Intervencionismo na Gonartrose: Corticoesteróides versus Hialuronatos versus Plasma Rico em Plaquetas: Uma Revisão Narrativa
DOI :
https://doi.org/10.25759/spmfr.349Mots-clés :
ácido Hialurónico/uso terapêutico, Corticoesteróides/uso terapêutico, Injeções Intra-Articulares, Osteoartrite do Joelho/tratamento, Plasma Rico em Plaquetas/uso terapêutico, ViscossuplementosRésumé
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.
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Références
Leyland KM, Hart DJ, Javaid MK, et al. The natural history of radiographic knee osteoarthritis: A fourteen-year population-based cohort study. Arthritis Rheum 2012;64:
-2251.
Osteoarthritis Fact Sheet. Centers for Disease Control and Prevention. January 10, 2019.
Kotlarz H, Gunnarsson CL, Fang H, Rizzo JA. Insurer and out-of-pocket costs of osteoarthritis in the US: evidence from national survey data. Arthritis Rheum. 2009 Dec. 60 (12):3546-53.
Nüesch E, Dieppe P, Reichenbach S, Williams S, Iff S, Jüni P. All cause and disease specific mortality in patients with knee or hip osteoarthritis: Population based cohort study. BMJ 2011;342:d1165.
William H. Robinson, Christin M. Lepus, Qian Wang, Harini Raghu, Rong Mao, Tamsin L. Lindstrom. Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nature Reviews Rheumatology volume 12, pages 580–592 (2016).
Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis.
World J Orthop. 2014 Jul 18; 5(3):351-61.
Kellgren JH, Lawrence JS. Osteoarthritis and disk degeneration in an urban population. Annals of 1958; 17:388-397
Hunter DJ, McDougall JJ, Keefe FJ. The symptoms of osteoarthritis and the genesis of pain. Rheum Dis Clin North Am. 2008 Aug; 34(3):623-43.
Symmons, Deborah & Mathers, C & Pfleger, Bruce. (2003). Global burden of osteoarthritis in the year 2000. WHO global burden of disease.
Hollander JL, Brown EM, Jessar RA, Brown CY. Hydro- cortisone and cortisone injected into arthritic joints; comparative effects of and use of hydrocortisone as a local antiarthritic agent. J Am Med Assoc 1951;147: 1629-1635.
Chatham WW, Kimberly RP. Treatment of lupus with corticosteroids. Lupus 2001;10:140-147.
MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: A review for radiologists. Radiology 2009;252:647-661.
O’Connor FG. Common injections in sports medicine: general principles and specific techniques. In: O’Connor FG, ed. Sports Medicine: Just the Facts. new York, nY: McGraw-Hill Medical Pub. Division; 2005:426-433.
Ostergaard M, Stoltenberg M, Gideon P, Sørensen K, Henriksen O, Lorenzen I. Changes in synovial membrane and joint effusion volumes after intraarticular methylprednisolone. Quantitative assessment of inflammatory and destructive changes in arthritis by MRI. J Rheumatol. 1996;23:1151-1161. 15. Hollander JL, Jessar RA, Brown EM. Intra-synovial corticosteroid therapy: A decade of use. Bull Rheum Dis. 1961;11:239-240. 16. Blyth T, Hunter JA, Stirling A. Pain relief in the rheumatoid knee after steroid injection. A single-blind com- parison of hydrocortisone succinate, and triamcinolone acetonide or hexacetonide. Br J Rheumatol 1994;33: 461-463.
Swerdlow M, Jones R. The duration of action of bupi- vacaine, prilocaine and lignocaine. Br J Anaesth 1970;42: 335-339.
Benzon HT, Chew TL, McCarthy RJ, Benzon HA, Walega DR. Comparison of the particle sizes of different steroids and the effect of dilution: A review of the relative neurotoxicities of the steroids. Anesthesiology 2007;106: 331-338.
Gomoll AH, Kang RW, Williams JM, Bach BR, Cole BJ. Chondrolysis after continuous intra-articular bupiva- caine infusion: An experimental model investigating chondrotoxicity in the rabbit shoulder. Arthroscopy 2006;22:813-819.
