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      Infiltraciones de esteroides y ácido hialurónico en la artrosis Translated title: Infiltrations of steroids and hyaluronic acid in osteoarthritis

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          Abstract

          RESUMEN Los esteroides intrarticulares (CS IA) se utilizan con frecuencia para el tratamiento del dolor de los pacientes con artrosis (OA) (tanto de rodilla como cadera), sobre todo en fases tempranas, con un comienzo de acción rápido proporcionando una mejoría a corto plazo (1-6 semanas). Los CS IA no mejoran clínica ni significativamente la función articular de rodillas o caderas (rigidez, distancia caminada ni movilidad articular) ni la calidad de vida. La eficacia de los CS IA en la OA de manos es menos evidente. El riesgo de efectos adversos precoces con el uso de CS IA es muy bajo. Sin embargo, los CS IA parece que producen efectos secundarios sobre el cartílago articular dependientes del tiempo y dosis. La tasa de infección después de una artroplastia de cadera no aumenta con las infiltraciones intrarticulares, siempre que pase suficiente tiempo entre la infiltración y la artroplastia (al menos 3-6 meses). En pacientes con OA de rodilla, el ácido hialurónico intrarticular (AH IA) se ha mostrado eficaz en el control del dolor a medio plazo (5-13 semanas) que se puede mantener a largo plazo (26 semanas) con resultados funcionales menos evidentes. La eficacia del AH en el control del dolor y la funcionalidad en los pacientes con OA de cadera y manos es menos evidente. Los efectos secundarios del AH son locales, generalmente leves y transitorios. No está bien establecido si son más frecuentes con AH de alto peso molecular, AH de origen aviar o con repetidas inyecciones. Las infiltraciones guiadas por imagen, en particular con ecografía, pueden mejorar la fiabilidad de la ubicación de la infiltración de CS o AH, sobre todo en cadera.

          Translated abstract

          ABSTRACT Intra-articular steroids (IA CS) are frequently used for the treatment of pain in patients with osteoarthritis (OA) of both the knee and the hip, especially in the early stages, with a rapid onset of action providing short-term pain relief (1-6 weeks). IA CS do not clinically or significantly improve joint function of the knees or hips (stiffness, distance walked, or joint mobility) or quality of life. The efficacy of IA CS in hand OA is less evident. The risk of early adverse effects with the use of IA corticosteroids is very low. However, IA CS appear to have time- and dose-dependent side effects on articular cartilage. The infection rate after hip replacement does not increase with intra-articular injections, as long as there is enough time between the injection and the replacement (at least 3-6 months). In patients with knee OA, intra-articular hyaluronic acid (IA HA) has been shown to be effective in controlling pain in the medium term (5-13 weeks) that can be maintained until the long term (26 weeks) with less obvious functional results. The efficacy of HA in pain control and functionality in patients with hip and hand OA is less evident. The side effects of HA are local, generally mild and transitory. It is not well established if they are more frequent with HA of high molecular weight, HA of avian origin or repeated injections. Image-guided injections, particularly with ultrasound, can improve the reliability of the CS or HA injection location, especially in the hip.

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          Most cited references69

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          OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis

          To update and expand upon prior Osteoarthritis Research Society International (OARSI) guidelines by developing patient-focused treatment recommendations for individuals with Knee, Hip, and Polyarticular osteoarthritis (OA) that are derived from expert consensus and based on objective review of high-quality meta-analytic data.
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            2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee

            To develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA.
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              Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.

              Synovitis is common and is associated with progression of structural characteristics of knee osteoarthritis. Intra-articular corticosteroids could reduce cartilage damage associated with synovitis but might have adverse effects on cartilage and periarticular bone.
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                Author and article information

                Journal
                dolor
                Revista de la Sociedad Española del Dolor
                Rev. Soc. Esp. Dolor
                Inspira Network Group, S.L (Madrid, Madrid, Spain )
                1134-8046
                2021
                : 28
                : suppl 1
                : 64-72
                Affiliations
                [1] Las Palmas de Gran Canaria orgnameHospital Universitario de Gran Canaria Dr. Negrín orgdiv1Servicio de Reumatología España
                Article
                S1134-80462021000100064 S1134-8046(21)02800000064
                10.20986/resed.2021.3854/2020
                9fcbd04e-95fd-44c4-98d9-4f61b8000ad8

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 69, Pages: 9
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                SciELO Spain

                Categories
                Artículos

                esteroides,corticosteroid,corticoides,glucocorticoides,ácido hialurónico,viscosuplementación,Osteoarthritis,intraarticular injections,steroids,viscosupplementation,hyaluronic acid,glucocorticoids,Artrosis,osteoartritis,infiltraciones intrarticulares,inyecciones intrarticulares,corticosteroides

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