RU2256470C1 - Method for treating patients with osteoarthrosis - Google Patents

Abstract

FIELD: medicine, physiotherapy, health resort treatment.

SUBSTANCE: one should affect with balneo-, peloido-, EHV-therapy daily at the following sequence: 9 - 11 a.m. - balneotherapy, 8-10 procedures/course, 11 a.m. - 1 p.m - therapy, 10 procedures/course, 2 p.m. - 4 p.m.- peloidotherapy, 8-10 procedures/course. Moreover, about 2-3 d before this impact one should prescribe a food additive as succinic acid at the dosage of 0.5 g thrice daily after meals for 14 -16 d. The method enables to shorten the frequency of appearance and degree of balneoreactions, shorten therapy terms without any decrease of productivity.

EFFECT: higher efficiency of therapy.

4 cl, 3 ex, 5 tbl

Description

The invention relates to medicine, namely physiotherapy and balneology. There is a method of improving the results of peloid therapy by prescribing small doses of iodine in order to limit the functional activity of the thyroid gland [6]. The disadvantages of this method include the inability to control the functional state of the thyroid gland by the level of hormones produced due to the lack of the necessary equipment and the high cost of reagents for the implementation of radioimmunoassay in the overwhelming majority of institutions, the undesirability of uncontrolled intervention in the functioning of the thyroid gland due to the significant an increase in the incidence of tumor and autoimmune diseases of the latter.

There is also a method of increasing the effectiveness and tolerance of rapopeloid therapy, taking into account the formation of various reactions in patients to resort factors by prescribing them: a) indomethacin (methindole) - with the appearance of ossalgia and myalgia, increased arthralgia; b) belloid (bellataminal) - in the presence of initial functional instability of the autonomic nervous system [1]. The disadvantages of the method are the presence of a large number of side effects and contraindications when using these pharmacological preparations (the development of gastrointestinal bleeding in 40-50% of cases, deafness, dizziness, allergic, hematological reactions, toxic damage to the liver and kidneys - in 10-40% of cases, negative effect on cartilage and subchondral bone when using indomethacin, the inability to use belloid in organic diseases of the cardiovascular system, especially the occlusive type, diseases of the thyroid gland, the formation of drug dependence with prolonged use of the latter), the absence of specific targeted effects on the pathogenetic mechanisms of osteoarthritis [3, 4, 9, 11, 14].

The objective of the invention is to increase efficiency, improve tolerability of balneotherapy, peloid and EHF-therapy, as well as reducing the course of treatment.

The task is carried out by the combined effects of balneotherapy, peloid and EHF-therapy, carried out daily in the following sequence: balneotherapy, EHF-therapy, peloid therapy, and 2-3 days before it begins, patients are prescribed a dietary supplement succinic acid in a dose of 0.5 g 3 times a day after meals, the reception of which is continued throughout the course of treatment, the duration of the treatment course is 14-16 days. As a balneotherapy, common sodium chloride baths with a concentration of 30-40 g / l, a temperature of 36-37 ° C, a duration of 10-12 minutes, prescribed daily from 9.00 to 11.00, for a course of 8-10 procedures are used. EHF therapy from the Stella-1 apparatus [10] is carried out by means of electromagnetic radiation of the millimeter range (EHF radiation) on biologically active points (BAP) with a frequency of 40-43 GHz, the duration of exposure to one BAP is 4-5 minutes, total the duration of the procedure is 20-40 minutes, for the course of 10 procedures conducted daily from 11.00 to 13.00. The choice of corporal BAT is carried out in accordance with the individual manifestations of the disease: G-29, G-30 - for osteoarthritis of the hip joints, M-34, M-35, Le-7, Le-8 - for osteoarthritis of the knee joints, 3E-4, Dü -5. Di-5 - with osteoarthritis of the joints of the upper extremities. In addition, all patients are affected by common points G-41, 3E-5 [2]. Peloid therapy uses peat applications on the affected joints, no more than 2-4 large joints in one procedure and the corresponding reflexogenic zones of the spine with a temperature of 40-42 ° C, lasting 20-30 minutes, prescribed daily from 14.00 to 16.00, for a course of 8- 10 treatments.

Example 1. Patient S., 56 years old, medical history No. 1264, was admitted to treatment at the rehabilitation therapy department of the Tomsk Research Institute of Balneology and Physiotherapy with a diagnosis of primary bilateral gonarthrosis, Rg stage II, insufficiency of joint function I.

Upon admission, he complained of severe pain in the knee joints of a aching or aching character, arising during movement, aggravating after physical exertion, as well as in the evening and I half of the night, limitation of movements and crunching in these joints, general weakness, increased sweating, fatigue, decreased performance.

