Influência do grau de dor na efetividade da injeção intra-articular de hexacetonide de triancinolona em pacientes com osteoartrite de joelhos: um estudo de coorte
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Data
2024-05-08
Autores
Lucena, Germana 
Orientadores
Furtado, Rita
Tipo
Dissertação de mestrado
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Introdução: A osteoartrite (OA) é um distúrbio que envolve articulações móveis, caracterizado por estresse celular e degradação da matriz extracelular iniciada por micro e macro lesões que ativam repostas de reparo mal adaptativas, incluindo vias pró-inflamatórias de imunidade inata. A dor constitui seu principal sintoma, causando enorme impacto funcional aos pacientes. A infiltração intra-articular (IIA) com corticosteroides, como o hexacetonide de triancinolona (HT), tem sua efetividade comprovada, é intervenção presente em todas as recomendações detratamento e procedimento muito realizado na prática clínica. No entanto, não existem estudoscontrolados que avaliem o efeito da dor articular prévia ao procedimento na efetividade da IIA com HT em pacientes com OA de joelho. Objetivos: Comparar, entre pacientes com baixo nível e alto nível de dor articular no joelho, a efetividade da IIA com HT em pacientescom OA nessa articulação quanto à melhora da dor, função, porcentagem de melhora e qualidade de vida. Material e Métodos: Foi realizado estudo de Coorte prospectivo em pacientes com OA de joelhos captados dos ambulatórios da Disciplina de Reumatologia da Universidade Federal de São Paulo 3 UNIFESP. Os pacientes foram divididos em Grupo Menor Dor [escala visual analógica de dor (EVA 0-10cm) ao movimento f 5] e Grupo Maior Dor (EVA de dor ao movimento g 8), ambos com 35 pacientes, pareados para sexo, idade, Índice de Massa Corpórea e Classificação Radiológica de Kelgreen and Lawrence (KL). Os pacientes foram submetidos a uma única IIA com 40mg (2ml) de HT no joelho mais sintomático pelo mesmo reumatologista e submetidos à avaliação <cega= nas semanas T0 (antes da IIA), T4 e T12, segundo os seguintes instrumentos de avaliação: EVA (0-10cm) para dor ao movimento, EVA para dor ao repouso, questionário funcional WOMAC e seus 4 domínios, teste funcional Timed Up and Go (TUG), porcentagem de melhora de 20%, 50% e 70% da EVA de dor ao movimento, Questionário Genérico de Qualidade de Vida SF 36 e seus oito domínios e critério OMERECT/OARSI de melhora. Considerou-se uma diferença estatística de 5%. Resultados: Nesse estudo foram avaliados 70 pacientes, com idade média de 66,6 (7,8) anos, tempo médio de doença de 5,3 (5,5) anos, dos quais 86% eram mulheres, 27% se consideraram de cor branca, e 7%/7%/63% tinham classificação KL I/II/III. As médias de EVA de dor ao movimento e ao repouso no T0 foram, respectivamente, de 4,3 (0,6) e 4,0 (2,6) para o Grupo Menor Dor e de 8,1 (0,5) e 5,9 (1,9) para o Grupo Maior Dor. Em relação à variável EVA de dor ao repouso, o Grupo Menor Dor evoluiu com média de percentual de melhora de 81,3 (35,4) no T4 e 46,2 (59,7) no T12, enquanto o Grupo Maior Dor evoluiu com média de percentual de melhora de 72,4 (31,3) no T4 e 61,2 (40,4) no T12, com diferença estatística entre eles no T4 favorável para o Grupo Menor Dor. Em relação ao domínio Capacidade Funcional do Questionário Genérico de Vida SF-36, o Grupo Menor Dor evoluiu com médias de 43,7(19,8) no T0, para 77,4(23,7) no T4 e 64,4(24,2) no T12, enquanto o Grupo Maior Dor evoluiu com médias de 28,6(16,5) no T0, para 76,7(28,1) no T4, e 62,3(29,3) no T12, com diferença estatística favorável ao Grupo Maior Dor. Para todos os outros instrumentos de avaliação, não houve diferença estatística na comparação entre os grupos. Conclusões: Quando se comparou a efetividade da IIA com HT em joelhos de pacientes com OA, observou-se evolução estatisticamente favorável para o Grupo Menor Dor em relação à EVA de dor ao repouso e para o Grupo Maior Dor em relação ao domínio Capacidade Funcional do Questionário SF-36. Em relação à todas as outras variáveis avaliadas, não se observou diferença estatística entre os dois grupos.
