Rev. Soc. Esp. Dolor. 2021; 28(5): 282-291 / DOI: 10.20986/resed.2021.3903/2021
Marcos Edgar Fernández, Olga Susana Pérez, María Jesús Albaladejo, Sandra Álava, María Jesús López, Javier Rodríguez
RESUMEN
Introducción: La osteoartritis (OA) es la causa más común de la artritis. Tradicionalmente, la OA se consideraba como una enfermedad de “desgaste”. Sin embargo, los factores metabólicos e inflamatorios se están considerando ahora como los factores patogénicos hasta el punto de que algunos autores están redefiniendo la OA como una enfermedad de “inflamación crónica de bajo grado”.
Evidencia: En la artrosis de rodilla están involucradas muchas vías de señalización y mediadores inflamatorios. El nuevo paradigma de tratamiento se basa en los tratamientos celulares sobre las vías de señalización de la inflamación, basados en componentes celulares y proteicos para combatir el entorno inflamatorio de la articulación artrósica y regenerar el tejido dañado.
Resultados: El enfoque de tratar solo una diana terapéutica (inhibidores de óxido nítrico, nutracéuticos, agentes reductores de uratos y fármacos biológicos) que han demostrado su eficacia en el tratamiento de enfermedades inflamatorias como la artritis reumatoide no se ha traducido en un manejo eficaz de la OA. Un enfoque de tratamiento dirigido simultáneamente a varias dianas sería capaz de manejar la OA de manera más eficiente. Las pautas estándar (AAOS, OARSI, ACR, NICE o EULAR) no consideran el ácido hialurónico, el plasma rico en plaquetas ni el ozono, aunque estas opciones de tratamiento han mostrado propiedades inmunomoduladoras y curativas. En ese escenario, planteamos la hipótesis de que el ácido hialurónico, el plasma rico en plaquetas y el ozono son alternativas prometedoras para el manejo de la OA de rodilla, debido a sus propiedades multidiana, como se observará en esta revisión.
Conclusión: En el presente estudio se ha revisado la fisiopatología de la OA, centrándose principalmente en el mecanismo inflamatorio, las vías de señalización implicadas y los posibles objetivos del tratamiento. El ácido hialurónico, el plasma rico en plaquetas y el ozono se postulan como opciones de tratamiento multidiana para el tratamiento de la artrosis de rodilla.
ABSTRACT
Introduction: Osteoarthritis (OA) is the most common cause of arthritis. Traditionally, OA was viewed as a “wear and tear” disease. However, metabolic and inflammatory factors are now being considered as pathogenic factors to the point that some authors are redefining OA as a “chronic low-grade inflammation” disease.
Evidence: In knee osteoarthritis, many inflammatory signaling pathways and mediators are involved. The new treatment paradigm is based on cellular treatments on the signaling pathways of inflammation, based on cellular and protein components to combat the inflammatory environment of the arthritic joint and regenerate damaged tissue.
Results: The approach of treating only one therapeutic target (nitric oxide inhibitors, nutraceuticals, urate reducing agents, and biologics) that have demonstrated their efficacy in the treatment of inflammatory diseases such as rheumatoid arthritis has not been translated into effective management in OA. A treatment approach aimed simultaneously at multiple targets would be able to manage OA more efficiently. The standard guidelines (AAOS, OARSI, ACR, NICE, or EULAR) do not consider hyaluronic acid, platelet-rich plasma, or ozone, although these treatment options have shown immunomodulatory and healing properties. In this scenario, we hypothesized that hyaluronic acid, platelet-rich plasma, and ozone are promising alternatives for the management of knee OA, due to their multidial properties, as will be seen in this review.
Conclusion: In the present study the pathophysiology of OA has been reviewed, focusing mainly on the inflammatory mechanism, the signaling pathways involved and the possible goals of treatment. Hyaluronic acid, platelet-rich plasma and ozone are proposed as multi-target options for the treatment of knee osteoarthritis.
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