RU2160079C2 - Method for performing osteoarthrosis patient rehabilitation - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying massage, medical training exercises and balneotherapy. Sodium humate is administered in 0.001% concentration. Baths are taken every second day. Bath temperature is gradually increased from 35 C to 37 C. Bath duration is 6-8 min to 12-15 min. The total course is 8-12 procedures long. EFFECT: enhanced effectiveness of treatment course applicable also at home. 2 dwg, 1 tbl

Description

 The invention relates to medicine, namely to balneological methods of treatment.

 Osteoarthrosis is clinically most often manifested in elderly people, when the percentage of combination with other diseases (atherosclerosis, coronary heart disease, hypertension) is high, and requires long-term medication.

 Osteoarthrosis is the most common disease of the musculoskeletal system, which has important social significance, which is determined not only by its high prevalence, but also by extremely high rates of temporary and permanent disability. This disease often leads to disability, reducing the economic potential of each nation. According to the Institute of Rheumatology, Russian Academy of Medical Sciences, there are 66.8 patients with diseases of the musculoskeletal system (which includes osteoarthritis) per 1000 population. Signs of degenerative changes in the cartilage of the knee joint are detected in 95% of people aged 40-50 years and in 100% of people over 50 years old. Diseases of the musculoskeletal system are constantly in second place in cases and in third place in days among all the recorded causes of temporary disability [9].

 The rehabilitation complex in patients with osteoarthritis is aimed at unloading the affected joints, improving metabolism, blood circulation in the joint tissues, and reducing inflammatory reactions. At the stage of rehabilitation treatment, long-term administration of non-steroidal anti-inflammatory drugs is often required, intra-articular injections of trasilol and arteparone are prescribed. Physiotherapy includes the use of ultrasound and phonophoresis, electrophoresis, pulsed currents of low frequency, ultraviolet radiation, balneotherapy, peloid therapy [8]. Long-term use of non-steroidal anti-inflammatory drugs in 40% of cases give various side effects. Nonsteroidal anti-inflammatory drugs inhibit the synthesis of prostaglandins, which leads to the development of complications: gastrointestinal bleeding, mucosal irritation, deafness, dizziness, allergic, hematological reactions, liver damage [1, 6]. Intra-articular injections are traumatic procedures and often cause complications, their use at the rehabilitation stage is undesirable.

 Along with drug therapy, which is partially associated with the occurrence of an increased number of side effects, various natural and preformed physical factors are widely used in complex rehabilitation treatment at the stage of rehabilitation of patients with osteoarthritis. An important place in the treatment of this disease is balneotherapy and peloid therapy [7].

 Balneotherapy is a widespread rehabilitation method for patients with osteoarthrosis. In the first two stages of the disease in the absence of synovitis or residual synovitis, sulfide, radon, iodine-bromide, chloride, and sodium baths have a beneficial effect on the metabolic processes of cartilage metabolism, peripheral hemodynamics, and microcirculation. Under their influence, metabolic processes in the body, peripheral blood flow are stimulated, and the state of the neuromuscular apparatus improves [5].

 Publications reflecting the successful use of peloid therapy in arthrological practice have appeared in Russian literature since the 40s.

 Mud and peat treatment are used to improve metabolism, affect the overall reactivity of the body. Peloid therapy helps to normalize the inflammatory process and immunological reactivity of the body [4].

 Despite the wide popularity of traditional mud therapy, it is unacceptable for medical reasons for some categories of patients, especially when combined with cardiovascular diseases. For storage and transportation of dirt requires large containers and storages, their use is possible only in a sanatorium. The severity of the pathological process, concomitant diseases, intolerance of patients with mud procedures, the complexity and cost of the mud treatment process limit the use of this method to a certain extent. The use of drugs based on therapeutic mud significantly expands the range of applications for a number of chronic diseases, since it was proved that biologically active compounds of therapeutic mud are non-toxic, have anti-inflammatory, analgesic effects, do not cause allergic reactions, have a multifaceted effect on tissues and body systems . The use of mud extracts creates the conditions for their economical and rational out-of-resort use [11].

