- 期刊
以Celecoxib 治療血友病膝關節病變合併滑囊炎
Effect of Celecoxib on Hemophilic Arthropathyof Knee Joint with Synovitis
摘要
目的：血友病關節反覆出血會造成滑囊炎（synovitis）進而產生軟骨破壞及關節病變，目前對於非類固醇消炎止痛藥治療血友病關節病變的研究並不多，本篇以前瞻性研究評估celecoxib治療血友病膝關節病變合併滑囊炎的成效及安全性。研究方法：於2009年8月至2010年4月間，在血友病中心招募血友病膝關節病變患者進行研究。收集其血友病類型與嚴重度、膝關節病變指數等相關基本資料。受試者接受每日早晚口服celecoxib 200mg治療為期30天，治療前評估膝關節活動度、疼痛指數、出血頻率、SF-36生活品質量表、肝腎功能檢查。並以骨骼肌肉超音波檢查量測膝關節滑囊膜厚度及功率杜卜勒超音波評估血流量。治療後追蹤病人相關參數以評估其生活品質，並監測有無藥物不良反應。結果：共收案15位血友病膝關節病變病人，全部為男性，14位為血友病A型重度，1位為B型重度。經過celecoxib連續30天的治療後，在疼痛指數（p＜0.001）、出血頻率（p=0.01）、SF-36生活品質量表分數（p=0.027）的改善達到統計學上顯著差異（p＜ 0.05），而滑囊膜厚度、血流、關節活動度的變化則未達顯著差異。治療過程中除了一位病患肝指數上升外，沒有發生腸胃道出血或增加其他部位出血等副作用。結論：短期使用celecoxib治療血友病膝關節病變合併滑囊炎，對於疼痛緩解及生活品質的提升有明顯的效果，不會增加關節出血頻率，也沒有其他嚴重副作用發生，可作為臨床治療血友病膝關節病變的選擇之一。
並列摘要
Introduction: Recurrent hemoarthrosis leads to synovitis, bone erosion, and subsequent hemoarthropathy in hemophilia. Few clinical trials have focused on the efficacy and adverse effects of nonsteroidal antiinflammatory drugs (NSAIDs), specifically cyclooxygenase-2-selective NSAIDs, in treating hemoarthropathy in patients with hemophilia. This study investigated the effect and safety of celecoxib in treating hemophilic arthropathy with synovitis. Materials and method: A total of 15 patients with hemophilic arthropathy were prescribed 200 mg of celecoxib twice per day for 30 days. Out come measurements regarding before and after treatment, joint range of motion, pain score (visual analogue scale), bleeding frequency, synovial thickness measured using ultrasonography, synovial vascularity measured using power Doppler ultrasonography, and 36-item short-form health survey (SF-36), were recorded to evaluate the efficacy and adverse effect of celecoxib. Result: After treatment with celecoxib for 30 days, the pain score (p＜ 0.001), bleeding frequency (p = 0.01), and SF-36 score (p=0.027) were statistically significant; however, synovial thickness, vascularity, and joint range of motion were not. Impaired liver function was only observed in one patient, and no significant adverse effects, such as gastrointestinal tract bleeding or other hemorrhage, occurred. Conclusion: Short-term use of celecoxib in treating hemophilic arthropathy with synovitis enables pain reduction and an improved quality of life. In addition, no significant increase in the risk of hemoarthrosis or other adverse effects was observed. Celecoxib is suggested for use before considering chemoablation or arthroscopic synovectomy.