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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2020; 55(05): 551-556
DOI: 10.1016/j.rbo.2018.01.001
Artigo Original
Joelho

Efeito comparativo entre a infiltração de plasma rico em plaquetas e o uso de corticosteroides no tratamento de osteoartrite do joelho: Estudo clínico prospectivo e randomizado[*]

Article in several languages: português | English
Marianna Ribeiro de Menezes Freire 
1   Faculty of Medicine, Universidade Tiradentes (Unitmed), Aracaju, SE, Brazil
,
Philippe Mota Coutinho da Silva
1   Faculty of Medicine, Universidade Tiradentes (Unitmed), Aracaju, SE, Brazil
,
Arthur Rangel Azevedo
2   Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo (Iamspe), São Paulo, SP, Brazil
,
Denison Santos Silva
3   Universidade Tiradentes (Unitmed), Aracaju, SE, Brazil
,
Ronald Bispo Barreto da Silva
3   Universidade Tiradentes (Unitmed), Aracaju, SE, Brazil
,
Juliana Cordeiro Cardoso
3   Universidade Tiradentes (Unitmed), Aracaju, SE, Brazil
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Resumo

Objetivo Analisar a eficácia do uso de plasma rico em plaquetas, obtido do sangue periférico e autólogo dos pacientes, na redução das queixas álgicas e melhoria funcional dos pacientes portadores de osteoartrite de joelhos, em comparação com o tratamento padrão com injeção de corticosteroides de depósito, como a triancilonola.

Métodos Os pacientes foram acompanhados clinicamente na consulta pré-infiltrativa, com avaliação quantitativa através das escalas Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), e Kellgren and Lawrence. Além disso, os pacientes foram reavaliados com as mesmas escalas após 1 mês e 6 meses de intervenção com 2,5 mL de acetato de triancinolona ou 5 mL de plasma rico em plaquetas. O estudo foi feito em 50 pacientes portadores de osteoartrite de joelhos atendidos no Centro de Especialidades Médicas, divididos em amostras equivalentes randomizadas para cada terapia.

Resultados No presente estudo, verificaram-se redução dos valores em escalas álgicas, como a WOMAC, e elevação das pontuações em escalas funcionais, como a KSS, evidenciadas em 180 dias após o uso de plasma rico em plaquetas, uma terapia feita a partir do sangue autólogo do paciente e com menos efeitos colaterais.

Conclusão Embora ambas as terapias com plasma rico em plaquetas e corticosteroides tenham se mostrado eficazes na redução das queixas álgicas e na recuperação funcional, houve diferença significativa entre as terapias aos 180 dias. De acordo com os resultados obtidos, no tratamento da osteoartrite do joelho, o plasma rico em plaquetas demonstrou efeitos mais duradouros em 180 dias.

Palavras-chave

osteoartrite - corticoterapia - plasma rico em plaquetas

* Trabalho desenvolvido no Centro de Especialidades Médicas da Universidade Tiradentes (Unitmed), Aracaju, SE, Brasil. Publicado Originalmente por Elsevier Editora Ltda.




Publication History

Received: 20 October 2017

Accepted: 04 January 2018

Article published online:
03 February 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações Ltda
Rio de Janeiro, Brazil

 