 The objective of the invention is to increase the effectiveness of rehabilitation measures for patients with osteoarthritis, the expansion of indications for balneotherapy, the possibility of use at home.

The method is as follows: the rehabilitation complex includes the appointment of patients with balneotherapy, massage and physiotherapy exercises. Balneotherapy includes conducting common baths with sodium humate with a concentration of 0.001% (this concentration is achieved by dissolving 2 g of powdered sodium humate in 200 l of fresh water). The water temperature of the first baths is 35 ^o C, with an increase to the third bath to 36 ^o C, from the fifth to 37 ^o C. Duration of procedures: the first bath is 6-8 minutes, with a gradual increase to 12-15 minutes. On a course of 8-12 baths. The use of common baths with sodium humate of low concentration according to a gentle method with a gradual increase in temperature and time of the procedures provides a good therapeutic effect, does not cause side effects and pathological balneoreaction, contributes to good tolerance by patients of this rehabilitation method.

 This method of rehabilitation treatment was carried out in patients with primary and secondary osteoarthrosis without synovitis or with residual synovitis, with muscle contractures. Contraindications for balneotherapy were: pronounced synovitis, large deformations, the rapidly progressive course of osteoarthritis, the early postoperative period (synovectomy, osteotomy, joint replacement).

 Extracted humic acids from various therapeutic muds contain hydroxyl and carboxyl groups, which determine important balneological properties. The stimulating regeneration effect on the skin of applications of humic acids isolated from peat has been experimentally shown. Moreover, their biological effect is not inferior in effectiveness to the effects of applications from natural peat.

When analyzing the experimental fundamentals and prospects for the use of peat humic acids, the mechanism of their action on the blood, cardiovascular and endocrine systems, according to published data, the practical harmlessness of sodium humate is revealed by its effect on vital organs and systems at the level of histological and histochemical studies. Humic acids are converted into a biologically active state when dissolved in sodium alkali with the formation of sodium humate. It does not cause allergic reactions and anaphylaxis, pathological sensitization to drugs, pyrogen-free. It does not have teratogenic, embryotoxic and carcinogenic properties. The established level of LD ₅₀ , equal to 0.536 g per 1 kg of weight, indicates the practical harmlessness of the drug. It was found that even a low concentration of sodium humate of 0.001% retains a statistically significant level of activity, which indicates the promise of using peat humic acids in medicine [10].

 Humic acids are the main active chemical factor in therapeutic muds and peats, which have a wide range of biomedical effects: biostimulating, anti-inflammatory, antiviral [12], and are a source for the manufacture of therapeutic mud preparations, but only a humic-based preparation is used in medical practice acids - Gumizol.

 Example 1. Patient I., 67 years old, was admitted to the clinic of IMKVL with complaints of pain in the knee, interphalangeal joints of the hands that occur after slight physical exertion, at rest are reduced, to restrict movement in the interphalangeal joints of the hands; paroxysmal constricting pains behind the sternum with radiation to the left hand that occur when climbing to the second floor, stopping when taking 1 tablet of sustac after 5-10 minutes, shortness of breath with little physical exertion, headaches, dizziness, noise in the head. From the anamnesis of the disease: joint pain has been disturbing for about 18 years, redness and swelling of the periarticular tissues are periodically noted, 12 years ago, the patient noted a restriction of movements in the joints of the hands. During an exacerbation of the disease (2-3 times a year), he takes non-steroidal anti-inflammatory drugs. Since 1981, paroxysmal compressive pains behind the sternum appeared, about which I was hospitalized for 1 month, an examination and outpatient treatment are annually performed. An increase in blood pressure was recorded 13 years ago, taking obzidan.

 Upon examination, the condition is satisfactory, normosthenic physique, heart sounds are rhythmic, muffled, the left border of the heart is 1.5 cm to the left of the mid-clavicular line. Blood pressure 160 and 90 mm RT. Art. Marked nodules of Heberden, Bouchard, restriction of flexion-extensor movements in the knee and interphalangeal joints of the hands. On the electrocardiogram, left ventricular myocardial hypertrophy. On the roentgenogram of the knee, pronounced subchondral sclerosis of the articular surfaces included in the knee joint. The upper edge of the articular surface of the left patella with marginal osteophyte. The radiographic articular gap is evenly narrowed.

