| Part Ⅰ Meta-analysis:Comparison of cyclooxygenase-2inhibitors alone with nonselective non-steroidal anti-inflammatory drugs plus proton pump inhibitors in regard to safety in osteoarthritisObjectives To compare cyclooxygenase-2(COX-2) inhibitors alone with nonselective nonsteroidal anti-inflammatory drugs(NSAIDs) plus proton pump inhibitors(PPIs) in preventing gastrointestinal adverse events:upper gastrointestinal(UGI) adverse events, gastrointestinal symptoms and cardiovascular adverse events in osteoarthritis.Methods PubMed, the Cochrane library, EMBASE, Web of science, Chinese Biomedical Literature Database, National Knowledge Infrastructure, Wanfang Database, Clinical Trials Registry Platform, and reference lists of relevant papers for articles published were searched. The related data matching standards set for this study were extracted. The methodological qualities of included studies were evaluated from the random method, allocation concealment, blinding, the results data integrity, selective bias in reporting results and other factors. The heterogeneity was tested and effect size was combined. Statistical analyses were carried out using RevMan(5.0) software. Recommended grade of measuring indicators were carried out using GRADEpro. Results The meta-analysis of six randomized controlled trials with a total of6219patients revealed that there was no difference in the UGI adverse events between COX-2inhibitors and nonselective NSAIDs with concurrent use of PPIs(OR0.61,95%confidence interval(CI)0.34-1.09). There was no significant difference in gastrointestinal symptoms(OR1.10,95%CI:0.88-1.39) and the cardiovascular adverse events(OR1.67,95%CI:0.78-3.59) between the two groups. The evaluations of GRADE system were moderate due to inconsistency.Conclusions COX-2inhibitors are no better than nonselective NSAIDs with PPIs in regard to UGI adverse events, gastrointestinal symptoms and cardiovascular adverse events in osteoarthritis arthritis. On the basis of the current evidence and the combined wishes of the patient, clinicians should carefully consider and weigh both gastrointestinal and cardiovascular risk before selecting NSAID plus PPIs or COX-2inhibitors. Part Ⅱ Clinical study of non-steroidal anti-inflammatory drugs combined glucosamine in patients with knee osteoarthritisObjectives The aims of this study were to assess the efficacy, safety and economy of non-selective non-steroidal anti-inflammatory drugs(NSAIDs) plus proton pump inhibitors(PPIs) and cyclooxygenase-2(COX-2) inhibitors, and those medications in combination with glucosamine respectively in patients with knee osteoarthritis.Methods A total of140patients with knee osteoarthritis were randomized to receive NSAIDs plus PPIs(gourp A), COX-2inhibitors(group B), NSAIDs plus PPIs in combination with glucosamine(group B) or COX-2inhibitors plus glucosamine(group D). Efficacy was assessed with the Japanese orthopaedic association(JOA) knee index and knee lysholm score at prior to treatment and at2,6,12and24weeks post-treatment. Medication-related complications and cost-effectiveness were also observed. Statistical analyses were carried out using SPSS19.0.Results Significant differences in JOA knee index and knee lysholm score were detected between the A, B groups and the C, D groups at6,12and24weeks post-treatment (P<0.05) but not at weeks2post-treatment (P>0.05). Significant differences in these indices were not detected at2,4,6,12,24weeks between group A and group B, group C and group D. Significant differences in JOA knee index were detected at different time-points in group A and group B(P<0.05). Significant differences in JOA knee index were also detected at different time-points in group C and group D(P<0.05), except between weeks12and24(P>0.05). Significant differences in lysholm score were detected at different time-points in each group(P<0.05). Significant differences in complications were not detected between four groups(P<0.05). Cost-effectiveness analysis showed group C was the best among four groups.Conclusions NSAIDs in combination with glucosamine is superior to NSAIDs alone in treatment of knee osteoarthritis although without clear long-term effect. NSAIDs alone are no better than NSAIDs plus glucosamine in regard to medication-related complications. The best cost-effectiveness is non-selective NSAIDs in combination with PPIs and glucosamine. Part III Clinical study of arthroscopic debridement surgery in combination with oral medication in patients with knee osteoarthritisObjectives The aims of this study were to assess the efficacy and safety of arthroscopic debridement in combination with oral medication for the treatment of knee osteoarthritis, and to provide evidence for selection of surgical approach with oral medication.Methods A total of60patients with knee osteoarthritis were randomized to receive either arthroscopic extensive cleanup in combination with oral medication group or focus cleanup in combination with oral medication group. Efficacy was assessed with the angle of knee fextion, lysholm score. Surgery-and medication-related complications were observed. Statistical analyses were carried out using SPSS19.0.Results Significant differences in flexion and lysholm scores of the knee-joint were detected between the two groups at2,6,12and24weeks post-treatment(P<0.05) but not at weeks2post-treatment(P>0.05). Significant differences in these indices were detected at different time-points in each group(P<0.05), except between weeks24and48(P>0.05). Significant differences in surgery-related complications were detected between two groups(P<0.05). Significant differences in medication-related complications were not detected between two groups(P>0.05).Conclusions Arthroscopic focus cleanup surgery, with fewer surgical complications, in combination with oral medication is superior to arthroscopic extensive cleanup surgery in combination with oral medication in the flexion and lysholm score... |
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