外用非甾体类消炎药治疗骨关节炎疗效的Meta分析

Efficacy of Topical NSAIDs in the Treatment of Osteoarthritis:A Meta-analysis of Randomized Controlled Trials

目的评价外用非甾体类消炎药治疗骨关节炎的疗效。方法计算机检索MEDLINE,EM-BASE,SCI,CINAHL,Cochrane图书馆和中国生物医学文献数据库等。手工检索已发表和未发表的所有外用非甾体类消炎药随机对照试验,对其逐个进行质量评价,并合并数据进行Meta分析。检索时间截至2005年3月30日。结果共纳入13篇随机对照试验,包括1983例患者,均为高质量研究。对治疗有效率的Meta分析结果显示,外用非甾体类消炎药治疗骨关节炎引起的疼痛仅在第1、2周疗效优于安慰剂,疼痛减轻的效应量分别是0·41[95%CI(0·16,0·660)]和0·40[95%CI(0·15,0·65)],而第3、4周疗效与安慰剂比较差异无统计学意义。结论现仅有短期(<4周)的随机对照试验评价外用非甾体类消炎药治疗骨关节炎的疗效。外用非甾体类消炎药用于治疗骨关节炎的疗效仅在第1、2周优于安慰剂,2周后其疗效与安慰剂的差异无统计学意义。目前还没有足够的临床试验证明,使用非甾体类消炎药治疗骨关节炎超过2周仍然有效。

Objective To assess the efficacy of topical non-steroidal anti-inflammatory drugs （NSAIDs） in the treatment of osteoarthritis （OA）. Methods MEDLINE, EMBASE, Scientific Citation Index, CINAHL, The Cochrane Library, CBMdisc and abstracts from conference were searched from 1966 to March 30, 2005. Randomized controlled trials （R.CT） comparing topical non-steroidal anti-inflammatory drug （NSAIDs） with placebo or oral NSAIDs in OA were induded. Effect size （ES） was calculated for pain, function and stiffness. Relative risk （RR） was calculated for dichotomous data such as clinical response rate and adverse effect rate. Number needed to treat to obtain the clinical response was estimated. The quality of trials was assessed and sensitivity analyses were undertaken. Results Topical NSAIDs were superior to placebo in relieving pain due to osteoarthritis only in the first 2 weeks of treatment; ES （95% CI） were 0.41 （0. 16 to 0.66） and 0.40 （0.15 to 0.65） at week 1 and 2 respectively. However, the effects were short-lived and no benefit was observed over placebo at the third and fourth week. A similar pattern was observed with function, stiflhess and clinical response RR and number needed to treat. Topical NSAIDs were inferior to oral NSAIDs at week 1, and associated with more local side effects such as rash, itch or burning （ RR 5.29, 95% CI 1.14 to 24. 51 ）. Conclusions Only very shortterm （ less than 4 weeks） RCTs have assessed topical NSAID efficacy in OA ; after 2 weeks no efficacy above placebo has been obsevrved. There are no trial data to support the long-term use of topical NSAIDs in osteoarthritis.