Efeitos clínicos da acupuntura e infiltração periarticular de corticosteróides no tratamento de gonartrose
DOI:
https://doi.org/10.11606/issn.2317-0190.v13i3a102731Palavras-chave:
Gonartrose, Acupuntura, Infiltração Local Periarticular de CorticosteróideResumo
Gonartrose é uma das doenças degenerativas mais comuns. Dor, deficiência e deformidade articular são os sinais clínicos dominantes. Objetivo do estudo: Comparar o efeito clínico obtido com três diferentes
modelos terapêuticos: 1. Acupuntura; 2. Infiltração local de corticosteróide; 3. Combinação de acupuntura e infiltração local de corticosteróide. Material e Métodos: Um estudo clínico prospectivo, aleatorizado, aberto incluiu 21 pacientes do sexo feminino em fase aguda de gonartrose. O diagnóstico foi feito através de exames clínicos e radiográficos. As pacientes foram divididas em três grupos: Grupo I: 7 pacientes com média de idade de 61,0 ± 6,8 anos, tratadas através de acupuntura com agulhas (pontas: Du20, Ex31, Ex32, St35, UB40, St44, UB60, Li4, Sp9,UB11), 10 tratamentos. Grupo II: 7 pacientes com 59,0 ± 10,1 anos, tratadas com infiltração de Betametasona – Diprofos, no primeiro dia de tratamento com abordagem frontal na parte lateral ou medial do tendão do músculo quadríceps. Grupo III: 7 pacientes, com 58,0 ± 6,07 anos, tratadas com uma combinação de infiltração inicial de Betametasona – Diprofos e acupuntura com agulhas, 10 tratamentos. A avaliação dos parâmetros de eficácia foi feita através dos seguintes parâmetros: 1. Dificuldades subjetivas – dor (Escala visual analógica – EVA de 0 a 100 mm); 2. tamanho do joelho, medido através do meio da patela em centímetros; 3. Amplitude de movimento articular (flexão), medida com um goniômetro. Todos esses parâmetros foram medidos no 1º, 8º e 21º dia de tratamento. ANOVA unifatorial, ANOVA de medida repetida e testes post hoc foram utilizados na análise estatística. Resultados: 1. Houve significativa melhora nos parâmetros de intensidade de dor e tamanho do joelho dentro dos grupos; ANOVA unifatorial, p<0,01; 2. Não houve melhora significativa no parâmetro de movimento articular dentro dos grupos; ANOVA unifatorial, p=0,528; 3. Houve melhoras significativas em todos os parâmetros (intensidade da dor, tamanho do joelho, movimento articular) nos três grupos; ANOVA de medida repetida, p<0,01. Conclusão: O tratamento combinado de acupuntura e infiltração de corticosteróide tem melhor efetividade em intensidade da dor, tamanho do joelho e melhora do movimento articular em comparação com a monoterapia.
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Referências
The Kneeguru Dictionary [dictionary on the Internet]. Worcester,UK: ftmg Associates Limited; 2004 [cited 2006 May 20]. Available from: http://www.kneeguru.co.uk/dictionary
Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001;60(2):91-7.
Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29(8):1039-49.
Hochberg MC, Altman RD, Brandt KD, Clark BM, Dieppe PA, Griffin MR, et al. Guidelines for the medical management of osteoarthritis. Part II. Osteoarthritis of the knee.American College of Rheumatology. Arthritis Rheum. 1995;38(11):1541-6.
Popovic M. i saradnici. Terapija reumaticnih oboljenja. Vojnoizdavacki Zavod, Beograd. 1999;7:306-8.
American Academy of Orthopaedic Surgeons.org [homepage on the Internet]. Rosemont: American Academy of Orthopaedic Surgeons;c1995 [cited 2006 May 20]. Available from: http://www.aaos.org/
Felson DT. Epidemiology of osteoarthritis. In: Brandt KD, Doherty M, Lohmander LS, editors. Osteoarthritis. Oxford: Oxford University Press; 2003.p. 9-16.
Guccione AA, Felson DT, Anderson JJ, Anthony JM, Zhang Y, Wilson PW, et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health. 1994;84(3):351-8.
Manek NJ, Lane NE. Osteoarthritis: current concepts in diagnosis and management. Am Fam Physician. 2000;61(6):1795-804.
Hochberg MC, Perlmutter DL, Hudson JI, Altman RD. Preferences in the management of osteoarthritis of the hip and knee: results of a survey of community-based rheumatologists in the United States. Arthritis Care Res. 1996;9(3):170-6.
Raynauld JP, Buckland-Wright C, Ward R, Choquette D, Haraoui B, Martel-Pelletier J, et al. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2003;48(2):370-7.
Hellman DB. Update in Rheumatology. Ann Intern Med. 2004;141(10):801-4.
Gray RG, Tenenbaum J, Gottlieb NL. Local corticosteriod injection treatment in rheumatic disorders. Semin. Arthritis rheum. 1981;10(4):231-54.
Gottlieb NL, Riskin WG. Complications of local corticosteroid injections. JAMA. 1980;243(5):1547-8.
