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家庭医による家庭医のためのプライマリケア上達術 » 変形性膝関節症OAでＮＳＡＩＤはできるだけ止めましょう

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変形性膝関節症OAでＮＳＡＩＤはできるだけ止めましょう

研修医の指導に携わっていて最近、気づいたことが少しばかり・・・・．
高齢者のOAの痛み止めの治療は最初カロナールで良いかと思います．
最大容量1500mg，米国では３ｇまでいけます.
それでも不良の場合，NSAIDを追加していきます.NSAIDとカロナールは痛みのメカニズムが違うため同時に併用が可能です.
特に，NSAIDは消化管出血のみならず，高血圧，腎機能障害を引き起こすことも言われています．
最近，AHAでも不安定狭心症とMI既往の患者にアスピリン以外原則NSAID使用禁止の勧告を出し始めました.

Antman EM, Hand M, Armstrong PW, et al. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction. J Am Coll Cardiol 2008;51:210-247.
Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction. J Am Coll Cardiol 2007;50:e1-e157.

COX2は心疾患リスクを挙げるということは前から言われており，これについては大方コンセンサスが得られていると思います.

現時点ではカロナールの方がNSAIDよりも安全性は確立されています．

update: 2008/07/18 | 家庭医プライマリケアアップデート
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