臨床整形外科52巻8号

2017年08月発行

連載 慢性疼痛の治療戦略　治療法確立を目指して・12

—ガイドラインを考慮した治療—変形性膝関節症

著者： 廣瀬隼¹ 水田博志¹

所属機関： ¹熊本大学医学部附属病院整形外科

ページ範囲：P.794 - P.799

はじめに

　変形性関節症(osteoarthritis：OA)は整形外科領域で最も頻度の高い疾患であり，なかでも膝関節におけるわが国の有病率は2,530万人¹⁾と推定されている．膝OAはロコモティブシンドロームの代表疾患の1つであり，進行すれば歩行などの日常生活動作に支障を来す．OAの病態は関節軟骨の摩耗変性を主体とし，それに続発する軟骨と骨の破壊および増殖性変化を来す，関節軟骨と関節構成体の退行変性を基盤とした慢性疾患である．現時点で根治療法はなく，進行予防や症状改善のために，患者教育，運動，減量，および薬物療法が主に行われ，病状が進行したものに対しては外科的療法が実施される．各種治療について，近年はエビデンスに基づき作成された膝OAの診療ガイドラインが複数の国際的な学会や機構から公表されている(表1)．本稿ではそれらのガイドラインを踏まえた薬物療法について概説する．

参考文献

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7) Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part ii:OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008;16:137-62.

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12) Goldberg VM, Buckwalter JA. Hyaluronans in the treatment of osteoarthritis of the knee:Evidence for disease-modifying activity. Osteoarthritis Cartilage 2005;13:216-24.

13) Bannuru RR, Natov NS, Obadan IE, et al. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis:A systematic review and meta-analysis. Arthritis Rheum 2009;61:1704-11.

14) Ghosh P, Guidolin D. Potential mechanism of action of intra-articular hyaluronan therapy in osteoarthritis:Are the effects molecular weight dependent? Semin Arthritis Rheum 2002;32:10-37.

15) 川口　浩．高齢者膝関節痛への多面的リハアプローチ．変形性関節症の治療ガイドライン．J Clinical Rehabilitation 2011；20：19-27．

16) Reginster JY, Deroisy R, Rovati LC, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression:A randomised, placebo-controlled clinical trial. Lancet 2001;357:251-6.

17) Cutolo M, Berenbaum F, Hochberg M, et al. Commentary on recent therapeutic guidelines for osteoarthritis. Semin Arthritis Rheum 2015;44:611-7.

18) Altman RD. Glucosamine therapy for knee osteoarthritis:Pharmacokinetic considerations. Expert Rev Clin Pharmacol 2009;2:359-71.