Diz Osteoartritinde Farmakolojik ve Nonfarmakolojik Tedavi Yöntemleri
Özet
Diz osteoartriti (OA) yönetiminde kullanılan farmakolojik ve nonfarmakolojik tedavi yöntemleri, TLAR, EULAR, OARSI, ACR ve ESCEO kılavuzlarının güncel önerileri doğrultusunda kapsamlı bir şekilde ele alınmaktadır. Dejeneratif bir eklem hastalığı olan osteoartrit tedavisinde nonfarmakolojik yaklaşımlar kapsamında hasta eğitimi, kilo yönetimi, ortezler, yürüme yardımcı cihazları, akuatik ve yer egzersizleri ile TENS, ultrason ve yüzeyel/derin sıcaklık ajanları içeren fizik tedavi uygulamaları incelenmektedir. Ayrıca Tai Chi, yoga, bilişsel davranışçı terapi, akupunktur ve kinezyobantlama gibi tamamlayıcı yöntemlerin klinik yansımaları değerlendirilmektedir. Farmakolojik basamakta ise asetaminofen, topikal ve oral nonsteroid anti-inflamatuar ilaçlar (NSAID), duloksetin, kapsaisin ve opioid analjeziklerin kullanımı analiz edilmektedir. Son dönemde popülerlik kazanan kurkumin, boswellia serrata, MSM ve undenature tip 2 kollajen gibi besin takviyeleri ile glukozamin ve kondroitin sülfat gibi SYSADOA grubu ajanların kılavuzlardaki yeri tartışılmaktadır. Eklem içi steroid, hyaluronik asit, PRP, ozon ve mezenkimal kök hücre enjeksiyonları ile proloterapi uygulamaları detaylandırılırken, Tanezumab ve Sprifermin gibi yeni monoklonal antikor ve büyüme faktörü tedavileri de tıp literatüründeki güncel kanıtlarıyla sunulmaktadır.
Pharmacological and non-pharmacological treatment modalities for knee osteoarthritis (OA) are evaluated comprehensively in accordance with recommendations from TLAR, EULAR, OARSI, ACR, and ESCEO guidelines. Non-pharmacological interventions addressed for this degenerative joint disease include patient education, weight loss, orthotics, assistive walking devices, aquatic or land-based exercises, and physical therapy modalities such as TENS, ultrasound, and thermal agents. Complementary strategies, including Tai Chi, yoga, cognitive behavioral therapy, acupuncture, and kinesio-taping, are also reviewed. Pharmacological analysis encompasses acetaminophen, topical and oral nonsteroidal anti-inflammatory drugs (NSAIDs), duloxetine, capsaicin, and opioid analgesics. The therapeutic status of dietary supplements like curcumin, boswellia serrata, MSM, and undenatured type 2 collagen, alongside SYSADOAs such as glucosamine and chondroitin sulfate, is discussed based on guideline consensus. Furthermore, intra-articular injection therapies, including corticosteroids, hyaluronic acid, platelet-rich plasma (PRP), ozone, mesenchymal stem cells, and prolotherapy, are examined. Finally, emerging biological interventions, including the anti-NGF monoclonal antibody tanezumab and the recombinant growth factor sprifermin, are highlighted with their clinical outcomes.
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