| Summary: | 碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 97 === osteoarthritis arthritis is the highest prevalence of arthritis and in human disease and disability of the most common reasons. osteoarthritis arthritis in the United States is second only to ischemic heart disease caused more than 50-year-old male of the reasons for work disability. Intra-articular injection of hyaluronic acid preparations in the treatment of osteoarthritis knee, which a new or controversial treatments. Medical care providers often raise the appropriateness of treatment, effectiveness, and safety be assessed. Similarly, clinicians must also consider the above issues, can provide patients with an appropriate, effective, and safe treatment.
Purposes: 1), to explore intra-articular hyaluronic acid preparation on the treatment of knee osteoarthritis efficacy (effect size) and safety. 2), with the traditional anti-inflammatory drugs oral analgesics compared with intra-articular hyaluronic acid efficacy and safety is better. 3), intra-articular hyaluronic acid preparation in the efficacy, safety, cost of the three issues under consideration, whether the inclusion of the traditional treatment of knee osteoarthritis of the standard treatment guidelines. 4), based on the results of the above-mentioned purposes, the treatment of the existing benefit rules, make appropriate recommendations.
Methods: through the computer network abroad literature search sites, according to Boolean logic, keywords Hyaluronic acid, Naproxen, Osteoarthritis knee and RCT were divided into two groups, separated from the search: the first group is: Hyaluronic acid AND Osteoarthritis knee AND RCT. The second group is: Naproxen AND Osteoarthritis knee AND RCT. Literature inclusion criteria: 1), the research done for human beings, and those published in English. 2), taken randomly assigned, double-blind design. 3), compared with placebo, and those before and after the test. 4), there is sufficient information on the effectiveness of value can be calculated. VAS and WOMAC osteoarthritis index choose from the results of the treatment group, respectively, with the number of the control group-Treatment N Variables & Control N Variables, average-Treatment Mean Variables & Control Mean Variables, and standard deviation -Treatment SD Variables & Control SD Variables and other variables, enter the NCSS software for statistical analysis, the results of the meta-analysis including the average of Meta-Analysis of Means, the value of Treatment Effects, the Effect-Equality (Heterogeneity) Test and the Forest Plot display.
Results: 1), the inclusion samples: HA Group 11, N group 6, a total of 17. On the other hand must make it clear: HA Group 9, N group 7, is the result of a trend showing a lack of sufficient data into the analysis, were excluded, non-quality factors from the literature. 2), HA Group (3-months ): the average value of the effect size is -14.0393, ranging from -14.4776 to -13.6011, indicating the prominent effect of hyaluronic acid on the treatment of knee osteoarthritis , and there is clear consistency of efficacy results. 3), HA Group (6-months ): the average value of the effect size is -1.8856, ranging from -2.9893 to -0.7819 ,showed minimal treatment effect in six months interval. With an average of three months to track the effectiveness of the value of -14.0393 comparison, the six-month follow-up of efficacy, significantly reduced much, it’s mean that treatment effect of hyaluronic acid on osteoarthritis knee, may not be able to maintain as long as six months. 4), N group for the treatment of osteoarthritis knee at two weeks: the average value of effect size is -4.1732, ranging from -4.6399 to -3.7065 , show non-steroidal anti-inflammatory drugs for osteoarthritis knee treatment, follow-up two weeks in effect from time to time, and the consistency of efficacy results. 5), N group for the treatment of osteoarthritis knee at 12 weeks: the average value of effect size is -4.3998, ranging from -4.8883 to -3.9113 , show non-steroidal anti-inflammatory drugs for the treatment of osteoarthritis knee in 12 weeks follow-up effect from time to time, and the consistency of efficacy results. compared with 2 weeks follow-up of efficacy , 12 weeks follow-up of efficacy is a little high. 6), security: In the HA group showed very few side effects, only a small number of local injection site pain, most do not have treatment and without sequelae. As regards the N group, mostly gastrointestinal side effects of the problem, the ratio of the incidence of side effects accounted for 20-45% between, and this is the main reason to withdraw from the study.
Conclusions and recommendations: 1), National Health Insurance Bureau set criteria of intra-articular hyaluronic acid preparations to treatment of knee osteoarthritis in the use of indications, in both patient safety and quality of medical care under the premise of intra-articular hyaluronic acid to enhance the preparation knee osteoarthritis treatment efficient, should the Government consider setting out a clear hierarchy of disease. 2), intra-articular hyaluronic acid preparations in treatment of knee osteoarthritis efficacy, although in individual studies of the phenomenon have been overestimated. However, the efficacy and safety considerations, in some patients with long-term use of selective than the traditional non-steroidal anti-inflammatory drugs have an advantage, if the cost of further incentives should be more competitive. 3),the use of hyaluronic acid on articular injection of treatment agents, only two courses each year, and the interval to six months, the general effect of the results of six months to continue to effect the outcome of the more volatile, with the present use, it seems to be gathering more appropriate clinical evidence adjustment can only be sustained if agents treatment of hyaluronic acid injections knee joint osteoarthritis of appropriate efficacy. 4), physicians in the treatment of patients with knee osteoarthritis, it is recommended to the United States Institute of ACR treatment guidelines based on different patients according to different conditions (indications), the appropriate choice of appropriate treatment. 5), physicians look at the results of meta-analysis, it is necessary to hyaluronic acid how agents can be used in patients, may be based on benefits higher than the risk and cost of the proportion, but also to decide how to use and when joint injections with hyaluronic acid preparations, the overall knee osteoarthritis as a medical treatment alternatives.
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