CHUYÊN ĐỀ THUỐC�PIASCLEDINE
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Khoa Dược
DS. ThS Nguyễn Kim Ngân, DS Phạm Hoàng Ngân
BỆNH VIỆN Y HỌC CỔ TRUYỀN TPHCM�“THÂN THIỆN – TẬN TÂM – HIỆU QUẢ”
NỘI DUNG
Khuyến cáo sử dụng thuốc
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Một số lưu ý trong điều trị thoái hoá khớp gối
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Một số lưu ý trong điều trị thoái hoá khớp háng
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CHUYÊN ĐỀ THUỐC
BHYT xuất toán trực tiếp trên cổng đối với các HSBA thiếu mã ICD
(Thoái hóa khớp hông – M16; Thoái hóa khớp gối - M17)
Đây là chuyên đề cũ, đã nhắc nhở nhiều lần
PIASCLEDINE
Hướng dẫn sử dụng và lưu ý trong chỉ định thuốc �PIASCLEDINE
Thành phần | Hàm lượng | Liều dùng – cách dùng | Chỉ định | Chống chỉ định |
Cao toàn phần không xà phòng hóa quả bơ và dầu đậu nành | 300mg | - Viên nang 300mg, 1 viên x 1 lần/ngày, uống cùng bữa ăn. - Tránh nhai viên thuốc mà uống nhiều với nước. - Thời gian dùng trung bình từ 3 đến 6 tháng. | - Cơ xương khớp: Điều trị triệu chứng các biểu hiện bệnh lý của thoái hóa khớp hông và khớp gối. - Răng miệng: điều trị hỗ trợ viêm nha chu. | Mẫn cảm với hoạt chất hay bất kì thành phần tá dược nào của thuốc. |
Tài liệu tham khảo:
1. Tờ HDSD thuốc.
2. Hoang Minh Phan, et al. The Efficacy of Piascledine in Alleviating Symptoms and Its Impact on Blood Lipid Levels and body Mass Index in Patients with Knee Osteoarthritis. Med Arch 2024;78(4):296–301. doi: 10.5455/medarh.2024.78.296-301 .
3. PIASCLEDINE 300 mg capsules. HAS. 2008.
4. Piotr Głuszko, et al Symptom-modifying effects of oral avocado/soybean unsaponifiables in routine treatment of knee osteoarthritis in Poland. An open, prospective observational study of patients adherent to a 6-month treatment. Reumatologia 2016;54(5):217-226. DOI: https://doi.org/10.5114/reum.2016.63661
5. Karel Pavelka, et al. Efficacy and safety of piascledine 300 versus chondroitin sulfate in a 6 months treatment plus 2 months observation in patients with osteoarthritis of the knee. Clinical Rheumatology. Volume 29, pages 659–670, (2010). doi: 10.1007/s10067-010-1384-8. Epub 2010 Feb 24.
6. Emmanuel Maheu, et al. Randomised, controlled trial of avocado-soybean unsaponifiable (Piascledine) effect on structure modification in hip osteoarthritis: the ERADIAS study. Annals of the Rheumatic Diseases. 2014 Feb;73(2):376-84. doi: 10.1136/annrheumdis-2012-202485. Epub 2013 Jan 23.
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Management of knee osteoarthritis
APPROACH BASED ON CLINICAL PRESENTATION
Mild knee osteoarthritis — Lifestyle modifications focused on education, exercise, and weight management, whether alone or in combination with topical therapies or analgesics as needed, are likely to provide adequate control of symptoms in this group of patients (algorithm 1).
Moderate/severe knee osteoarthritis — Lifestyle modifications are the first-line therapy for this group of patients. Patients with severe pain generally tolerate aquatic exercises better than land-based exercises (algorithm 2). Special consideration should be given to other factors that may contribute to pain, such as mood disturbances, pain catastrophizing, sleep problems, and chronic widespread pain. Other treatment alternatives may be required, including oral nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular glucocorticoids, duloxetine, and surgery.
https://www-uptodate-com/contents/management-of-knee-osteoarthritis
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Mild knee osteoarthritis
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Moderate/severe knee osteoarthritis
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* For patients already on oral NSAIDs, topical therapies are generally not recommended because they are unlikely to provide additional pain relief. Gel measurements from tubes are approximate.
¶ Pain relief usually begins within the first week of treatment, and full effect is seen with regular application over approximately 4 weeks. Topical capsaicin should not come in contact with mucous membranes, abraded skin, eyes, or genital areas.