Mayer DJ. Acupuncture: an evidence-based review of the clinical literature. Annu Rev Med. 2000;51:49-63.
Ernst E. Acupuncture as a symptomatic treatment of osteoarthritis: a systematic review. Scand J Rheumatol. 1997;26(6):444-7.
Ezzo J, Hadhazy V, Birch S, Lao L, Kaplan G, Hochberg M, et al. Acupuncture for osteoarthritis of the knee: a systematic review. Arthritis Rheum. 2001;44:819-25.
Felson DT, Chaisson CE, Hill CL, Totterman SM, Gale ME, Skinner KM, et al. The association of bone marrow lesions with pain in knee osteoarthritis. Ann Intern Med. 2001;134(7):541-9.
Hill CL, Gale DG, Chaisson CE, Skinner K, Kazis L, Gale ME, et al. Knee effusions, popliteal cysts, and synovial thickening: association with knee pain in osteoarthritis. J Rheumatol. 2001;28(6):1330-7.
Hill CL, Gale DR, Chaisson CE, Skinner K, Kazis L, Gale ME, et al. Periarticular lesions detected on magnetic resonance imaging: prevalence in knees with and without symptoms. Arthritis Rheum. 2003;48(10):2836-44.
Haraoui B, Pelletier JP, Cloutier JM, Faure MP, Martel-Pelletier J. Synovial membrane histology and immunopathology in rheumatoid arthritis and osteoarthritis. In vivo effects of antirheumatic drugs. Arthritis Rheum. 1991;34(2):153-63.
Konttinen YT, Kemppinen P, Segerberg M, Hukkanen M, Rees R, Santavirta S, et al. Peripheral and spinal neural mechanisms in arthritis, with particular reference to treatment of inflammation and pain. Arthritis Rheum. 1994;37(7):965-82.
Altman RD, Dean D. Pain in osteoarthritis. Introduction and overview. Semin Arthritis Rheum. 1989;18(4 Suppl 2):1-3.
Spector TD, Hart DJ, Nandra D, Doyle DV, Mackillop N, Gallimore JR. Low-level increases in serum C-reactive protein are present in early osteoarthritis of the knee and predict progressive disease. Arthritis Rheum. 1997;40(4):723-7.
Kazic T. Gotovi lekovi. V izdanje. Zlatni presek, Beograd; 1995. p.56.
Myers SL. Suppression of hyaluronic acid synthesis in synovial organ cultures by corticosteroid suspensions. Arthritis Rheum. 1985;28(11):1275-82.
Butler M, Colombo C, Hickman L, O'Byrne E, Steele R, Steinetz B, et al. A new model of osteoarthritis in rabbits. III. Evaluation of anti-osteoarthritic effects of selected drugs administered intraarticularly. Arthritis Rheum. 1983;26(11):1380-6.
Williams JM, Brandt KD. Triamcinolone hexacetonide protects against fibrillation and osteophyte formation following chemically induced articular cartilage damage. Arthritis Rheum. 1985;28(11):1267-74.
Pelletier JP, DiBattista JA, Raynauld JP, Wilhelm S, Martel-Pelletier J. The in vivo effects of intraarticular corticosteroid injections on cartilage lesions, stromelysin, interleukin-1, and oncogene protein synthesis in experimental osteoarthritis. Lab Invest. 1995;72(5):578-86.
Pelletier JP, Martel-Pelletier J, Cloutier JM, Woessner JF Jr. Proteoglycan-degrading acid metalloprotease activity in human osteoarthritic cartilage, and the effect of intraarticular steroid injections. Arthritis Rheum. 1987;30(5):541-8.
Myers SL, Brandt KD, O'Connor BL. Low dose prednisone treatment does not reduce the severity of osteoarthritis in dogs after anterior cruciate ligament transection. J Rheumatol. 1991;18(12):1856-62.
Mankin HJ, Conger KA. The acute effects of intra-articular hydrocortisone on articular cartilage in rabbits. J Bone Joint Surg Am. 1966;48(7):1383-8.
Cooper C, Kirwan JR. The risks of local and systemic corticosteroid administration. Baillieres Clin Rheumatol. 1990;4(2):305-32.
Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;(2):CD005328.
Pomeranz B, Stux G. Scientific bases of acupuncture. New York: Springer-Verlag; 1989.
Kaptchuk TJ. Acupuncture: theory, efficacy, and practice. Ann Intern Med. 2002;136(5):374-83.
Ferkovic M, Topalovic M. Akupunktura. Cetvrto izdanje. Skolska knjiga, Zagreb.1990;15-32.
Cho ZH, Chung SC, Jones JP, Park JB, Park HJ, Lee HJ, et al. New findings of the correlation between acupoints and corresponding brain cortices using functional MRI. Proc Natl Acad Sci U S A. 1998;95(5):2670-3.
Sun YM. Acupuncture and inflammation. International Journal of Chinese Medicine. 1984;1:15-20.
Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AM, Hochberg MC. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med. 2004;141(12):901-10.
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