Manejo no quirúrgico de la artrosis de rodilla: ¿Son efectivos los medicamentos orales complementarios?

Resumen

La artrosis es una enfermedad progresiva de las articulaciones sinoviales que causa dolor, impotencia funcional, discapacidad, y degeneración progresiva de la articulación. En sus tratamientos, sobre todo en etapas tempranas, existen distintas intervenciones para evitar tanto su desarrollo y progresión como también para lograr un adecuado manejo de los síntomas, y hay tratamientos médicos orales no convencionales con evidencia controvertida. El objetivo de este trabajo es proporcionar una actualización, dirigida a especialistas en Ortopedia y Traumatología, respecto a la evidencia actual sobre las terapias complementarias orales en el tratamiento de la artrosis de rodilla. Se hace referencia a los métodos fármacológicos complementarios más usados y estudiados, mencionando el método de acción y las consecuencias estudiadas sobre la artrosis de rodilla. Se finaliza con una tabla de recomendaciones basada en evidencia actual.

Palabras Clave

artrosis - dolor - rodilla - condroitina - diacereína - ácido hialurónico - colágeno

Publication History

Received: 30 August 2020

Accepted: 24 September 2021

Publication Date:
22 December 2021 (online)

• Referencias

• 1 Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet 2011; 377 (9783): 2115-2126 DOI: 10.1016/S0140 -6736(11)60243-2.
• 2 Vos T, Flaxman AD, Naghavi M. et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380 (9859): 2163-2196 DOI: 10.1016/s0140 -6736(12)61729-2.
• 3 Bruyère O, Cooper C, Pelletier JP. et al. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: a report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum 2014; 44 (03) 253-263 https://doi.org/10.1016/j . semarthrit.2014.05.014
• 4 Black C, Clar C, Henderson R. et al. The clinical effectiveness of glucosamine and chondroitin supplements in slowing or arresting progression of osteoarthritis of the knee: a systematic review and economic evaluation. Health Technol Assess 2009; 13 (52) 1-148 DOI: 10.3310/hta13520.
• 5 McCarty MF. The neglect of glucosamine as a treatment for osteoarthritis–a personal perspective. Med Hypotheses 1994; 42 (05) 323-327 DOI: 10.1016/0306-9877(94)90007-8.
• 6 Bassleer C, Rovati L, Franchimont P. Stimulation of proteoglycan production by glucosamine sulfate in chondrocytes isolated from human osteoarthritic articular cartilage in vitro. Osteoarthritis Cartilage 1998; 6 (06) 427-434 DOI: 10.1053/joca.1998.0146.
• 7 Reginster JY, Deroisy R, Rovati LC. et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 2001; 357 (9252): 251-256 DOI: 10.1016/S0140-6736(00)03610-2.
• 8 Henrotin Y, Mathy M, Sanchez C, Lambert C. Chondroitin sulfate in the treatment of osteoarthritis: from in vitro studies to clinical recommendations. Therapeutic Advances in Musculoskeletal Disease 2010; 2 (06) 335-348 DOI: 10.1177/1759720X10383076.
• 9 Mathieu P. [A new mechanism of action of chondroitin sulfates ACS4-ACS6 in osteoarthritic cartilage]. Presse Med 2002; 31 (29) 1383-1385 https://www.ncbi.nlm.nih.gov/pubmed/12375394
• 10 Simental-Mendía M, Sánchez-García A, Vilchez-Cavazos F, Acosta-Olivo CA, Peña-Martínez VM, Simental-Mendía LE. Effect of glucosamine and chondroitin sulfate in symptomatic knee osteoarthritis: a systematic review and meta-analysis of randomized placebo-controlled trials. Rheumatol Int 2018; 38 (08) 1413-1428 DOI: 10.1007/s00296-018-4077-2.
• 11 Towheed TE, Maxwell L, Anastassiades TP. et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev 2005; (02) CD002946 DOI: 10.1002/14651858.CD002946.pub2.
