Revista de Medicina Desportiva (English) March 2018 | Page 10

Photoreport
Innovation and challenges in
the prevention and treatment of
patients with osteoarthritis
The 4 th Scientific Meeting on Gonar-
throsis and Sports Medicine was
held last November in Funchal. Dr.
Pedro Pessoa, head of the knee unit
of the Hospital Santiago, Outão,
and coordinator of the event, said
that osteoarthritis was considered
a pathology exclusively associated
with ageing and the elderly popula-
tion, but “the disease is increasingly
related to the sport of high competi-
tion “and between 1990 and 2010
there was an exponential growth of
the younger patients with general-
ized arthrosis, namely the knee and”
when this type of cartilage lesions
occurs in athletes, the treatment can
be complex , as the great concern
goes through the return to physical
activity.” Many patients continue to
ask for prosthesis placement, but
before we get to the prosthesis we
have other solutions. “ The visco-
supplementation is one of these
solutions and has demonstrated
effectiveness in pain control and
improved functionality. “In addition,
surgical treatment can be delayed.
Whatever the therapeutic decision,
“our concern is to treat the carti-
lage lesions as best we can, with
8 march 2018 www.revdesportiva.pt
all the materials we have access
to,” he stressed. In short, “the great
challenge is to find the best combi-
nations. Those that translate into
greater benefits for the patient. In
cases where active inflammation
is present, we turn first to corti-
coids and only after that we do the
infiltration of hyaluronic acid.” If
the patient does not have any type
of synovitis and if the knee is dry,
we can perform viscosupplementa-
tion infiltration immediately. “The
combination of PRP with hyaluronic
acid also looks promising.” On the
one hand, it attenuates cartilage
degeneration and, on the other, it
has anti-inflammatory elements.
Hyaluronic acid increases the dura-
tion of PRP and works as a central
thread,” added Dr Pedro Pessoa.
With extensive experience in the
treatment of osteoarthritis in ath-
letes, Prof. Dr José Carlos Noronha
stressed that knee arthrosis is a
relatively frequent consequence of
high-performance sport. “Football
itself is a modality that is prone to
cause injuries.” The increase of this
type of injury in athletes is related to
the increase of competitiveness and
the requirements to which they are
currently subjected to. Therefore, the
possibility of micro or macro trauma
injury is very significant.
“Even without serious injuries,
repetitive injuries will degrade the
knee over time,” added the orthopae-
dist from Porto. In addition to the risk
associated with sports, and regard-
less of the overload, there are indi-
viduals who are predisposed to the
appearance of this cartilage deforma-
tion because they present other risk
factors, such as cruciate ligament
and meniscus injuries, fatigue and
muscular discoordination.
There is also the influence of the
heredity factor. “Even without hav-
ing suffered serious injuries, it is to
be expected that, out of those who
have parents with gonarthrosis, 25%
will also develop the condition,” he
explained. However, “a radiologically
extensive arthrosis does not always
correspond to severe symptomatol-
ogy. Just as the patients’ complaints
regarding the pain do not always
correspond to serious radiologi-
cal injuries.” That is why, according
to Prof. Dr José Carlos Noronha,
“patients, not X-rays, should be
operated on”. In other words, only
patients who have complaints
should be treated. The cause of the
pain and functional disability does
not lie necessarily in the injury
presented in the X-rays, but rather
in the so-called “pro-inflammatory
mediators,” namely interleukins.
For the first time, an edition of
the Gonartrose and Sports Medicine
Scientific Meeting was attended by
a psychiatrist. As a matter of fact,
the osteoarticular pathology can
pass from the bones and joints to
the brain, and cause depression and
anxiety. This is demonstrated by epi-
demiological studies. “The incidence
of depression in the global popula-
tion, according to 2015 data from
the World Health Organisation, is of
4.4%. Which means that more than
300 million people worldwide suffer
from depression. The incidence of
depression in the population with
osteoarthritis is of 18% and some
studies suggest that it can reach
40%,” stated Dr Gustavo Jesus, a
psychiatrist currently completing his
doctorate at Faculdade de Medicina
de Lisboa [Faculty of Medicine in
Lisbon].
“In patients with osteoarthritis
who show signs of depression, it is
very important to implement con-
comitant treatment for depression,
so that the burden of disability is not
so relevant and that the economic
burden these diseases represent is
also relieved,” said Dr Gustavo Jesus,
adding that osteoarthritis is a cause
of depression, probably not only
because of the pain it causes, but
also because of the loss of func-
tionality. On the other hand, the
existence of depression aggravates
the prognosis of osteoarthrosis and
osteoarticular pathology in gen-
eral. “It has also been shown that
patients with osteoarthritis and
depression have lower adherence to
treatment.
Although it is not often mentioned
at these meetings, informed consent
represents a source of concern for