Piper SL, Kramer JD, Kim HT, Feeley BT. Effects of local anesthetics on articular cartilage. Am J Sports Med 2011;39:2245-2253.
Raynauld JP, Buckland-Wright C, Ward R, et al. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: A randomized, double- blind, placebo-controlled trial. Arthritis Rheum 2003;48: 370-377.
Hollander JL, Jessar RA, Brown EM. Intra-synovial corticosteroid therapy: A decade of use. Bull Rheum Dis. 1961;11:239-240.
Friedman DM, Moore ME. The efficacy of intraarticular steroids in osteoarthritis: A double-blind study. J Rheumatol 1980;7:850-856.
Courtney P, Doherty M. Joint aspiration and injection. Best Pract Res Clin Rheumatol. 2005;19(3):345-369.
Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;(2):CD005328.
Jüni P, Hari R, Rutjes AWS, Fischer R, Silletta MG, Reichenbach S, da Costa BR. Intra‐articular corticosteroid for knee osteoarthritis. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD005328. DOI: 10.1002/14651858.CD005328.
Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. BMJ. 2004;328:869.
Hepper CT, Halvorson JJ, Duncan ST, Gregory AJ, Dunn WR, Spindler KP. The efficacy and duration of intra-articular corticosteroid injection for knee osteoarthritis: a systematic review of level I studies. J Am Acad Orthop Surg. 2009;17:638–646.
Arden NK, Reading IC, Jordan KM, Thomas L, Platten H, Hassan A, Ledingham J. A randomised controlled trial of tidal irrigation vs corticosteroid injection in knee osteoarthritis: the KIVIS Study. Osteoarthritis Cartilage. 2008;16:733–739.
Jevsevar DS. Treatment of osteoarthritis of the knee: Evidence-based guideline, 2nd edition. J Am Acad Orthop Surg 2013;21:571-576.
Meyer K, Palmer JW. The polysaccharide of the vitreous humor. J Biol Chem 1934;107:629-634.
Balazs EA. Hyaluronic acid and matrix implantation: A report on the biologic activity and therapeutic use of hyaluronic acid, Ed 2. Arlington, MA: Biotrix, 1971.
Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop. 2014;5(3):351–361. Published 2014 Jul 18. doi:10.5312/wjo.v5.i3.351
Moreland LW. Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action. Arthritis Res Ther. 2003; 5(2):54-67.
Axe JM, Snyder-Mackler L, Axe MJ. The role of viscosupplementation. Sports Med Arthrosc Rev. 2013 Mar; 21(1):18-22.
Amiel D, Toyoguchi T, Kobayashi K, Bowden K, Amiel ME, Healey RM. Long-term effect of sodium hyaluronate (Hyalgan) on osteoarthritis progression in a rabbit model.
Osteoarthritis Cartilage. 2003 Sep; 11(9):636-43.
Goldberg VM, Buckwalter JÁ. Hyaluronans in the treatment of osteoarthritis of the knee: evidence for disease-modifying activity. Osteoarthritis Cartilage. 2005 Mar; 13(3):216-24.
Amiel D, Toyoguchi T, Kobayashi K, Bowden K, Amiel ME, Healey RM. Long-term effect of sodium hyaluronate (Hyalgan) on osteoarthritis progression in a rabbit model.
Osteoarthritis Cartilage. 2003 Sep; 11(9):636-43.
Gomis A, Miralles A, Schmidt RF, Belmonte C. Intra-articular injections of hyaluronan solutions of different elastoviscosity reduce nociceptive nerve activity in a model of osteoarthritic knee joint of the guinea pig. Osteoarthritis Cartilage. 2009 Jun; 17(6):798-804.
McArthur BA, Dy CJ, Fabricant PD, Valle AG. Long term safety, efficacy, and patient acceptability of hyaluronic acid injection in patients with painful osteoarthritis of the knee. Patient Prefer Adherence 2012;6:905-910.
Rutjes AW, Jüni P, da Costa BR, Trelle S, Nüesch E, Reichenbach S. Viscosupplementation for osteoarthritis of the knee: A systematic review and meta-analysis. Ann Intern Med 2012;157:180-191.