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THERAPIES LACKING EFFICACY OR OF UNCERTAIN BENEFIT
Oral therapies
●Acetaminophen – Due to safety concerns pertaining to acetaminophen (paracetamol) use and an increased awareness of its negligible and non-clinically significant effects on pain, we do not initiate treatment with acetaminophen for knee OA in our clinical practice.
●Opioids – We avoid using opioids whenever possible, given poor or modest efficacy and the potential for harm, especially in the older adult population. In our clinical practice, we use opioids very rarely, only in the short-term, for patients with severe pain awaiting joint replacement who are not highly vulnerable to drug dependence or misuse. We use it in the lowest dose and duration necessary to control symptoms and monitor common side effects and dependence.
● Glucosamine and chondroitin – In our clinical practice, we recommend against glucosamine and/or chondroitin; however, we do not discourage their use for patients who are keen to take them, especially if symptomatic benefit is achieved with their use.
https://www-uptodate-com/contents/management-of-knee-osteoarthritis
KHÔNG DÙNG THUỐC DÙNG THUỐC
PHẪU THUẬT
(SYSADOA Symptomatic Slow Acting Drugs for OA)
THOÁI HOÁ KHỚP GỐI
KHUYẾN CÁO ESCEO, 2019��
O. BRUYERE ET AL. / SEMINARS IN ARTHRITIS AND RHEUMATISM 00 (2019) 114
ESCEO: HIỆP HỘI CHÂU ÂU CHUYÊN NGHIÊN CỨU VỀ LOÃNG XƯƠNG VÀ THK VÀ CÁC KHÍA CẠNH LS VÀ KINH TẾ
Results The revised recommendations include two overarching principles and eight evidence-based recommendations including
The mean level of agreement on the recommendations ranged between 9.2 and 9.8 (0–10 scale, 10=total agreement). The research agenda highlighted areas related to these interventions including adherence, uptake and impact on work
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Management of hip osteoarthritis
https://www-uptodate-com/contents/management-of-hip-osteoarthritis
MANAGEMENT
Initial approach — Nonpharmacologic measures, including education and support for self-management, exercise, and weight control, should be part of the initial approach for all patients with symptomatic hip OA regardless of the severity of symptoms.
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Pharmacologic management
•NSAIDS as first-line pharmacotherapy – For patients with hip OA who have had insufficient relief with nonpharmacologic measures, we suggest oral nonsteroidal anti-inflammatory drugs (NSAIDs) rather than acetaminophen, preferably on an as-needed basis (Grade 2B). The choice of NSAID is based on a variety of factors including adverse effect profile, patient comorbidities, cost to patient, and patient preference regarding frequency of administration.
•Limited role of intra-articular glucocorticoids – We suggest against the routine use of intra-articular glucocorticoid injections for patients with hip OA (Grade 2C). We limit the use of injections to patients with moderate to severe hip pain when short-term pain relief is desired and there are contraindications to, or failure of, other treatment alternatives. Image guidance (eg, with ultrasound or, less commonly, fluoroscopy) is usually required for intra-articular hip injections due to technical difficulties owing to the joint's depth and proximity to the femoral vessels.
•Surgical referral for refractory symptoms – We refer patients for surgical evaluation when they have not improved after a trial of nonpharmacologic and pharmacologic options, have advanced structural OA, and have substantial symptoms impacting their quality of life. •Therapies lacking efficacy or of uncertain benefit – There are several approaches that have been used to treat patients with hip OA that we do not routinely recommend due to the lack of data demonstrating efficacy. Examples of such therapies include duloxetin, glucosamin and chondroitin, acetaminophen, hyaluronans, acupuncture, platelet-rich plasma (PRP) injections, and opioids
https://www-uptodate-com/contents/management-of-hip-osteoarthritis
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Overview of the management of osteoarthritis
Nonpharmacologic therapy
Nonpharmacologic therapies include weight management and exercises, braces and foot orthoses for patients suitable to these interventions, education, and use of assistive devices when required .
●Exercises have effects of similar magnitude on pain and function compared with NSAIDs .
A combination of aerobic and strengthening exercises is usually indicated to address the whole spectrum of disability associated with OA, but optimal prescription should be individualized
●Loss of at least 10 percent of body weight through a combination of diet and exercises has been associated with a 50 percent reduction in pain scores in patients who are overweight or have obesity with knee OA after 18 months.
●Walking aids and knee braces for patients with malalignment may improve pain and should be considered adjunctive treatments.
Kết luận
+ Thoái hóa khớp hông – M16;
+ Thoái hóa khớp gối - M17.