Uso intra-articular do plasma rico em plaquetas versus triancinolona hexacetonida versus solução salina em osteoartrite de joelhos: um estudo controlado randomizado duplo cego com seguimento de um ano

• Ano de defesa: 2020
• Autor(a) principal: Tamashiro, Jose Carlos Nunes [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Plasma Rico Em Plaquetas; Osteoartrite; Cartilagem; Infiltração Intra-Articular; Osteoartrite De Joelho
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=8859254; https://hdl.handle.net/11600/64652

INTRODUCTION: Intra-articular (IIA) injection of Platelet-Rich Plasma (PRP) has been considered a therapeutic option for knee osteoarthritis (OA). However, studies comparing this intervention with corticosteroid IIA or saline are rare. Objectives: To compare the effect of PRP versus triamcinolone hexacetonide (TH) vs. saline solution (isotonic SS at 0.9%) on improvement of pain, function, perception of improvement, ultrasound measurement of synovial hypertrophy and long-term radiographic evolution (52 weeks) in knee OA patients. Methods: A double-blind prospective, randomized controlled trial was conducted in 100 symptomatic knee OA patients. Patients were randomized into three IIAs groups (one single IIA in the most symptomatic knee): PRP group (n = 34), TH group (n = 33) and SS group (n = 33). The evaluations were performed by both "blind" clinician and radiologist. Evaluation tools: visual analogue scale (EVA of 0-10) of pain at rest (EVAr) and movement (EVAm), WOMAC questionnaire, Timed Up and Go test (TUG), improvement rate, Likert improvement scale, ultrasound measurement of knee synovial hypertrophy and radiographic evolution according to Kellgren and Lawrence – KL scale). Five evaluation times were used: T0 and T4, T8, T12 and T52 weeks. Results: A total of 100 patients, 90 (90%) women and 10 men (10%) were studied, with a mean age of 67.13 (± 6.56) years and symptom time of 8.03 (± 5.9) years. In the initial evaluation, the groups were homogeneous for all parameters except for time of symptoms, higher in PRP group. The analysis between the groups at the end of the study, using GLM test for repeated measures, showed a statistically significant difference between groups for the following variables: for WOMAC PAIN at T4, TH group obtained a mean better than PRP group {3.24 (± 2.92) versus 5.38 (± 3.05); p = 0.047); for WOMAC RIGIDITY in T12, TH group obtained a mean better than SS group (1.12 (± 1.34) versus 2.39 (± 1.41); p = 0.035). For WOMAC FUNCTION at T4, TH group had a better mean than SS (13.1 (± 10.6) versus 23.9 (± 11.5); p = 0.005); in T8 (TH 15.0 (± 11.4) versus PRP 14.4 (± 11.6) versus SS 24.3 (± 10.1)) TH group (p = 0.031) and PRP group (p = 0.018) evolved better than SS group, but without difference between TH and PRP groups (p = 1.00); in T12 (TH 12.1 (± 10.3) versus PRP 13.5 (± 10.5) versus SS 24.2 (± 11.5)) TH group (p = 0.03) and PRP group (p = 0.014) evolved better than SS group, but with no difference between TH and PRP groups xvii (p = 1.00); in T52 (TH 14.2 (± 12.1) versus PRP 12.0 (± 10.8) versus SS 24.6 (± 12.2)) TH group (p = 0.018) and PRP group (p = 0.002) evolved better than SS group, but with no difference between TH and PRP groups (p = 1.00); for improvement percentage, TH group evolved better than SS group at all times (p = 0.032); for radiographic evolution, PRP group was the one with the lowest radiographic classification from KLII to KL III (p = 0.015 in relation to SS group). Conclusion: The TH group was superior to others by percentage of improvement and by WOMAC PAIN and RIGIDITY. For WOMAC FUNCTION, SS group was lower than others. For radiographic evolution according to KL, PRP group showed the lowest progression.