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Colegio de Medicina Interna de México.

2013, Number 1

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Med Int Mex 2013; 29 (1)

Multidisciplinary meeting of experts for the diagnosis and treatment of osteoarthritis. Evidence-based update

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

Language: Spanish
References: 98
Page: 67-92
PDF size: 564.86 Kb.


ABSTRACT

Background: Osteoarthritis is the most common form of arthritis affecting 60% of men and 70% of women older than 70 years. The prevalence of knee osteoarthritis in men and women over 60 years old is among 10% and 13%, respectively. The pathophysiology is the cartilage loss. Pain and loss of function are the main clinical features. Currently there are treatments to control pain, to reduce functional limitation and to modify the disease course.
Objective: To update the evidence of the diagnosis and treatment of osteoarthritis.
Methods: A retrospective study was done based on the analysis of information found in PubMed of clinical practice guides, control clinical assays and meta-analyses related to diagnosis and treatment of adult patients older than 18 years, men and women, published in English and Spanish from April, 2011 to August, 2012. Children and pregnant women were excluded from the search. The clinical practice guides search also included specialized web sites: 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 and MINSAL.
Results: The MRI helps to establish an early diagnosis of osteoarthritis because it is able to visualize the loss of articular cartilage and the narrowing of the joint space in early stages of the disease. Analgesics such as paracetamol, NSAID, COX-2 inhibitors and opioids are used to reduce symptoms, as well as SYSADOA, viscossupplementation with hylan GF-20, and bioactive collagen peptides. Furthermore, glucosamine sulfate and chondroitin reduces symptoms of knee osteoarthritis. AAOS, ACR and EULAR support the prescription of hyaluronic acid or hylan GF-20 to patients with little response to conventional analgesics, or with contraindication or little tolerance to non-steroid anti-inflammatories or selective COX2 inhibitors.
Conclusions: Nevertheless therapeutic arsenal is wide and even effective, it continues being a wish to find drugs modifying the natural course of the disease. Thus, different treatments addressed explicitly to joint cartilage are being assessed. Treatment with bioactive collagen peptides is very promising because preclinical and clinical studies suggest that hydrolyzed collagen reaches the cartilage and stimulates the production of extracellular matrix from chondrocytes.


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