2017 were retrospectively enrolled. Demographic characteristics,clinical data,medicine application,and joint function were evaluated. All the data were analyzed by SPSS software 19. 0. t test,Mann-Whitney U test and chi-square test were used for statistical analysis. Results: In the 1 066 cases,the male-to-female ratio was 1 ∶ 3. 6 and the average age was( 61. 9 ± 11. 0) years,with an age range from 36 to 94 years.The incidence of knee OA,hip OA,and hand OA were respectively 81. 9%( 873/1 066),14. 1%( 150/1 066),and 36. 3%( 387/1 066). In the study,242( 22. 7%) cases had two kinds of joint areas involved and three joint areas were involved in 51 cases( 4. 8%),and 56. 6%( 603/1 066) of the patients used more than one kind of non-steroid anti-inflammatory drugs( NSAIDs) while 61. 2%( 652/1 066) used disease modifying osteoarthritis drugs( DMOADs),including glucosamine( 37. 5%,400/1 066),chondroitin sulfate( 2. 0%,21/1 066),diacetate( 5. 9%,63/1 066),and the combination of these drugs( 15. 8%,168/1 066). 8. 6%( 92/1 066) patients only took analgesics to relieve the pain,not using any kind of NSAIDs or DMOADs. And 232 patients( 21. 7%) had intra-articular injections,including 9. 2%( 98/1 066) sodium hyaluronate,4. 5%( 48/1 066) glucocorticoid,and 8. 1%( 86/1 066) combination of the two drugs. The proportion of the patients taking topical drugs accounted for26. 5%( 283/1 066) and physical therapy accounted for 15. 8%( 168/1 066). Compared with those who suffered from knee OA,the patients who suffered from hip OA had more severe disease assessment.Moreover,there were significant differences in pain( Z =-7. 625,P < 0. 001),morning stiffness( Z =-6. 229,P < 0. 001),and joint function( Z =-6. 777,P < 0. 001) between the two groups of the patients who suffered from knee or hip OA with The Western Ontario and McMaster Universities( WOMAC)osteoarthritis index. Furthermore,patients with hip OA took more analgesics( χ~2= 24. 838,P < 0. 001).Conclusion: Oral NSAIDs and DMOADs are wildly used in patients with OA in China. However,the treatment of some patients still need to be improved. Patients with hip OA are more seriously ill and require aggressive treatment.
引文
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[2]栗占国.骨性关节炎的发病机制[J].中华全科医师杂志,2003,2(6):339-340.
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[5] Pang J,Cao YL,Zheng YX,et al. Influence of pain severity on health-related quality of life in Chinese knee osteoarthritis patients[J]. Int J Clin Exp Med,2015,8(3):4472-4479.
[6] Hiligsmann M,Cooper C,Arden N,et al. Health economics in the field of osteoarthritis:an expert’s consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis(ESCEO)[J]. Semin Arthritis Rheum,2013,43(3):303-313.
[7] Centers for disease control and prevention. Projected state-specific increases in self-reported doctor-diagnosed arthritis and arthritisattributable activity limitations:United States,2005—2030[J].MMWR Morb Mortal Wkly Rep,2007,56(17):423-425.
[8] Hochberg MC,Altman RD,Brandt KD,et al. Guidelines for the medical management of osteoarthritis. PartⅡ. Osteoarthritis of the knee. American College of Rheumatology[J]. Arthritis Rheum,1995,38(11):1541-1546.
[9] Hochberg MC,Altman RD,Brandt KD,et al. Guidelines for the medical management of osteoarthritis. PartⅠ. Osteoarthritis of the hip. American College of Rheumatology[J]. Arthritis Rheum,1995,38(11):1535-1540.
[10] Altman R,Alarcon G,Appelrouth D,et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand[J]. Arthritis Rheum,1990,33(11):1601-1610.
[11] Allen KD,Bosworth HB,Chatterjee R,et al. Clinic variation in recruitment metrics,patient characteristics and treatment use in a randomized clinical trial of osteoarthritis management[J]. BMC Musculoskelet Disord,2014,15(1):413.
[12] Reginato AM,Riera H,Vera M,et al. Osteoarthritis in Latin America:study of demographic and clinical characteristics in3 040 Patients[J]. J Clin Rheumatol,2015,21(8):391-397.
[13] Sancheti P,Shetty VD,Dhillon MS,et al. India-based knee osteoarthritis evaluation(i Kare):a multi-centre cross-sectional study on the management of knee pain and early osteoarthritis in India[J]. Clin Orthop Surg,2017,9(3):286-294.
[14] Michl GL,Katz JN,Losina E. Risk and risk perception of knee osteoarthritis in the US:a population-based study[J]. Osteoarthritis Cartilage,2015,24(4):593-596.
