Rev. Soc. Esp. Dolor. 2024; 31(3): 157-164 / DOI: 10.20986/resed.2025.4105/2023
Elena Oliver, Elena Cañadillas, Jacobo Yáñez, Cilia Peralta, Pilar del Río, Eva Palero
RESUMEN
Introducción: La artrosis (OA) es una enfermedad degenerativa que ocasiona cuadros dolorosos con importante limitación funcional. Actualmente, la tasa de éxito terapéutico del tratamiento conservador de la OA es altamente mejorable, lo que favorece el interés por encontrar nuevas terapias eficaces para su manejo. La radioterapia a dosis bajas (RT-DB) se ha utilizado desde hace años para aliviar los síntomas de la OA, sin embargo, en muchos países no se ha extendido su uso debido a la ausencia de una base científica consolidada que apoye su eficacia. Recientemente, se han publicado varios artículos con resultados prometedores respaldados por cierta evidencia científica gracias a diseños aleatorizados y controlados.
Nuestro objetivo es describir los resultados de estas investigaciones, que han analizado la eficacia, seguridad y base patogénica de la RT-DB.
Método: Se realizó una búsqueda sistemática de la literatura publicada en las bases de datos PubMed, Embase y Cochrane. Para describir la eficacia, únicamente se seleccionaron ECA y EO prospectivos.
Resultados: Se observó el poder antinflamatorio y osteoformador de la RT-DB en un total de 6 investigaciones experimentales. Para evaluar la eficacia se incluyeron 10 estudios, que mostraron resultados positivos, salvo dos ECA que no encontraron diferencias respecto a placebo. En cuanto a la seguridad de esta terapia, parece descartarse la asociación de eventos adversos graves inmediatos.
Conclusiones: Las últimas investigaciones parecen apoyar la hipótesis de que la RT-DB puede resultar eficaz para mitigar la repercusión clínica de la OA, lo cual parece fundamentarse en su efecto antinflamatorio a nivel del cartílago. Sin embargo, aunque es indiscutible la gran afluencia de ECA en comparación con décadas anteriores, persiste la necesidad de mejorar el diseño metodológico de nuevas investigaciones que se lleven a cabo, fundamentalmente a través de muestras de mayor tamaño, participación multicéntrica y comparación con otras terapias disponibles.
ABSTRACT
Introduction: Osteoarthritis (OA) is a degenerative disease that causes painful conditions with significant functional limitation. Currently, the therapeutic success rate of conservative treatment of OA can be improved, which favors the interest in finding new effective therapies for its management. Low-dose radiotherapy (LD-RT) has been used for years to alleviate the symptoms of OA; however, in many countries this therapy is not widely used due to the absence of a solid scientific basis. Recently, several articles have been published with promising results supported by some scientific evidence thanks to randomized and controlled designs.
Our objective is to describe the results of these recently published investigations, which have analyzed the effectiveness, safety and pathogenic basis of RT-DB.
Methods: A systematic search of the published literature was performed in Pubmed, Embase and Cochrane databases. To describe efficacy, only RCTs and prospective OEs were selected.
Results: The anti-inflammatory and osteoforming power of RT-DB was observed in a total of 6 investigations. To evaluate efficacy, 10 studies were included, all of which showed positive results, except for two RCTs that found no differences with respect to placebo. Regarding the safety of this therapy, the association of immediate serious adverse events seems to be ruled out.
Conclusions: The latest research seems to support the hypothesis that RT-DB may be effective in mitigating the clinical impact of OA, which seems to be based on its anti-inflammatory effect at the cartilage level. However, although the large influx of RCTs compared to previous decades is indisputable, there is still a need to improve the methodological design of new research, mainly through larger sample sizes, multicenter participation and comparison with other available therapies.
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