Centros de excelência no manejo da osteoartrite na América Latina: uma proposta baseada em uma revisão da literatura
Discussões e conclusões
Discussion
By centralizing expertise and resources, CoEs can deliver comprehensive, multidisciplinary care tailored to the individual needs of patients. This model aligns with international standards and optimizes resource utilization, resulting in improved patient outcomes (11,20).
A well-structured CoE-OA requires a robust infrastructure, including specialized clinical facilities, advanced diagnostic tools, and rehabilitation services. The center should be staffed with healthcare professionals trained in the multidisciplinary management of OA, such as rheumatologists, orthopedic specialists, physiatrists, physiotherapists, psychologists, and other allied health providers. Additionally, educational and research initiatives should be integrated into the center’s operations to foster continuous learning and promote evidence-based practices in OA management.
Early Diagnosis and Screening Programs
Early diagnosis is fundamental to effective OA management. Many patients are diagnosed only after significant joint damage has occurred, which negatively impacts long-term outcomes. Screening programs targeting high-risk individuals—such as those in physically demanding occupations or those with metabolic conditions—are essential. Advances in imaging technologies and biomarkers present opportunities for earlier detection, allowing for timely intervention before the disease progresses (8–15).
Multidisciplinary Approach and Phenotyping
The PANLAR guidelines stress the importance of a comprehensive, multidisciplinary approach to OA management. This involves regular follow-ups with various specialists and utilizing diagnostic imaging and lab tests to monitor disease progression. Imaging techniques like X-rays, ultrasound, and MRI are crucial for precise assessment and tracking (11,17).
Implementing phenotyping in OA management allows for more personalized treatment strategies. A multidisciplinary team—including rheumatologists, physiotherapists, pain specialists, and nutritionists—should tailor interventions based not only on phenotypic classifications but also on patient-specific factors, such as comorbid conditions, to optimize management (12)
Flexible Management Protocols
A flexible management protocol based on the PANLAR guidelines enables phenotype-specific treatment strategies. Combining pharmacological treatments (e.g., paracetamol, NSAIDs, viscosupplementation, DMOAs/SYSADOAs) with non-pharmacological approaches, including physical therapy and weight management, enhances treatment adherence and improves patient outcomes (12, 24–27). Non-pharmacological strategies are particularly beneficial for managing mechanical and metabolic OA. Complementary therapies such as yoga, tai chi, and acupuncture also show promise in managing symptoms and improving patient functionality. Surgery is reserved for severe cases where conservative treatments fail, with joint replacement considered as a final option (11,19).
Periodic Evaluations and Outcome Monitoring
Periodic evaluations are vital to assess the center’s impact on patient outcomes and its overall effectiveness. Clinimetrics should be incorporated into routine evaluations to monitor OA progression and assess the impact of care on patients’ quality of life. By tracking key clinical outcomes, such as functional status and pain levels, CoEs can provide valuable data on the benefits of specialized OA care.
Telemedicine and Remote Care
Telemedicine is a key component of the CoE model, particularly in regions with limited access to care. Virtual consultations and remote monitoring help improve patient adherence to treatment plans and provide continuous support, which is especially beneficial for chronic conditions like OA (43–44). Telemedicine can also be instrumental in enhancing access to care for patients in rural or underserved areas.
To ensure successful implementation, it is crucial to establish criteria for selecting patients who will benefit most from telemedicine, ensuring both effectiveness and adaptability to various settings. Patients who are technologically proficient, have access to necessary equipment, and are motivated to engage in remote care are ideal candidates for telemedicine. This approach can be particularly beneficial for those with mild to moderate OA, especially in the disease’s early stages. For more advanced cases requiring complex interventions, telemedicine can still serve as a supplementary tool for follow-up consultations, education, and monitoring.
Long-Term Follow-Up
Long-term follow-up is essential for managing OA effectively. Regular use of patient-reported outcome measures (PROMs) and imaging ensures that treatment plans evolve alongside the patient’s condition, preventing deterioration and optimizing quality of life. Ongoing evaluations allow for timely adjustments to treatment strategies, ensuring their continued relevance as the disease progresses.
