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Colegio de Medicina Interna de México.

2013, Número 1

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Med Int Mex 2013; 29 (1)


Reunión multidisciplinaria de expertos en diagnóstico y tratamiento de pacientes con osteoartritis. Actualización basada en evidencias

Espinosa MR, Arce SCA, Cajigas MJC, Esquivel VJA, Gutiérrez GJJ, Martínez HJL, Méndez MC, Restrepo GN, Robles SM, Ruiz MJ, Santillán BE, Torres RF, Villalobos CE, Sosa GJO, Aldrete VJ, Cantú RAT

Idioma: Español
Referencias bibliográficas: 98
Paginas: 67-92
Archivo PDF: 564.86 Kb.


RESUMEN

Antecedentes: la osteoartritis es la forma más común de artritis que afecta a 60% de los hombres y 70% de las mujeres mayores de 70 años de edad. Los estudios de prevalencia reportan que la osteoartritis de rodilla la padecen 10% de los hombres y 13% de las mujeres de 60 años y más de edad. Su base fisiopatológica es la pérdida progresiva del cartílago articular. Las principales manifestaciones clínicas son el dolor y la limitación funcional. En la actualidad existen tratamientos analgésicos, para disminuir la limitación funcional y para modificar el curso de la enfermedad.
Objetivo: actualizar, con base en evidencias, el conocimiento para el diagnóstico y tratamiento de pacientes con osteoartritis.
Método: estudio retrospectivo efectuado con base en el análisis de la información encontrada en PubMed de guías de práctica clínica, ensayos clínicos controlados y metanálisis relacionados con el diagnóstico y tratamiento de pacientes adultos mayores de 18 años de edad, de uno y otro sexo, publicados en idioma inglés y español entre los meses de abril de 2011 al 7 de agosto de 2012. Se excluyeron de la búsqueda los niños y las mujeres embarazadas. La búsqueda de guías de práctica clínica también incluyó sitios web especializados: TRIPDATABASE, CMA INFOBASE, NGC, NHS, NICE, Alberta Medical Association Guidelines, American College of Physicians, ICSI, Australian Government, National Health and Medical Research Council, NZGG, Singapore MOH Guidelines, MINSAL.
Resultados: la resonancia magnética ayuda a establecer el diagnóstico temprano de osteoartritis porque detecta los cambios estructurales iniciales en el espacio articular y en el grosor del cartílago. El paracetamol, los antiinflamtorios no esteroides, los inhibidores de la COX-2 y los opioides siguen prescribiéndose para disminuir los síntomas; al igual que los SYSADOA, la viscosuplementación con el hilano GF-20, y los péptidos de colágeno bioactivo. El sulfato de glucosamina y de condroitina disminuyen los síntomas de la osteoartritis de rodilla. La AAOS, ACR y EULAR apoyan la prescripción de ácido hialurónico o de hilano GF-20 a pacientes con poca respuesta a los analgésicos convencionales, o con contraindicación o poca tolerancia a los antiinflamatorios no esteroides o inhibidores selectivos COX2.
Conclusiones: si bien el arsenal terapéutico es amplio y eficaz, sigue siendo un anhelo encontrar fármacos que modifiquen el curso natural de la enfermedad. Para esto se están evaluando diferentes tratamientos dirigidos explícitamente al cartílago articular. El tratamiento con péptidos de colágeno bioactivo es muy prometedor porque los estudios preclínicos y clínicos sugieren que el colágeno hidrolizado llega al cartílago y estimula la producción de la matriz extracelular, a partir de los condrocitos.


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