Revista de Medicina Desportiva (English) May 2018 - Page 16

Rev. Medicina Desportiva informa, 2018; 9(3):14-17 Minimal Invasive Treatment of Knee Osteoarthritis: Corticosteroids, Hyaluronic Acid or Regenerative Biological Products? Dr. José Luís Carvalho 1 , Dr. Gonçalo Borges 2 1 Resident; 2 Specialist doctor. Physical medicine and rehabilitation. Prelada Hospital, Porto. Abstract ABSTRACT Introduction. Therapeutics like hyaluronic acid (HA), platelet rich plasma (PRP) and autologous mesenchymal stem cells (MSC) have been recognized as alternatives with potential in knee osteoar- thritis (OA) treatment, in a symptomatic but also regenerative point of view. Material and Methods. A research in Pubmed database was carried out, concerning the terms “knee osteoarthritis”, “knee intra-articular” and “knee injections”, (limits: publication date – last 5 years; article type – review and clinical research). Results. They were obtained 29 articles in the proposed design of this study. However, a further 4 articles of the research bibliography were added, performing a total of 33 analyzed articles. Discussion and Conclusions. Options like HA, PRP and MSC appear to be alterna- tives with the potential to alter the OA treatment paradigm, from a pure symptomatic approach to a minimally invasive perspective with potential for regeneration. Knee osteoarthritis, intra-articular injections, corticosteroids, hyaluronic acid, platelet rich plasma and mesenchymal stem cells Osteoarthritis (OA) is a progressive degenerative pathology with an extraordinary impact concerning pain and impairment on the popula- tion. However, it also has an impor- tant expression in younger ages of specific populations, like high- competition athletes. Lawrence et al. stated that even in younger individu- als the prevalence was very high (> 20% in individuals with > 45 years). 1 The main risk factors related to the development of OA include age, obesity, history of trauma or knee injuries, status postmenopausal in women, abnormal articulation align- ment and certain genetic factors. 2 From a pathophysiological point of view, OA is a more complex pathology than initially thought, not depending solely on biomechanical factors and joint overload, because highly active processes of inflamma- tion and joint remodeling are present in the various stages of the disease. During the phases of active remode- ling, enhanced by local inflammatory 14 may 2018 www.revdesportiva.pt Material and methods A search was carried out in the PubMed database of the terms “knee osteoarthritis”, “knee articular” and “knee injections”, (Limits: Date of publication – Last 5 years; type of article – Review and Clinical Inves- tigation). From a more specific point of view, articles were researched addressing knee articular injection with corticosteroids (CS), hyaluronic acid (AH) and recent regenerative medicine, notably platelet-rich plasma (Platelet Rich plasma – PRP) and mesenchymal stem cells (Mesen- chymal stem Cells – MSC). Results KEYWORDS Introduction invasive interventions available for the treatment of the knee OA, namely the most used therapies and those with the potential to address the pathophysiologic processes of base, thus modulate the evolution of the disease. processes, the quality of extracel- lular matrix is compromised due to the rapid rate of turnover and consequent atypical composition of neo-matriz. 3-5 In this sense, there is a direct relationship between an inflammatory environment, changes in the function of cells, ineffective synthesis of extracellular matrix and joint destruction. The most influential inflammatory cytokines in the pathophysiologic process of OA are the interleukin(IL)- 1b, the alpha factor of tumor necro- sis (TNF-a) and IL-6. Theoretically, these cytokines contribute to OA through various mechanisms that alter the proper functioning of the chondrocytes, increasing the expres- sion of catabolic and inflammatory genes, altering secondarily the struc- ture and function of the matrix. 6 The treatment of OA is not con- sensual, presenting pharmacological approaches, rehabilitation medicine, minimally invasive treatments and surgery, among other modalities. The objective of this investigation is to address the main minimally 29 articles were obtained at the limits proposed in the design of this work, however four more articles men- tioned in the bibliography obtained in the research were added, for the rel- evance of their results and the obvi- ous validity for the discussion of the topic, totaling 33 articles analyzed. Discussion 1. Corticosteroids The mechanism underlying the inflammatory effectiveness of the CS in joint environment is related to the blockade of the opsonization of the antigens, adhesion leucocyte and diapedesis of the cytokines of the capillary endothelium. At the same time, this potent anti-inflammatory decreases the effects of IL-1, reduces the release of leukotrienes and pros- taglandins