Rev. Soc. Esp. Dolor. 2021; 28(13): 4-10 / DOI: 10.20986/resed.2021.3874/2020
Víctor Mayoral
ABSTRACT
Osteoarthritis is one of the main health problems in all countries, most prevalent in developed countries, probably due to factors such as increased longevity, a sedentary lifestyle and obesity. Health statistics show a continued growth in its overall impact and importance on disability.
The objective is to analyze and synthesize the health problem posed by osteoarthritis, providing epidemiological data on prevalence, clinical impact, loss of quality of life and costs it causes. Those therapeutic objectives that are clinically relevant, will be shown, both those preventive and modifiable as well as the cofactors that modify the degree of response to them.
Systematic review of the literature of the last 10 years in the Pubmed database for terms "Mesh" related to epidemiology, prevention, treatment, and patient reported outcomes for knee and hip osteoarthritis.
We have found great variability in reported epidemiological results, a consequence of the different inclusion criteria and methodology of studies, showing prevalence of 83% in Magnetic Resonance studies with asymptomatic patients up to 3.8% of symptomatic knee osteoarthritis in adult population studies. Age, female sex, ethnicity and obesity seem like the most important factors related to the disease. Other factors such as genetics, biomechanics resulting from sports and occupational injuries, hormonal, metabolic syndrome and sedentary lifestyles have shown a clear association with the disease. The direct and indirect cost of osteoarthritis represents between 0.5 and 1% of GDP, according to countries. The review of therapeutic goals shows that patients perceive as minimally relevant changes those therapies that achieve a decrease of 2 points or 33 % on the VAS Analypain scale, but these cut-off points will depend on the affected joint and the severity of the initial pain. The chronology and persistence of pain despite treatments that may correct the mechanical component such as joint replacement seems related to extraarticular factors such as psychological ones, non-nociceptive pain phenotype, other diseases that cause local or diffuse pain with different degrees of sensitization as well as sociocultural factors.
The incidence and prevalence of symptomatic osteoarthritis is high. We know those modifiable factors with which we can help patients and people prevent it or minimize its consequences on disability. Therapeutic efforts should be aimed at using resources that have shown real clinically relevant changes. We must also address those non-mechanical cofactors that promote the persistence of pain and enhance those therapeutic strategies that are based on a multidisciplinary approach.
RESUMEN
La artrosis es uno de los principales problemas de salud en todos los países, más prevalente en los países desarrollados probablemente debido a factores como el aumento de la longevidad, el sedentarismo y la obesidad. Las estadísticas de salud muestran un continuo crecimiento de su incidencia e importancia global sobre la discapacidad.
El objetivo es analizar y sintetizar el problema de salud que representa la artrosis, aportando datos epidemiológicos de prevalencia, repercusión clínica, pérdida de calidad de vida y costes que ocasiona. Se muestran los objetivos terapéuticos que son clínicamente relevantes, tanto aquellos preventivos o modificables como los cofactores que modifican el grado de respuesta a los mismos.
Se trata de una revisión sistemática de la literatura de los últimos 10 años en la base de datos PubMed para términos “Mesh” relacionados con epidemiología, prevención, tratamiento y resultados informados por el paciente para artrosis de rodilla y cadera.
Hemos encontrado una gran variabilidad en los resultados epidemiológicos comunicados, consecuencia de los diferentes criterios de inclusión y metodología de los estudios, mostrando prevalencias del 83 % en estudios con resonancia magnética en pacientes asintomáticos hasta el 3,8 % de artrosis sintomática de rodilla en estudios poblacionales en adultos. La edad, el sexo femenino, la etnia y la obesidad parecen ser los factores más importantes relacionados con la enfermedad. Otros factores como los genéticos, biomecánicos (consecuencia de lesiones deportivas y ocupacionales), hormonales, el síndrome metabólico y el sedentarismo han mostrado una clara asociación con la enfermedad. El coste directo e indirecto de la artrosis representa entre el 0,5 y el 1 % del PIB, según países. La revisión de los objetivos terapéuticos muestra que los pacientes perciben como cambios mínimamente relevantes aquellas terapias que consiguen una disminución de 2 puntos en la escala de dolor EVA o un 33 %, pero estos puntos de corte van a depender de la articulación afectada y del grado de dolor inicial. La cronificación y persistencia del dolor, a pesar de tratamientos que corrigen el componente mecánico como el protésico articular, parecen relacionados con factores extrarticulares como los psicológicos, fenotipos de dolor no nociceptivos, otras enfermedades que provocan dolor local o difuso con diferentes grados de sensibilización y otros factores socioculturales.
La incidencia y prevalencia de la artrosis sintomática es alta. Conocemos aquellos factores modificables con los que podemos ayudar a los pacientes y población a prevenirla o minimizar sus consecuencias sobre la discapacidad. Los esfuerzos terapéuticos deben ir encaminados a utilizar recursos que hayan mostrado cambios clínicamente. Debemos también incidir en aquellos cofactores no mecánicos que favorecen la persistencia del dolor y potenciar las estrategias terapéuticas que se apoyan en un enfoque multidisciplinar.
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