The establishment of CoEs-OA management is critical in addressing the rising prevalence and growing burden of OA, especially in regions such as Latin America. The available data on weight-bearing OA highlights its significant impact on patients' quality of life, with substantial economic burdens that vary according to the healthcare systems of different countries. Current evidence underscores the considerable burden of OA in Latin America (45).
In summary, a CoE for OA should be a specialized healthcare program that centralizes expertise and resources to provide comprehensive, multidisciplinary care tailored to OA patients. Key components of the center should include early diagnosis through advanced imaging and biomarkers, a personalized approach based on OA phenotypes, and a multidisciplinary team to address the complex needs of patients. Evidence-based pharmacological and non-pharmacological treatments, such as exercise programs, weight management, and patient education, should be integrated into the care model. Additionally, telemedicine should be leveraged to improve access to care, especially for remote populations. Long-term follow-up and continuous monitoring should be core to the program’s approach.
CoEs offer several advantages over the current fragmented approach to OA management. These include enhanced care coordination, more personalized treatment, and optimized resource utilization. Such centers could also help reduce healthcare costs by preventing or delaying costly interventions, such as knee or hip joint replacements, through early, comprehensive OA management.
The economic benefits of establishing CoEs for OA are significant, not only in terms of direct healthcare savings but also by reducing the broader economic burden on patients and society. By effectively managing OA, the need for surgical interventions and long-term disability could be minimized, leading to lower healthcare costs and reduced lost productivity.
To clearly present this proposal, we recommend a detailed outline the CoE design, focusing on infrastructure, services, and educational and research components. The justification for establishing CoEs for OA is grounded in their potential to improve patient outcomes, reduce costs, and advance knowledge in the field.
Conclusions
Centers of Excellence (CoEs) for osteoarthritis (OA) represent a transformative opportunity to elevate patient care through early diagnosis, multidisciplinary treatment, and a combination of pharmacological and non-pharmacological strategies. By implementing PANLAR guidelines and tailoring interventions to individual phenotypes, CoEs can deliver comprehensive, personalized care that improves both short- and long-term outcomes for OA patients.
The establishment of CoEs is essential to advance specialized care, align treatments with Treat-to-Target (T2T) goals, and enhance overall patient outcomes. By centralizing care within expert, multidisciplinary teams, promoting patient education, and ensuring thorough clinical oversight, CoEs offer a crucial framework for optimizing OA management.
Furthermore, these centers can significantly reduce long-term healthcare costs by delaying or preventing expensive interventions, such as joint replacements, through early and comprehensive management. This approach not only alleviates disability and enhances quality of life but also mitigates the socioeconomic burden associated with OA’s long-term effects. The integration of evidence-based guidelines strengthens the ability of CoEs to provide accessible, efficient, and patient-centered care, ensuring that OA patients receive the best possible treatment throughout their care journey.
Interest Conflict
Authors declare no conflict of interests. This work was made with any funding.
Author contributions:
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Pedro Santos-Moreno, Oscar Rillo, Maritza Quintero, Gabriel-Santiago Rodríguez-Vargas. The first draft of the manuscript was written by Pedro Santos-Moreno, Oscar Rillo, Carlos Pineda, Rolando Espinosa-Morales, José Angel Salas Siado, Oswaldo Castañeda, Roberto Muñoz Louis, Ingrid Möller, Gabriel-Santiago Rodríguez-Vargas, Vianna Khoury, Maritza Quintero, Rodolfo Arape, Oswaldo Castañeda, Araceli Chica, Blanca Herrera Velasco, and Miguel Albanese. All authors commented on different versions of the manuscript. All authors read and approved the final manuscript.
Financiamento
This manuscript has not received funding from any entity.
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Fig. 1 Approximation and route for diagnosing of the OA patient
Fig. 2 Frequency of consultation with the multidisciplinary team
