Nefarmakološko liječenje osteoartritisa utemeljeno na dokazima

Ivan Vlak, Tonko Vlak

Osteoarthritis (OA ) is the most common rheumatic joint disease, but also a disease that affects the entire joint and all structures surrounding the joint (periarticular structures). Literature dealing with this topic most commonly includes results related to the treatment of knee osteoarthritis (OA ), while other localisations of degenerative changes of the joints are not researched in such a detailed way. In addition to that, these degenerative changes exhibit less evidence strength, so the same will be used in this review. According to the latest 2019 ESCEO guidelines for the treatment of OA , non-pharmacological treatment (NPT) has an important role in OA treatment and it is a part of all OA treatment algorithms, and it has to be a part of evidence-based medicine (EBM). With technological progress in rehabilitation medicine, new solutions have appeared, as well as new forms of NPT aimed at helping patients, relieving pain, increasing the patients’ functional ability and improving their quality of life. Due to this, in this literature review, which was accessed through the Cochrane library, PEDro database and PubMed search, we mostly found discussions about new technologies in OA treatment. During that search, we can easily conclude that results of many systematic reviews and meta-analyses about the use of conventional methods of physical therapy did not change much compared to the methods used 10 years ago.
When it comes to all of these methods, medical exercise is considered to be the most effective one, with the highest evidence strength. Nowadays, as opposed to literature sources in the past, in most literature we are able to find a significantly more accurate and precise definition of the term “physical activity”. It is defined as an activity performed during an individual’s stay at their workplace, during transport, while doing one’s chores or housework, and durin leisure time. We believe that the newest, modern technologies in rehabilitation medicine, such as the following ones: high-intensity laser therapy (HILT ), extracorporeal shock wave therapy (ESWT), radio frequency (RF) and electromagnetic therapy super inductive system (SIS ), present the biggest challenge in the NPT of OA today. These treatment methods, according to the available EBM data, have shown outstanding efficiency in the treatment of OA by reducing the patients’ pain, improving patients’ functional ability as well as their quality of life, with minimal adverse effects. Today, the general opinion is that we should give advantage to modern technologies in combination with already well- known and defined medical exercises with implementing preventive activities.

Osteoartritis (OA ) najčešća je reumatska bolest zgloba i svih okolozglobnih struktura. U literaturi su najčešće zastupljeni rezultati vezani uz liječenje OA koljena, a ostale lokalizacije degenerativnih promjena zglobnih struktura manje su istraživane. Pritom su i dokazi manje snage pa će tako biti i u ovome preglednom članku. Prema ažuriranim smjernicama ESCEO-a iz 2019. g., bitnu ulogu u liječenju bolesnika s OA ima i nefarmakološko liječenje (NFL) – dio svih algoritama liječenja OA , uz preporuku da mora biti utemeljeno na dokazima (EBM). Tehnološki napredak u rehabilitacijskoj medicini nudi neka nova rješenja, nove oblike NFL-a radi pomoći bolesnicima, uklanjanja boli i povećanja funkcionalnih mogućnosti, čime se poboljšava i kvaliteta života. Zbog toga se u literaturi koja je dostupna pregledom Cochraneove knjižnice, baze PEDro i tražilice PubMed danas najčešće raspravlja o novim tehnologijama u liječenju OA . Primjećujemo da se rezultati brojnih sustavnih pregleda i metaanaliza o primjeni konvencionalne fizikalne terapije nisu bitno promijenili u odnosu prema onima u sličnim analizama i prije 10-ak godina. Najučinkovitijom metodom, uz najkvalitetniju snagu dokaza, smatra se medicinska vježba. No, za razliku otprije, danas u literaturi nalazimo znatno točniju i precizniju definiciju pojma tjelesne aktivnosti: to je aktivnost tijekom boravka na radnome mjestu, za vrijeme transporta, tijekom obavljanja kućanskih poslova i u slobodno vrijeme. Najveći izazov u NFL-u OA danas jesu moderne tehnologije u rehabilitacijskoj medicini, a to su terapije laserom visokog intenziteta (HILT ), udarnim valom (ESWT), radiofrekvencijom (RF) i elektromagnetskim poljem visokog intenziteta (SIS ). Te metode liječenja, prema dostupnim podatcima EBM-a, pokazale su izrazitu učinkovitost u liječenju OA : reduciranu bol kod ispitanika, poboljšane funkcionalne sposobnosti i kvalitetu života bolesnika. Sve to uz izrazito malo neželjenih događaja. Danas je uvriježeno mišljenje da treba davati prednost modernim tehnologijama, dobro definiranim medicinskim vježbama i provođenju preventivnih aktivnosti.