[15]中华医学会风湿病学分会.骨关节炎诊断及治疗指南[J].中华风湿病学杂志,2010,14(6):416-419.
[16] Kingsbury SR,Hensor EM,Walsh CA,et al. How do people with knee osteoarthritis use osteoarthritis pain medications and does this change over time? Data from the osteoarthritis initiative[J]. Arthritis Res Ther,2013,15(5):R106.
[17] Wise BL,Felson DT,Clancy M,et al. Consistency of knee pain and risk of knee replacement:themulticenter osteoarthritis study[J]. J Rheumatol,2011,38(7):1390-1395.
[18] Cross M,Smith E,Hoy D,et al. The global burden of hip and knee osteoarthritis:estimates from the global burden of disease2010 study[J]. Ann Rheum Dis,2014,73(7):1323-1330.
[19] Prasanna SS,Kornerbitensky N,Ahmed S. Why do people delay accessing health care for knee osteoarthritis? Exploring beliefs of health professionals and lay people[J]. Physiother Can,2013,65(1):56-63.
[2]栗占国.骨性关节炎的发病机制[J].中华全科医师杂志,2003,2(6):339-340.
[3] Litwic A,Edwards M,Dennison E,et al. Epidemiology and burden of osteoarthritis[J]. Br Med Bull,2013,105(1):185-199.
[4] Dorner T,Stein K. Prevalence and status quo of osteoarthritis in Austria. Analysis of epidemiological and social determinants of health in a representative cross-sectional survey[J]. Wien Med Wochenschr,2013,163(9/10):206-211.
[5] Pang J,Cao YL,Zheng YX,et al. Influence of pain severity on health-related quality of life in Chinese knee osteoarthritis patients[J]. Int J Clin Exp Med,2015,8(3):4472-4479.
[6] Hiligsmann M,Cooper C,Arden N,et al. Health economics in the field of osteoarthritis:an expert’s consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis(ESCEO)[J]. Semin Arthritis Rheum,2013,43(3):303-313.
[7] Centers for disease control and prevention. Projected state-specific increases in self-reported doctor-diagnosed arthritis and arthritisattributable activity limitations:United States,2005—2030[J].MMWR Morb Mortal Wkly Rep,2007,56(17):423-425.
[8] Hochberg MC,Altman RD,Brandt KD,et al. Guidelines for the medical management of osteoarthritis. PartⅡ. Osteoarthritis of the knee. American College of Rheumatology[J]. Arthritis Rheum,1995,38(11):1541-1546.
[9] Hochberg MC,Altman RD,Brandt KD,et al. Guidelines for the medical management of osteoarthritis. PartⅠ. Osteoarthritis of the hip. American College of Rheumatology[J]. Arthritis Rheum,1995,38(11):1535-1540.
[10] Altman R,Alarcon G,Appelrouth D,et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand[J]. Arthritis Rheum,1990,33(11):1601-1610.
[11] Allen KD,Bosworth HB,Chatterjee R,et al. Clinic variation in recruitment metrics,patient characteristics and treatment use in a randomized clinical trial of osteoarthritis management[J]. BMC Musculoskelet Disord,2014,15(1):413.
[12] Reginato AM,Riera H,Vera M,et al. Osteoarthritis in Latin America:study of demographic and clinical characteristics in3 040 Patients[J]. J Clin Rheumatol,2015,21(8):391-397.
[13] Sancheti P,Shetty VD,Dhillon MS,et al. India-based knee osteoarthritis evaluation(i Kare):a multi-centre cross-sectional study on the management of knee pain and early osteoarthritis in India[J]. Clin Orthop Surg,2017,9(3):286-294.
[14] Michl GL,Katz JN,Losina E. Risk and risk perception of knee osteoarthritis in the US:a population-based study[J]. Osteoarthritis Cartilage,2015,24(4):593-596.
[15]中华医学会风湿病学分会.骨关节炎诊断及治疗指南[J].中华风湿病学杂志,2010,14(6):416-419.
[16] Kingsbury SR,Hensor EM,Walsh CA,et al. How do people with knee osteoarthritis use osteoarthritis pain medications and does this change over time? Data from the osteoarthritis initiative[J]. Arthritis Res Ther,2013,15(5):R106.
[17] Wise BL,Felson DT,Clancy M,et al. Consistency of knee pain and risk of knee replacement:themulticenter osteoarthritis study[J]. J Rheumatol,2011,38(7):1390-1395.
[18] Cross M,Smith E,Hoy D,et al. The global burden of hip and knee osteoarthritis:estimates from the global burden of disease2010 study[J]. Ann Rheum Dis,2014,73(7):1323-1330.
[19] Prasanna SS,Kornerbitensky N,Ahmed S. Why do people delay accessing health care for knee osteoarthritis? Exploring beliefs of health professionals and lay people[J]. Physiother Can,2013,65(1):56-63.