• 12 Eriksen P, Bartels EM, Altman RD, Bliddal H, Juhl C, Christensen R. Risk of bias and brand explain the observed inconsistency in trials on glucosamine for symptomatic relief of osteoarthritis: a meta-analysis of placebo-controlled trials. Arthritis Care Res (Hoboken) 2014; 66 (12) 1844-1855 DOI: 10.1002/acr.22376. https://doi.org/10.1002/acr.22376
• 13 McAlindon TE, LaValley MP, Gulín JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA 2000; 283 (11) 1469-1475 DOI: 10.1001/jama.283.11.1469.
• 14 Reichenbach S, Sterchi R, Scherer M. et al. Meta-analysis: chondroitin for osteoarthritis of the knee or hip. Ann Intern Med 2007; 146 (08) 580-590 DOI: 10.7326/0003-4819-146-8-200704170-00009.
• 15 Singh JA, Noorbaloochi S, MacDonald R, Maxwell LJ. Chondroitin for osteoarthritis. Cochrane Database Syst Rev 2015; 1: CD005614 DOI: 10.1002/14651858.cd005614.pub2.
• 16 Vlad SC, LaValley MP, McAlindon TE, Felson DT. Glucosamine for pain in osteoarthritis: why do trial results differ?. Arthritis Rheum 2007; 56 (07) 2267-2277 DOI: 10.1002/art.22728.
• 17 Cameron M, Gagnier JJ, Little CV, Parsons TJ, Blümle A, Chrubasik S. Evidence of effectiveness of herbal medicinal products in the treatment of arthritis. Part I: Osteoarthritis. Phytother Res 2009; 23 (11) 1497-1515 [PubMed: 19856319]
• 18 Henrotin YE, Labasse AH, Jaspar JM. et al. Effects of three avocado/soybean unsaponifiable mixtures on metalloproteinases, cytokines and prostaglandin E2 production by human articular chondrocytes. Clin Rheumatol 1998; 17 (01) 31-39 DOI: 10.1007/bf01450955.
• 19 Cameron M, Chrubasik S. Oral herbal therapies for treating osteoarthritis. Cochrane Database Syst Rev 2014; (05) CD002947 DOI: 10.1002/14651858.cd002947.pub2.
• 20 Christensen R, Bartels EM, Astrup A, Bliddal H. Symptomatic efficacy of avocado-soybean unsaponifiables (ASU) in osteoarthritis (OA) patients: a meta-analysis of randomized controlled trials. Osteoarthritis Cartilage 2008; 16 (04) 399-408 DOI: 10.1016/j.joca.2007.10.003.
• 21 Martel-Pelletier J, Pelletier JP. Effects of diacerein at the molecular level in the osteoarthritis disease process. Ther Adv Musculoskelet Dis 2010; 2 (02) 95-104 DOI: 10.1177/1759720 × 09359104.
• 22 Moldovan F, Pelletier JP, Jolicoeur FC, Cloutier JM, Martel-Pelletier J. Diacerhein and rhein reduce the ICE-induced IL-1beta and IL-18 activation in human osteoarthritic cartilage. Osteoarthritis Cartilage 2000; 8 (03) 186-196 DOI: 10.1053/joca.1999.0289.
• 23 Martel-Pelletier J, Mineau F, Jolicoeur FC, Cloutier JM, Pelletier JP. In vitro effects of diacerhein and rhein on interleukin 1 and tumor necrosis factor-alpha systems in human osteoarthritic synovium and chondrocytes. J Rheumatol 1998; 25 (04) 753-762 https://www.ncbi.nlm.nih.gov/pubmed/9558181
• 24 Pelletier JP, Mineau F, Ranger P, Tardif G, Martel-Pelletier J. The increased synthesis of inducible nitric oxide inhibits IL-1ra synthesis by human articular chondrocytes: possible role in osteoarthritic cartilage degradation. Osteoarthritis Cartilage 1996; 4 (01) 77-84 DOI: 10.1016/S1063-4584(96)80009-4.
• 25 Yaron M, Shirazi I, Yaron I. Anti-interleukin-1 effects of diacerein and rhein in human osteoarthritic synovial tissue and cartilage cultures. Osteoarthritis Cartilage 1999; 7 (03) 272-280 DOI: 10.1053/joca.1998.0201.
• 26 Brandt KD, Smith G, Kang SY, Myers S, O'Connor B, Albrecht M. Effects of diacerhein in an accelerated canine model of osteoarthritis. Osteoarthritis Cartilage 1997; 5 (06) 438-449 DOI: 10.1016/s1063-4584(97)80048-9.
• 27 Kitadai HK, Takahashi HK, Straus AH. et al. Effect of oral diacerein (DAR) in an experimental hip chondrolysis model. J Orthop Res 2006; 24 (06) 1240-1248 DOI: 10.1002/jor.20180.