Bannuru RR, Natov NS, Dasi UR, Schmid CH, McAlindon TE. Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis--meta-analysis. Osteoarthritis Cartilage. 2011 Jun; 19(6):611-9.
Wang CT, Lin J, Chang CJ, Lin YT, Hou SM. J Bone Joint Surg Am. 2004 Mar; 86(3):538-45. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials.
Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006 Apr 19; (2):CD005321.
Divine JG, Shaffer MD. Use of viscosupplementation for knee osteoarthritis: an update. Curr Sports Med Rep. 2011 Sep-Oct; 10(5):279-84.
Lo GH, LaValley M, McAlindon T, Felson DT. Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a meta-analysis. JAMA. 2003 Dec 17; 290(23):3115-21.
Modawal A, Ferrer M, Choi HK, Castle JÁ. Hyaluronic acid injections relieve knee pain. J Fam Pract. 2005 Sep; 54(9):758-67.
Arrich J, Piribauer F, Mad P, Schmid D, Klaushofer K, Müllner M. Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis. CMAJ. 2005 Apr 12; 172(8):1039-43.
Medina JM, Thomas A, Denegar CR. Knee osteoarthritis: should your patient opt for hyaluronic acid injection? J Fam Pract. 2006 Aug; 55(8):669-75.
Rutjes AW, Jüni P, da Costa BR, Trelle S, Nüesch E, Reichenbach S. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann Intern Med. 2012 Aug 7; 157(3):180-91.
Kon E, Filardo G, Drobnic M, Madry H, Jelic M, van Dijk N, Della Villa S. Non-surgical management of early knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2012 Mar; 20(3):436-49.
Wang Y, Hall S, Hanna F, Wluka AE, Grant G, Marks P, Feletar M, Cicuttini FM.
Effects of Hylan G-F 20 supplementation on cartilage preservation detected by magnetic resonance imaging in osteoarthritis of the knee: a two-year single-blind clinical trial.
BMC Musculoskelet Disord. 2011 Aug 24; 12():195.
Kingsley CS. Blood coagulation; evidence of an antago- nist to factor VI in platelet-rich human plasma. Nature 1954;173(4407):723-724.
Filardo G, Kon E, Buda R, et al. Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2011;19:528-535.
Marx RE. Platelet-rich plasma (PRP): What is PRP and what is not PRP? Implant Dent 2001;10:225-228.
Zhu Y, Yuan M, Meng HY, et al. Basic science and clinical application of platelet-rich plasma for cartilage defects and osteoarthritis: A review. Osteoarthritis Cartilage 2013;21:1627-1637.
Sundman EA, Cole BJ, Karas V, et al. The anti- inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med 2014;42:35-41.
Sun Y, Feng Y, Zhang CQ, Chen SB, Cheng XG. The regenerative effect of platelet-rich plasma on healing in large osteochondral defects. Int Orthop 2010;34: 589-597.
Sundman EA, Cole BJ, Fortier LA. Growth factor and catabolic cytokine concentrations are influenced by the cellular composition of platelet-rich plasma. Am J Sports Med 2011;39:2135-2140.
Anitua E, Sánchez M, Nurden AT, et al. Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by sy- novial fibroblasts from arthritic patients. Rheumatology (Oxford) 2007;46:1769-1772. 61. Levy DM, et all. Injections for Knee Osteoarthritis: Corticosteroids, Viscosupplementation, Platelet-Rich Plasma, and Autologous Stem Cells Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 34, No 5 (May), 2018: pp 1730-1743.
Spaková T, Rosocha J, Lacko M, Harvanová D, Gharaibeh A. Treatment of knee joint osteoarthritis with autologous platelet-rich plasma in comparison with hyaluronic acid. Am J Phys Med Rehabil 2012;91:411-417.
Sampson S, Reed M, Silvers H, Meng M, Mandelbaum B.
Injection of platelet-rich plasma in patients with primary and secondary knee osteoarthritis: A pilot study. Am J Phys Med Rehabil 2010;89:961-969.
Kanchanatawan W, Arirachakaran A, Chaijenkij K, et al. Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 2016;24:1665-1677.
Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: A prospective, double-blind, randomized trial. Am J Sports Med 2013;41: 356-364.
