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      Evaluación de los tratamientos del dolor crónico en artrosis Translated title: Evaluation of chronic pain treatments in arthrosis

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          Abstract

          Abstract La artrosis es una enfermedad degenerativa de las articulaciones, con una prevalencia del 10% en España, siendo la primera causa de discapacidad. El principal síntoma, y hacia el cual se dirigen la mayoría de las terapias, es el dolor. El objetivo de esta revisión bibliográfica es saber cómo se puede tratar esta enfermedad, cuales son las terapias en investigación, mostrando estudios ejemplo que nos ayuden a sacar conclusiones. Se realiza a través de la consulta de diferentes fuentes bibliográficas. Existe un tratamiento no farmacológico basado en la educación sanitaria del paciente, incluyendo prácticas como la acupuntura o los ultrasonidos, determinados alimentos, ejercicio físico y plantas medicinales. También existe un tratamiento farmacológico con analgésicos y antiinflamatorios vía oral y de acción rápida, para aliviar el dolor, como paracetamol y AINES, opioides débiles y opioides fuertes que se usan vía transdérmica en esta patología; y por último capsaicina o AINES vía tópica. Existen fármacos modificadores de la enfermedad denominados SYSADOA de acción lenta, como el condroitín sulfato, sulfato de glucosamina y diacereína. En ocasiones se hacen infiltraciones articulares con ácido hialurónico y corticoides para que actúe de forma local y sea más eficaz, e incluso a veces con toxina botulínica y otras sustancias que veremos. El tratamiento quirúrgico es otra alternativa, pero no hablaremos de ella en nuestro trabajo. El tratamiento de la artrosis se centra sobre todo en aliviar el dolor de los pacientes y mejorar su calidad de vida.

          Translated abstract

          Abstract Osteoarthritis is a degenerative disease of the joints, with a prevalence of 10% in Spain, being the leading cause of disability. The main symptom, and towards which most of the therapies are directed, is pain. The objective of this bibliographic review is to know how this disease can be treated, which are the therapies under investigation, showing example studies that help us draw conclusions. It is done through the consultation of different bibliographic sources. There is a non-pharmacological treatment based on the health education of the patient, including practices such as acupuncture or ultrasounds, certain foods, physical exercise and medicinal plants. There is also a pharmacological treatment with oral and fast-acting analgesics and anti-inflammatories, to relieve pain, such as paracetamol and NSAIDs, weak opioids and strong opioids that are used transdermally in this pathology; and finally capsaicin or NSAIDs topically. There are disease-modifying drugs called SYSADOA slow-acting, such as chondroitin sulfate, glucosamine sulfate, and diacerein. Sometimes joint infiltrations are made with hyaluronic acid and corticosteroids to act locally and be more effective, and even sometimes with botulinum toxin and other substances that we will see. Surgical treatment is another alternative, but we will not talk about it in our work. Treatment of osteoarthritis is primarily focused on relieving pain for patients and improving their quality of life.

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          Aerobic walking or strengthening exercise for osteoarthritis of the knee? A systematic review.

          To compare the efficacy of aerobic walking and home based quadriceps strengthening exercises in patients with knee osteoarthritis. The Medline, Pubmed, EMBASE, CINAHL, and PEDro databases and the Cochrane controlled trials register were searched for randomised controlled trials (RCTs) of subjects with knee osteoarthritis comparing aerobic walking or home based quadriceps strengthening exercise with a non-exercise control group. Methodological quality of retrieved RCTs was assessed. Outcome data were abstracted for pain and self reported disability and the effect size calculated for each outcome. RCTs were grouped according to exercise mode and the data pooled using both fixed and random effects models. 35 RCTs were identified, 13 of which met inclusion criteria and provided data suitable for further analysis. Pooled effect sizes for pain were 0.52 for aerobic walking and 0.39 for quadriceps strengthening. For self reported disability, pooled effect sizes were 0.46 for aerobic walking and 0.32 for quadriceps strengthening. Both aerobic walking and home based quadriceps strengthening exercise reduce pain and disability from knee osteoarthritis but no difference between them was found on indirect comparison.
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            Osteoarthritis of the knee and hip and activity: a systematic international review and synthesis (OASIS).