  • Referências

  • 1 Jordan KM, Arden NK, Doherty M. et al. Standing Committee for International Clinical Studies Including Therapeutic Trials ESCISIT. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003; 62 (12) 1145-1155
    CrossrefPubMedGoogle Scholar
  • 2 Lawrence RC, Felson DT, Helmick CG. et al. National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008; 58 (01) 26-35
    CrossrefPubMedGoogle Scholar
  • 3 Rezende MU, De Campos GC. A osteoartrite é uma doenc¸a mecânica ou inamatória?. Rev Bras Ortop 2013; 48 (06) 471-474
    CrossrefPubMedGoogle Scholar
  • 4 Scarpone M, Rabago D, Snell E. et al. Effectiveness of platelet-rich plasma injection for rotator cuff tendinopathy: a prospective open-label study. Glob Adv Health Med 2013; 2 (02) 26-31
    PubMedGoogle Scholar
  • 5 Pelletier JP, Martel-Pelletier J, Abramson SB. Osteoarthritis, an inflammatory disease: potential implication for the selection of new therapeutic targets. Arthritis Rheum 2001; 44 (06) 1237-1247
    CrossrefPubMedGoogle Scholar
  • 6 Fitzgerald JB, Jin M, Grodzinsky AJ. Shear and compression differentially regulate clusters of functionally related temporal transcription patterns in cartilage tissue. J Biol Chem 2006; 281 (34) 24095-24103
    CrossrefPubMedGoogle Scholar
  • 7 Sarvimäki A, Stenbock-Hult B. Quality of life in old age described as a sense of well-being, meaning and value. J Adv Nurs 2000; 32 (04) 1025-1033
    CrossrefPubMedGoogle Scholar
  • 8 Clauw DJ, Witter J. Pain and rheumatology: thinking outside the joint. Arthritis Rheum 2009; 60 (02) 321-324
    CrossrefPubMedGoogle Scholar
  • 9 Hameed F, Ihm J. Injectable medications for osteoarthritis. PM R 2012; 4 (5, Suppl): S75-S81
    CrossrefPubMedGoogle Scholar
  • 10 Evaniew N, Simunovic N, Karlsson J. Cochrane in CORR®: Viscosupplementation for the treatment of osteoarthritis of the knee. Clin Orthop Relat Res 2014; 472 (07) 2028-2034
    CrossrefPubMedGoogle Scholar
  • 11 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; 61 (12) 1704-1711
    CrossrefPubMedGoogle Scholar
  • 12 Cheng OT, Souzdalnitski D, Vrooman B, Cheng J. Evidence-based knee injections for the management of arthritis. Pain Med 2012; 13 (06) 740-753
    CrossrefPubMedGoogle Scholar
  • 13 Nguyen RT, Borg-Stein J, McInnis K. Applications of platelet-rich plasma in musculoskeletal and sports medicine: an evidence-based approach. PM R 2011; 3 (03) 226-250
    CrossrefPubMedGoogle Scholar
  • 14 Krogh TP, Bartels EM, Ellingsen T. et al. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med 2013; 41 (06) 1435-1446
    CrossrefPubMedGoogle Scholar
  • 15 Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg 2004; 114 (06) 1502-1508
    PubMedGoogle Scholar
  • 16 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 (02) 356-364
    CrossrefPubMedGoogle Scholar
  • 17 Sonnleitner D, Huemer P, Sullivan DY. A simplified technique for producing platelet-rich plasma and platelet concentrate for intraoral bone grafting techniques: a technical note. Int J Oral Maxillofac Implants 2000; 15 (06) 879-882
    Google Scholar
  • 18 Messora MR, Nagata MJ, Furlaneto FA. et al. Análise da eficiência do protocolo de dupla centrifugac¸ão para o preparo do plasma rico em plaquetas (PRP) - estudo experimental em coelhos. RSBO Rev Sul-Bras Odontol. 2009; 6 (03) 291-296
    Google Scholar
  • 19 Schiphof D, Boers M, Bierma-Zeinstra SMA. Differences in descriptions of Kellgren and Lawrence grades of knee osteoarthritis. Ann Rheum Dis 2008; 67 (07) 1034-1036
    CrossrefPubMedGoogle Scholar
  • 20 Silva AL, Demange MK, Gobbi RG, da Silva TF, Pécora JR, Croci AT. Translation and Validation of the Knee Society Score - KSS for Brazilian Portuguese. Acta Ortop Bras 2012; 20 (01) 25-30
    CrossrefPubMedGoogle Scholar
  • 21 Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988; 15 (12) 1833-1840
    Google Scholar
  • 22 Dinjens RN, Senden R, Heyligers IC, Grimm B. Clinimetric quality of the new 2011 Knee Society score: high validity, low completion rate. Knee 2014; 21 (03) 647-654
    CrossrefPubMedGoogle Scholar
  • 23 Oliveira AM, Peccin MS, Silva KN, Teixeira LE, Trevisani VF. Impact of exercise on the functional capacity and pain of patients with knee osteoarthritis: a randomized clinical trial. Rev Bras Reumatol 2012; 52 (06) 876-882
    Google Scholar
  • 24 Hmamouchi I, Allali F, Tahiri L. et al. Clinically important improvement in the WOMAC and predictor factors for response to non-specific non-steroidal anti-inflammatory drugs in osteoarthritic patients: a prospective study. BMC Res Notes 2012; 5: 58
    CrossrefPubMedGoogle Scholar
  • 25 Eccles M, Freemantle N, Mason J. The North of England Non-Steroidal Anti-Inflammatory Drug Guideline Development Group. North of England evidence based guideline development project: summary guideline for non-steroidal anti-inflammatory drugs versus basic analgesia in treating the pain of degenerative arthritis. BMJ 1998; 317 (7157): 526-530
    CrossrefPubMedGoogle Scholar
  • 26 Roddy E, Zhang W, Doherty M. Aerobic walking or strengthening exercise for osteoarthritis of the knee? A systematic review. Ann Rheum Dis 2005; 64 (04) 544-548
    CrossrefPubMedGoogle Scholar
  • 27 Mei-Dan O, Carmont MR, Laver L, Mann G, Maffulli N, Nyska M. Platelet-rich plasma or hyaluronate in the management of osteochondral lesions of the talus. Am J Sports Med 2012; 40 (03) 534-541
    CrossrefPubMedGoogle Scholar
  • 28 Leitner GC, Gruber R, Neumüller J. et al. Platelet content and growth factor release in platelet-rich plasma: a comparison of four different systems. Vox Sang 2006; 91 (02) 135-139
    CrossrefPubMedGoogle Scholar
  • 29 Mohammadi F, Taghizadeh S, Ghaffarinejad F, Khorrami M, Sobhani S. Proprioception, dynamic balance and maximal quadriceps strength in females with knee osteoarthritis and normal control subjects. Int J Rheum Dis 2008; 11 (01) 39-44
    CrossrefGoogle Scholar
  • 30 Oliveira NC, Vatri S, Alfieri FM. Comparação dos efeitos de exercícios resistidos versus cinesioterapia na osteoartrite de joelho. Rev Acta Fisiátr. 2016; 23 (01) 7-11
    Google Scholar