DEGENERATIVE ARTICULAR CARTILAGE DISEASE, OSTEOARTHROSIS

Abstract

Introduction: Osteoarthrosis (OA), degenerative articular cartilage disease is a chronic inflammatory arthropathy involving joint elements (subchondral bone, synovial membrane, hyaline cartilage and others). It is due to a disorder in the regulation between degradation and synthesis of the extracellular matrix of cartilage, involving bone and synovial membrane in a biochemical process mediated by growth factors and cytokines which, in turn, intervene in the course of bone remodeling and joint destruction.

Objective: to detail the current information related to osteoarthrosis, description, etiology, classification, imaging classification, management and current treatments.

Methodology: a total of 52 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 38 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: arthrosis, osteoartrose, bones, osteoartrosis, articular cartilage.

Results: The prevalence of osteoarthrosis increases directly with age 25-35 years 0.1 % 35-65 years 30 % and over 80 years 80-100 %. An improvement of pain and sensitivity is observed with local treatment with capsaicin. Paracetamol can be considered as the basic analgesic in the treatment of most chronic osteoarticular pain in doses of 1 gram four times/day. Opioids have an analgesic effect that almost completely eliminates all kinds of pain regardless of its intensity or site of affection. Short-term and long-term parenteral corticosteroid use is effective in controlling pain and stiffness. Systemic use of corticosteroids in OA is not warranted and only intra-articular injections are advised. Diacerein decreases IL 1Beta production in cartilage as well as nitric oxide levels by antagonizing the catabolic process and stimulates the anabolic process of cartilage. Chondroitin sulfate does not present a clinically relevant effect on joint pain or joint space reduction.

 Conclusions: osteoarthritis should be considered as a chronic, irreversible and progressive lesion. There are factors that aggravate its prognosis. Many measures are recommended to the patient and his family, especially if it is an elderly patient, in order to avoid the progression of joint damage. Surgical treatment is reserved for patients with severe pain or marked deformity, which occurs in advanced OA. Among the most frequently used procedures are: valgus osteotomy of the proximal tibia, arthroplasty, arthrodesis and amniotic membrane implantation. Bone tissue regenerative currents using tetracyclines that prevent the activation of metalloproteases, autologous chondrocyte implants, hypoxia inducible factor (HIF-1/2a), parathyroid hormone that stimulates chondrocyte multiplication and the use of in situ stem cells, cartilage regeneration and a better understanding of the developmental protein ancestor of osteogenesis, will be part of the medical management protocol, being a promising therapy for future therapy.