Introduction: Osteoarthritis (OA) is disorder involving mobile joints, characterized by cellular stress and manipulation of extracellular matrix triggered by micro- and macro-injuries that activate maladaptive repair responses, including pro-inflammatory pathways of innate immunity. Its main symptom is pain, which causes enormous functional impact on patients. The intra-articular infiltration (IIA) with corticosteroids, such as triamcinolone hexacetonide (HT), is an intervention present in all treatment recommendations and it has proven to be an effective procedure frequently performed in clinical practice. However, there are no controlled studies that evaluate the effect of joint pain prior to the procedure on the effectiveness of IIA with HT in patients with knees affected by OA. Objectives: the present study aims to compare the effectiveness of IIA with HT in knees affected by OA between patients with low and severe levels of pain in terms of pain improvement, function, percentage of improvement and quality of life. Materials and Methods: A prospective cohort study was carried out in patients with knees affected by OA. The patients were taken from the outpatient clinics of the Discipline of Rheumatology at the Universidade Federal de São Paulo- UNESP. The patients were divided into two groups: The mild to moderate pain group [visual analogue pain scale (VAS 0-10 cm) for movement-Evoked pain f5] and major pain group (VAS for movement-Evoked pain g 8), both composed by 35 patients, matched for sex, age, Body Mass Index and Kelgreen and Lawrence (KL) Radiological Classification. The patients underwent a single IIA with 40mg (2ml) of HT in the most symptomatic knee by the same rheumatologist. In addition, they underwent "blind" evaluation in the weeks T0 (before the IIA), T4 and T12, according to the following evaluation instruments: VAS (0-10cm) for movement-Evoked pain and VAS for pain at rest, WOMAC functional questionnaire and its 4 domains, Timed Up and Go functional test (TUG), percentage of improvement of 20%, 50% and 70% of VAS for movement-Evoked pain, Generic Questionnaire Quality of Life SF-36 and its eight domains and OMERACT/OARSI improvement criteria. A statistical difference of 5% was considered. Results: In this study, 70 patients were evaluated, with average age of 66.6 (7.8) years, average disease duration of 5.3 (5.5) years, of which 86% were woman, 27% considered themselves to be white color, and 7%/7%/63% had KLI/II/III classification, respectively. The average VAS for movement-Evoked pain and at rest at T0 were, respectively, 4.3 (0.6) and 4.0 (2.6) for the mild to moderate pain group; 8.1 (0.5) and 5.9 (1.9) for the major pain group. Regarding to the VAS variable of pain at rest, the mild to moderate pain group evolved with an average percentage of improvement of 81.3 (35.4) at T4 and 46.2 (59.7) at T12, while the major pain group evolved with average percentage of improvement of 72.4 (31.3) at T4 and 61.2 (40.4) at T12, with a statistical difference between them at T4 favorable for the mild to moderate pain group. In relation to the Functional Capacity domain of the Generic Questionnaire Quality of Life SF-36, the mild to moderate pain group evolved with averages of 43.7 (19.8) at T0, to 77.4 (23.7) at T4 and 64.4 (24.2) at T12, while the major pain group evolved with averages from 28.6 (16.5) at T0, to 76.7 (28.1) at T4, and 62.3 (29.3) at T12, with statistical difference in favor of the major pain group. For all other assessment instruments, there was no statistical difference when comparing the groups. Conclusions: When comparing the effectiveness of IIA with HT in the knees of patients with OA, a statistically favorable evolution was observed for the mild to moderate pain group in relation to the VAS of pain at rest and for the major pain group in relation to the Functional Capacity domain of SF-36 questionnaire. In relation to all other variables evaluated, no statistical difference was observed between the two groups.