From the data of a laboratory study: ESR 10 mm / hour, leukocytes 4.4 • 10 ⁹ / l, sial test 145 units. rel. pl., DFA reaction 278 units rel.pl., total blood cholesterol 9.12 mmol / L, B-lipoproteins 79 units, triglycerides 1.42 mmol / L.

 Diagnosed with Osteoarthrosis of the knee, interphalangeal joints of the hands, II R-logical stage, impaired joint function of the I-II stage. Coronary heart disease, stable angina pectoris II-III functional class. Hypertension stage II. Circulatory failure stage I.

 The patient received the following treatment for 24 days: baths of a 0.001% solution of sodium humate according to the gentle method N 9, massage according to Mashkov, physiotherapy exercises, 10 mg 2 times a day were examined.

As a result of the treatment, a positive dynamics was noted in the form of a significant reduction in pain in the joints, an increase in the amount of flexion-extensor movements by 7-12 ^o in the joints of the hands. During treatment, no angina attacks were noted, blood pressure stabilized at 150 and 90 mm Hg. Art. According to electrocardiography, no changes were recorded. From laboratory indicators: the sial sample decreased to 85 rel. pl. , DFA reaction up to 170 units rel. (to normal values). Atherogenic fractions of blood serum decreased: total cholesterol to 7.02 mmol / L, B-lipoproteins to 71 units, triglycerides to 1.21 mmol / L.

 This example shows the anti-inflammatory effect of baths with a 0.001% sodium humate solution in a patient with osteoarthritis, which is manifested in a clinical improvement in the course of the disease, confirmed by laboratory data. With concomitant coronary heart disease and hypertension, the general condition stabilized, there was no negative effect on the course of the disease, hypocholesterolemic effect was detected without the use of an appropriate diet and medications.

 Clinical studies were conducted to develop a method and evaluate the effectiveness of balneotherapy with sodium humate in IMKVL SB RAMS. There were 37 people with osteoarthritis of the older age group (average age 57.5 ± 1.9 years), of which 24 OA were combined with IHD (9 people) and hypertension (15 patients). The generalized nature of osteoarthritis with a primary lesion of large joints was revealed in 12 patients, small in 8, multiple joint damage in 11 people. Joint function deficiency of stage I was detected in 22 patients, stage II - in 12. Joints were deformed in 12 people, in 6 the process was accompanied by reactive synovitis, hypercholesterolemia was detected in 20 patients.

 The clinical condition was assessed by the main symptoms of osteoarthritis in the point system (from one to three): joint pain in motion and rest, joint mobility, the presence of reactive synovitis, skin color in the joints. The severity of inflammatory and metabolic disturbances was judged by the results of a clinical blood test and some biochemical parameters: ESR and white blood cell count, sialic test (according to Hess), seromucoid by turbidimetric method, diphenylamine reaction (DPA reaction), uric acid was determined by direct spectroscopy (Nikitina I.I.). In addition to the severity of the clinical manifestations of osteoarthritis, heart rate, blood pressure (BP) were recorded, and electrocardiography was performed. The lipid spectrum of blood serum was studied: total cholesterol (OXS) and high density lipoprotein cholesterol using the unified Ilk method [2], B-lipoproteins (B-PL) using the turbidimetric method according to Burstein and Samai [3], sets were used to determine triglycerides (TG) firms "LACHEMA". The data obtained were processed by the method of variation statistics using Student's criterion.

 A clinical blood test in most patients was without signs of inflammation, the studied ESR was increased in 7 people, the number of leukocytes did not go beyond the physiological norm. Biochemical acute phase indicators were determined at the level of normal values.

