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 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