Filardo G, Kon E, Buda R, et al. Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2011;19:528-535.
Campbell KA, Saltzman BM, Mascarenhas R, et al. Does intra-articular platelet-rich plasma injection provide clinically superior outcomes compared with other ther- apies in the treatment of knee osteoarthritis? A system- atic review of overlapping meta-analyses. Arthroscopy 2015;31:2213-2221.
Laudy AB, Bakker EW, Rekers M, Moen MH. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: A systematic review and meta-analysis. Br J Sports Med 2015;49:657-672.
Bannuru RR, Natov NS, Obadan IE, Price LL, Schmid CH, McAlindon TE. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Arthritis Rheum. 2009 Dec 15; 61(12):1704-11.
Kon E, Mandelbaum B, Buda R, Filardo G, Delcogliano M, Timoncini A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Arthroscopy. 2011 Nov; 27(11):1490-501.
Sánchez M, Fiz N, Azofra J, Usabiaga J, Aduriz Recalde E, Garcia Gutierrez A, Albillos J, Gárate R, Aguirre JJ, Padilla S, Orive G, Anitua E. A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Arthroscopy. 2012 Aug; 28(8):1070-8.
Cerza F, Carnì S, Carcangiu A, Di Vavo I, Schiavilla V, Pecora A, De Biasi G, Ciuffreda M. Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis. Am J Sports Med. 2012 Dec; 40(12):2822-7.
Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med. 2013 Feb; 41(2):356-64.
Meheux CJ; McCulloch PC; Lintner DM; Varner KE; Harris JD. Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review. Arthroscopy. 2016; 32(3):495-505.
Huang Y, Liu X, Xu X, Liu J. Intra-articular injections of platelet-rich plasma, hyaluronic acid or corticosteroids for knee osteoarthritis : A prospective randomized controlled study. Orthopade. 2019 Mar;48(3):239-247
Friedenstein AJ, Piatetzky-Shapiro II, Petrakova KV. Osteogenesis in transplants of bone marrow cells. J Embryol Exp Morphol 1966;16:381-390.
Barry F, Murphy M. Mesenchymal stem cells in joint disease and repair. Nat Rev Rheumatol 2013;9:584-594.
Chen FH, Tuan RS. Mesenchymal stem cells in arthritic diseases. Arthritis Res Ther 2008;10:223.
Hunziker EB, Rosenberg LC. Repair of partial-thickness defects in articular cartilage: Cell recruitment from the synovial membrane. J Bone Joint Surg Am 1996;78:721-733.
Orozco L, Munar A, Soler R, et al. Treatment of knee osteoarthritis with autologous mesenchymal stem cells: A pilot study. Transplantation 2013;95:1535-1541.
Wong KL, Lee KB, Tai BC, Law P, Lee EH, Hui JH. Injectable cultured bone marrow-derived mesenchymal stem cells in varus knees with cartilage defects under- going high tibial osteotomy: A prospective, randomized controlled clinical trial with 2 years’ follow-up. Arthros- copy 2013;29:2020-2028.
Jo CH, Lee YG, Shin WH, et al. Intra-articular injection of mesenchymal stem cells for the treatment of osteoar- thritis of the knee: A proof-of-concept clinical trial. Stem Cells 2014;32:1254-1266.
Centeno C, Pitts J, Al-Sayegh H, Freeman M. Efficacy of autologous bone marrow concentrate for knee osteoar- thritis with and without adipose graft. Biomed Res Int 2014;2014:370621.
Suzuki K, Sun R, Origuchi M, et al. Mesenchymal stro- mal cells promote tumor growth through the enhance- ment of neovascularization. Mol Med 2011;17:579-587.
Yamasaki S, Mera H, Itokazu M, Hashimoto Y, Wakitani S. Cartilage repair with autologous bone marrow mesenchymal stem cell transplantation: Review of preclinical and clinical studies. Cartilage 2014;5: 196-202.
Printz JO, Lee JJ, Knesek M, Urquhart AG. Conflict of interest in the assessment of hyaluronic acid injections for osteoarthritis of the knee: an updated systematic review.
J Arthroplasty. 2013 Sep; 28(8 Suppl):30-33.e1.
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