Intervencionismo na Gonartrose: Corticoesteróides versus Hialuronatos versus Plasma Rico em Plaquetas: Uma Revisão Narrativa

Diogo Ribeiro Martins, Susana Rosa, Jorge Dias, Afonso Pegado, Miguel Reis e Silva

Resumo


Introdução: A osteoartrose é uma patologia comum e incapacitante, associada a importante perda da qualidade de vida e gastos em saúde. Cursa habitualmente com dor, rigidez, redução das amplitudes articulares e perda da capacidade funcional. O tratamento é multimodal, envolvendo medicação oral/tópica, educação para a saúde, fisioterapia; em casos refractários ao tratamento conservador e com dor moderada a grave o tratamento intervencionista é uma opção válida. A injecção intrarticular é utilizada desde há décadas, sendo habitualmente três os fármacos/produtos injectados: corticoesteróides, hialuronatos e plasma rico em plaquetas. O objectivo deste artigo é encontrar e sumarizar a evidência científica actual sobre o tratamento intervencionista da gonartrose, relativamente aos três fármacos/produtos supramencionados.

Métodos: Revisão narrativa da literatura publicada nas bases de dados Medscape, Cochrane Library e PubMed.

Resultados: Existe evidência de resultados positivos com as três opções em análise; o perfil de segurança é favorável. Os corticoesteróides são uma opção segura e eficaz, sobretudo em fase inflamatória/flare, permitindo um alívio da dor de curto prazo. Os hialuronatos demonstram eficácia, com possível benefício até às 24 semanas, com potencial perfil desfavorável de custo-efectividade. O plasma rico em plaquetas, mais recente, apresenta um perfil promissor de eficácia sobre a dor e qualidade de vida, com potencial benefício até os 12 meses.

Discussão: O tratamento intervencionista da gonartrose é amplamente difundido e utilizado, no entanto, à data, não existem ainda guidelines formais que permitam guiar o clínico. Por outro lado, o conceito de osteoartrose merece, provavelmente, uma revisão, uma vez que se trata de uma patologia extremamente heterogénea e de difícil definição. A semiologia e exame objectivo detalhados são de particular importância, uma vez que o foco deverá ser a identificação da origem dos estímulos álgicos, com vista a um correcto raciocínio para selecionar a abordagem que garanta um bom controlo sintomático. A maioria dos estudos analisados apresentam uma qualidade metodológica subóptima, o que compromete a análise dos resultados e eventuais ilações.

Conclusão: A gonartrose é um problema de saúde mundial, que tenderá a aumentar de acordo com a evolução da pirâmide demográfica. A injecção intrarticular é uma opção válida e segura, que deverá ser ponderada de acordo com um exame clínico detalhado, e, consoante o objectivo, estadiamento e prognóstico funcional, deverá ser selecionada a opção mais válida. É necessária mais investigação, estudos com maior rigor metodológico e tempos de follow-up mais alargados para retirar conclusões mais robustas.


Palavras-chave


ácido Hialurónico/uso terapêutico; Corticoesteróides/uso terapêutico; Injeções Intra-Articulares; Osteoartrite do Joelho/tratamento; Plasma Rico em Plaquetas/uso terapêutico; Viscossuplementos

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DOI: http://dx.doi.org/10.25759/spmfr.349

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