Introduction: Osteoarthritis (OA) is disorder involving mobile joints, characterized by cellular stress and manipulation of extracellular matrix triggered by micro- and macro-injuries that activate maladaptive repair responses, including pro-inflammatory pathways of innate immunity. Its main symptom is pain, which causes enormous functional impact on patients. The intra-articular infiltration (IIA) with corticosteroids, such as triamcinolone hexacetonide (HT), is an intervention present in all treatment recommendations and it has proven to be an effective procedure frequently performed in clinical practice. However, there are no controlled studies that evaluate the effect of joint pain prior to the procedure on the effectiveness of IIA with HT in patients with knees affected by OA. Objectives: the present study aims to compare the effectiveness of IIA with HT in knees affected by OA between patients with low and severe levels of pain in terms of pain improvement, function, percentage of improvement and quality of life. Materials and Methods: A prospective cohort study was carried out in patients with knees affected by OA. The patients were taken from the outpatient clinics of the Discipline of Rheumatology at the Universidade Federal de São Paulo- UNESP. The patients were divided into two groups: The mild to moderate pain group [visual analogue pain scale (VAS 0-10 cm) for movement-Evoked pain f5] and major pain group (VAS for movement-Evoked pain g 8), both composed by 35 patients, matched for sex, age, Body Mass Index and Kelgreen and Lawrence (KL) Radiological Classification. The patients underwent a single IIA with 40mg (2ml) of HT in the most symptomatic knee by the same rheumatologist. In addition, they underwent "blind" evaluation in the weeks T0 (before the IIA), T4 and T12, according to the following evaluation instruments: VAS (0-10cm) for movement-Evoked pain and VAS for pain at rest, WOMAC functional questionnaire and its 4 domains, Timed Up and Go functional test (TUG), percentage of improvement of 20%, 50% and 70% of VAS for movement-Evoked pain, Generic Questionnaire Quality of Life SF-36 and its eight domains and OMERACT/OARSI improvement criteria. A statistical difference of 5% was considered. Results: In this study, 70 patients were evaluated, with average age of 66.6 (7.8) years, average disease duration of 5.3 (5.5) years, of which 86% were woman, 27% considered themselves to be white color, and 7%/7%/63% had KLI/II/III classification, respectively. The average VAS for movement-Evoked pain and at rest at T0 were, respectively, 4.3 (0.6) and 4.0 (2.6) for the mild to moderate pain group; 8.1 (0.5) and 5.9 (1.9) for the major pain group. Regarding to the VAS variable of pain at rest, the mild to moderate pain group evolved with an average percentage of improvement of 81.3 (35.4) at T4 and 46.2 (59.7) at T12, while the major pain group evolved with average percentage of improvement of 72.4 (31.3) at T4 and 61.2 (40.4) at T12, with a statistical difference between them at T4 favorable for the mild to moderate pain group. In relation to the Functional Capacity domain of the Generic Questionnaire Quality of Life SF-36, the mild to moderate pain group evolved with averages of 43.7 (19.8) at T0, to 77.4 (23.7) at T4 and 64.4 (24.2) at T12, while the major pain group evolved with averages from 28.6 (16.5) at T0, to 76.7 (28.1) at T4, and 62.3 (29.3) at T12, with statistical difference in favor of the major pain group. For all other assessment instruments, there was no statistical difference when comparing the groups. Conclusions: When comparing the effectiveness of IIA with HT in the knees of patients with OA, a statistically favorable evolution was observed for the mild to moderate pain group in relation to the VAS of pain at rest and for the major pain group in relation to the Functional Capacity domain of SF-36 questionnaire. In relation to all other variables evaluated, no statistical difference was observed between the two groups.
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Citação
LUCENA, Germana Ribeiro Araujo Carneiro de. Influência do grau de dor na efetividade da injeção intra-articular de hexacetonide de triancinolona em pacientes com osteoartrite de joelhos: um estudo de coorte. 2024. 84 f. Dissertação (Mestrado) – Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2024.