 Patients were divided into two groups: group I (observation) received balneotherapy with humic acids (23), II (comparison) - pearl baths (14). As a result of the comprehensive treatment in patients in both groups, an improvement in overall health and an increase in working capacity were noted. Against the background of an improvement in the general condition in group I, there was a decrease in hyperemia (43.7%) and periarticular edema (in 51% of cases), sensitivity during palpation, intensity of pain in the joints (in 55.1%), the range of motion in the joints increased an average of 15%. Moreover, in the group of patients receiving balneotherapy with sodium humate, a positive effect was noted after 4-5 procedures, in the comparison group - to 8-10 baths. When comparing the therapeutic effect of balneotherapy with sodium humate and pearl baths, the patients of the first group showed better tolerance of this method, especially with concomitant cardiovascular pathology and in old age, a lower frequency of balneoreaction in the middle of the treatment course, a clear reduction in the severity of symptoms from the joints (table. )

 Assessment of the dynamics of biochemical parameters after treatment revealed the presence of the anti-inflammatory effect of sodium humate balneotherapy. Accelerated ESR at the beginning of treatment in 4 patients normalized during the rehabilitation process. Although the average values of sialic acids and the DPA reaction did not exceed the values of the upper limit of the norm, in the process of balneotherapy with sodium humate, their decrease within the reference values was noted. The sialic test decreased from 114.1 ± 9.2 to 107.6 ± 8.7 units. rel.pl (figure 1), the DPA reaction - from 251.5 ± 21.5 to 217.0 ± 21.1 units. rel. pl (Fig. 2). In the comparison group, these indicators remained unchanged. The data obtained indicate a positive clinical effect, the dynamics of laboratory parameters, which indicates the anti-inflammatory and analgesic effects of sodium humate balneotherapy.

 The effect of sodium humate balneotherapy on an elevated level of total serum cholesterol was revealed; there was a significant decrease from 6.43 ± 0.35 to 5.8 ± 0.31 mmol / L (p <0.01). In the comparison group, changes in the lipid spectrum compared to the initial one were not detected.

 Thus, the developed method of balneotherapy with salts of humic acids in patients with deforming osteoarthritis has analgesic and anti-inflammatory effects. The advantages of this rehabilitation method are its relation to non-drug therapy, good tolerance, and the possibility of use at home.

LITERATURE
1. Karateev D.E. // Russian. Honey. Journal.- 1997. - T. 5, N 15.- S. 962-965.

 2. Kolb V.T., Kamyshnikov B.C. Clinical biochemistry. - Minsk, 1976.

 3. Laboratory research methods in the clinic // Ed. V.V. Menshikov. - M .: Medicine. - 1987.

 4. Leshchinsky A. F., Zuza Z.I. Peloid and pharmacotherapy for inflammatory diseases. - Kiev: Health. - 1985.

 5. Non-drug treatment in the clinic of internal diseases / Ed. L. A. Serebrina. - Kiev: 3 health, 1995.

 6. Polunina T.E., Fomichev V.I., Vasiliev A.P. Ter. Archive. - 1994. - N 5. - S. 79-80.

 7. Directory of sanatorium selection / Ed. V.M. Bogolyubov. - M .: Medicine. - 1986.

 8. Handbook of physiotherapy / Ed. V.G. Yasnogorodsky. - M. - 1992.

 9. Falomeeva O.M., Amirjanova V.A. / Russian honey. Journal.- 1997. - N 7. - S. 415 - 417.

 10. Tsoi E.P., Lenkova S.N. Sat scientific tr Kyrgyz Research Institute of Balneology and Restoration. treatment (issue 1). - Bishkek, 1993 .-- S. 71-75.

 11. Shustov L.P. Extracts of silt sulfide mud and their therapeutic use. - Tomsk. - 1996.

 12. Cozzi R., Nicolai M., Perticona P. Et al. / Research.- 1993. - 299 (1). - P. 37-44.

Claims (1)

A method for the rehabilitation of patients with osteoarthritis, including balneotherapy, massage, physiotherapy exercises, characterized in that for the preparation of baths using sodium humate with a concentration of 0.001%, baths are prescribed every other day with a gradual increase in temperature from 35 to 37 ^o C and lasting from 6 - 8 to 12 - 15 minutes, course 8 - 12 procedures.

Images