            The goal of this study was to determine which activities in four domains, daily life, exercises, sports and occupational activities, should be recommended, in favor or against, for the patient suffering from knee or hip OA. Scientific literature was searched in Medline, Embase and Cochrane databases for articles in French or English, reporting original data. The articles were evaluated with standardized epidemiological criteria. Seventy-two articles were retained. Recommendations were graded according to the level of scientific evidence (A high, B moderate, C clinical consensus) and were formulated for primary care. For activity of daily life (ADL), the OASIS group states with a moderate level of scientific evidence, that ADL are a risk factor for knee OA and that risk increases with intensity and duration of activity. The group concludes that healthy subjects as well as OA patients in general can pursue a high level of physical activity, provided the activity is not painful and does not predispose to trauma (grade B). Radiographic or clinical OA is not a contraindication to promoting activity in patients who have a sedentary lifestyle (grade C). For exercises and other structured activities pursued with a goal of health improvement, the group states with a high level of scientific evidence that they have a favourable effect on pain and function in the sedentary knee OA patient. The OASIS group recommends the practice of exercises and other structured activities for the sedentary patient with knee OA (grade A). Static exercises are not favored over dynamic exercises, availability, preference and tolerance being the criteria for the choice of an exercise (grade A). As results deteriorate when exercises are stopped, they should be performed at a frequency of between one and three times per week (grade B). Professional assistance can be useful in improving initial compliance and perseverance (grade B). There is no scientific argument to support halting exercise in case of an OA flare-up (grade C). For sports and recreational activity, the group states with a high degree of scientific evidence, that these activities are a risk factor for knee and hip OA and that the risk correlates with intensity and duration of exposure. The group also states, with a high degree of scientific evidence, that the risk of OA associated with sport is lesser than that associated with a history of trauma and overweight. No firm conclusion could be drawn about the possible protective role of sports such as cycling, swimming or golf. The OASIS group recommends that athletes should be informed that joint trauma is a greater risk factor than the practice of sport (Grade A). The high level athlete should be informed that the risk of OA is associated with the duration and intensity of exposure (Grade B). The OA patient can continue to engage regularly in recreational sports as long as the activity does not cause pain (Grade C). The OA patient who practices a sport at risk for joint trauma should be encouraged to change sport (Grade C). For occupational activity, the OASIS group states with a high level of scientific evidence that there is a relationship between occupational activity and OA of the knee and hip. The precise nature of biomechanical stresses leading to OA remains unclear but factors such as high loads on the joint, unnatural body position, heavy lifting, climbing and jumping may contribute to knee and hip OA. The group recommends that taking an occupational history should always be part of managing the OA patient (Grade B). In the knee or hip OA patient, work-related activity that produces or maintains pain should be avoided (Grade B). Physicians should be alerted by the early knee and hip signs and symptoms in workers exposed to stresses that are known or supposed to favour knee or hip OA (Grade C).
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              The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial.

              To test the effects of a high intensity home-based progressive strength training program on the clinical signs and symptoms of osteoarthritis (OA) of the knee. Forty-six community dwelling patients, aged 55 years or older with knee pain and radiographic evidence of knee OA, were randomized to a 4 month home based progressive strength training program or a nutrition education program (attention control). Thirty-eight patients completed the trial with an adherence of 84% to the intervention and 65% to the attention control. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index pain and physical function subscales. Secondary outcomes included clinical knee examination, muscle strength, physical performance measures, and questionnaires to measure quality of life variables. Patients in the strength training group who completed the trial had a 71% improvement in knee extension strength in the leg reported as most painful versus a 3% improvement in the control group (p < 0.01). In a modified intent to treat analysis, self-reported pain improved by 36% and physical function by 38% in the strength training group versus 11 and 21%, respectively, in the control group (p = 0.01 for between group comparison). In addition, those patients in the strength training group who completed the trial had a 43% mean reduction in pain (p = 0.01 vs controls), a 44% mean improvement in self-reported physical function (p < 0.01 vs controls), and improvements in physical performance, quality of life, and self-efficacy when compared to the control group. High intensity, home based strength training can produce substantial improvements in strength, pain, physical function and quality of life in patients with knee OA.
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                Author and article information

                Journal
                jonnpr
                Journal of Negative and No Positive Results
                JONNPR
                Research and Science S.L. (Madrid, Madrid, Spain )
                2529-850X
                2021
                : 6
                : 8
                : 997-1033
                Affiliations
                [2] orgnameEAP Zona 5 A. España
                [3] Zaragoza orgnameHospital Clínico Universitario Lozano Blesa Spain
                [5] orgnameUCLM España
                [1] Albacete orgnameHospital General de Albacete orgdiv1Servicio Urgencias España
                [4] Almansa orgnameHospital Almansa España
                Article
                S2529-850X2021000800997 S2529-850X(21)00600800997
                10.19230/jonnpr.3998
                da718030-0b9d-4662-876f-ecec4fd88cc5

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

                History
                : 22 March 2021
                : 21 September 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 58, Pages: 37
                Product

                SciELO Spain

                Categories
                Original

                Artrosis,Tratamiento dolor,ejercicio,antiinflamatorios,Osteoarthritis,Pain treatment,exercise,anti-inflammatories

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