Tratamiento de Primera Línea para la Artrosis del Pulgar

La artrosis del pulgar es una causa frecuente de dolor en la articulación basal y limitación funcional. Las guías clínicas actuales convergen en un enfoque farmacológico estructurado de primera línea, con la selección del agente adaptada a la tolerabilidad individual del paciente, las contraindicaciones y el riesgo gastrointestinal.

Enfoque de tratamiento — resumen parcial

El manejo de primera línea se centra en la terapia antiinflamatoria — las formulaciones tópicas cuentan con un respaldo sólido en las guías clínicas, mientras que los agentes antiinflamatorios orales son una alternativa con cobertura gastroprotectora recomendada para pacientes con riesgo gastrointestinal elevado; existe una opción analgésica disponible para quienes presentan contraindicaciones o intolerancias, y un suplemento con recomendación condicional en las guías para la artrosis de mano también está incluido en el protocolo. La selección completa de agentes, umbrales de dosificación y secuenciación se encuentran en el protocolo completo…

Acceso Instantáneo a Regímenes Estructurados Basados en Evidencia

References

DOI: 10.1016/j.rdc.2022.03.009.

Topical NSAIDs were uniformly strongly recommended for knee OA by all guidelines and were strongly and conditionally recommended for hand OA by EULAR and ACR/AF, respectively, with the strength of recommendation influenced by practicality of using topical agents on finger joints.

Oral NSAIDs were generally recommended for all sites of OA, but strength of recommendations (conditional/weak versus strong) varied among guidelines, primarily reflecting concerns about adverse effects.

The only guidelines that provided a strong recommendation for acetaminophen were AAOS for the knee and EULAR for the hand.

Acetaminophen is no longer considered "first-line" for OA due to its relative poor efficacy, though it is still an option for those who have contraindications or intolerances to NSAIDs.

Chondroitin, on the other hand, had a conditional recommendation for its use in hand OA by both EULAR and ACR/AF on the basis of a single trial that had low risk of bias, and none of the guidelines recommended chondroitin for other sites with the exception of ESCEO which again provided a strong recommendation for its use in knee OA.

Consider adding proton pump inhibitor or misoprostol in patients at risk for upper gastrointestinal events who require treatment with NSAIDs or COX-2 inhibitors.

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