• 28 Ghosh P, Xu A, Hwa SY, Burkhardt D, Little C. Evaluation des effets de la diacerhéine dans un modèle ovin d'arthrose [Evaluation of the effects of diacerhein in an ovine model of osteoarthritis]. Rev Prat 1998; 48 (17) S24-S30 French. https://doi.org/
• 29 Fidelix TS, Macedo CR, Maxwell LJ, Fernandes Moça Trevisani V. Diacerein for osteoarthritis. Cochrane Database Syst Rev 2014; 2 (02) CD005117 DOI: 10.1002/14651858.CD005117.pub3.
• 30 Rintelen B, Neumann K, Leeb BF. A meta-analysis of controlled clinical studies with diacerein in the treatment of osteoarthritis. Arch Intern Med 2006; 166 (17) 1899-1906 DOI: 10.1001/archinte.166.17.1899.
• 31 Bruyère O, Cooper C, Arden N. et al. Can we identify patients with high risk of osteoarthritis progression who will respond to treatment? A focus on epidemiology and phenotype of osteoarthritis. Drugs Aging 2015; 32 (03) 179-187
• 32 European Medicines Agency. Assessment report for diacerein containing medicinal products. EMA. 2014 Aug 28. https://www.ema.europa.eu/en/documents/referral/diacerein-article-31-referral-prac-assessment-report_en.pdf
• 33 Altman RD, Manjoo A, Fierlinger A, Niazi F, Nicholls M. The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review. BMC Musculoskelet Disord 2015; 16: 321 DOI: 10.1186/s12891-015-0775-z.
• 34 Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop 2014; 5 (03) 351-361 DOI: 10.5312/wjo.v5.i3.351.
• 35 Stern R, Jedrzejas MJ. Hyaluronidases: their genomics, structures, and mechanisms of action. Chem Rev 2006; 106 (03) 818-839 DOI: 10.1021/cr050247k.
• 36 Oe M, Tashiro T, Yoshida H. et al. Oral hyaluronan relieves knee pain: a review. Nutr J 2016; 15: 11 DOI: 10.1186/s12937-016-0128-2.
• 37 Moreland LW. Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action. Arthritis Res Ther 2003; 5 (02) 54-67 DOI: 10.1186/ar623.
• 38 Balazs EA. Viscosupplementation for treatment of osteoarthritis: from initial discovery to current status and results. Surg Technol Int 2004; 12: 278-289 https://www.researchgate.net/publication/8260767_Viscosupplementation_for_treatment_of_osteoarthritis_From_initial_discovery_to_current_status_and_results
• 39 Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2006; 19 (02) CD005321 DOI: 10.1002/14651858.CD005321.pub2.
• 40 Bannuru RR, Natov NS, Dasi UR, Schmid CH, McAlindon TE. Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis–meta-analysis. Osteoarthritis Cartilage 2011; 19 (06) 611-619 DOI: 10.1016/j.joca.2010.09.014.
• 41 Fakhari A. Biomedical application of hyaluronic acid nanoparticles. PhD thesis. 2012 Jan 19. https://kuscholarworks.ku.edu/bitstream/handle/1808/9825/Fakhari_ku_0099D_11965_DATA_1.pdf;sequence=1
• 42 Panuccio E, Memeo A, Richetta S. [Evaluation of the combined treatment of oral viscosupplementation with hyaluronic acid intra-articular injection on symptomatic knee osteoarthritis]. Clin Ter 2015; 166 (05) e321-e326 DOI: 10.7417/T.2015.1886.
• 43 Sawitzke AD, Shi H, Finco MF. et al. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT. Ann Rheum Dis 2010; 69 (08) 1459-1464 DOI: 10.1136/ard.2009.
• 44 Oesser S, Seifert J. Stimulation of type II collagen biosynthesis and secretion in bovine chondrocytes cultured with degraded collagen. Cell Tissue Res 2003; 311 (03) 393-399 DOI: 10.1007/s00441-003-0702-8.
• 45 Benito-Ruiz P, Camacho-Zambrano MM, Carrillo-Arcentales JN. et al. A randomized controlled trial on the efficacy and safety of a food ingredient, collagen hydrolysate, for improving joint comfort. Int J Food Sci Nutr 2009; 60 (Suppl. 02) 99-113 DOI: 10.1080/09637480802498820.
• 46 Bruyère O, Zegels B, Leonori L. et al. Effect of collagen hydrolysate in articular pain: a 6-month randomized, double-blind, placebo controlled study. Complement Ther Med 2012; 20 (03) 124-130 DOI: 10.1016/j.ctim.2011.12.007.