From the anamnesis: for the first time pains in the knee joints appeared about 5 years ago after hypothermia and significant physical exertion (work on the garden site in the autumn). Since then, an average of 2 times a year notes an exacerbation of the disease. Previously, I received only outpatient treatment (non-steroidal anti-inflammatory drugs, compresses of dimexide on joints, vitamins).

Of the concomitant pathology, the patient was diagnosed with cervical osteochondrosis, chronic parasitic (opisthorchiasis) cholecystitis in the phase of remission, and hypertension of the first stage.

Objective status: increased nutrition (height - 178 cm, weight - 90 kg). General condition is satisfactory. The skin and mucous membranes are clean, moist. Lymph nodes are not enlarged, painless. Heart sounds are muffled, the rhythm is correct, 62 beats / min. Blood pressure 130/90 mm Hg In the lungs, vesicular breathing, no wheezing. The abdomen on palpation is soft, painless. The knee joints are deformed in the medial sections, painful on palpation. Movements in the joints are somewhat limited due to incomplete bending, cause pain, crunch.

X-ray examination of joints: intermuscular elevations in both joints are pointed. Joint spaces narrowed in the medial sections, more to the right. Subchondral sclerosis of the locking plates of the heads of the bones that form the joints. Small bony growths of the external condyles of both thigh bones. The inner angles of both patella are pointed; there are osteophytes along the outer contour of both patella. Conclusion: osteoarthritis of the knee joints, stage II.

Biochemical blood parameters before treatment: sialic acids - 3.06 mmol / l (with a norm of 1.9-2.5 mmol / l), ceruloplasmin - 496 mg / l (with a norm of 280-400 mg / l), catalase - 37 4 mccatal / l (with a norm of 4.5-30.3 mccatal / l), malondialdehyde - 4.3 mmol / l (with a norm - <3.8 mmol / l).

Immunological blood counts before treatment: T-lymphocytes - 34% (with a norm of 40-68%), B-lymphocytes - 33% (with a norm of 12-32%), immunoglobulins of class A (Ig A) - 3.7 g / l (with a norm of 1.5-3.5 g / l), immunoglobulins of class G (Ig G) - 19.2 g / l (with a norm of 8.4-18.0 g / l), circulating immune components (CEC ) - 115 conventional units (at a rate of 38-95 conventional units).

The treatment was carried out in accordance with the claimed method. From the day of admission to the clinic, the patient was prescribed succinic acid at a dose of 0.5 g 3 times a day after meals, which the patient continued to take throughout the course of treatment. From the third day of the patient’s stay at the Tomsk Scientific Research Institute of Balneology and Physiotherapy, the treatment complex includes peat applications on the knee joints and lumbosacral spine with a temperature of 40 ° C, lasting 20 minutes in 1-3 procedures, 30 minutes on the following days of treatment, dispensed daily in 10.00, on a course of 8 procedures; EHF therapy from the Stella-1 apparatus, also carried out daily at 12.00 by exposure to BAT M-34, M-35, Le-7, Le-8, G-41, 3E-5 EHF radiation with a frequency of 40-43 GHz, exposure for one BAT for 5 minutes, the total duration of the procedure is 30 minutes, for a course of 8 procedures; total sodium chloride baths with a concentration of 30 g / l, temperature 36 ° С, duration 10 minutes, dispensed daily at 14.00, for a course of 8 procedures.

The patient tolerated the treatment well. Clinical manifestations of balneoreaction were not recorded. No sharp fluctuations in the vegetative indices characterizing the vegetative security and reactivity were found.

The adaptation reaction, regarded before treatment as a reaction of increased activation, after the completion of the treatment course was within the calm activation reaction, most favorable for anabolic processes, indicating the absence of adaptive mechanisms stress and the adequacy of the treatment load.

At the end of the treatment course, the patient's pain in the joints disappeared both during movement and at rest, the range of movements in the right knee joint increased from 115 ° to 138 °, in the left from 120 ° to 140 °, general weakness and sweating significantly decreased.

Normalization of initially changed biochemical and immunological blood parameters was noted: sialic acid - 2.44 mmol / l, ceruloplasmin - 398 mg / l, catalase - 21.4 mccal / l, malondialdehyde - 3.1 mmol / l, T-lymphocytes - 47%, B-lymphocytes - 23%, Ig A-2.6 g / l, Ig G-17.8 g / l, CEC - 93 conventional units

The immediate result of treatment is rated as a significant improvement. Control examinations conducted by the patient after 3, 6, 9 months revealed the absence of episodes of exacerbation of the disease during the entire observation period and the preservation of the achieved therapeutic effect.

Example 2. Patient P., 54 years old, medical history No. 205, was admitted for treatment to the rehabilitation therapy department of the Tomsk Scientific Research Institute of Balneology and Physiotherapy with a diagnosis of primary bilateral coxarthrosis, Rg stage II, insufficiency of joint function I.

Upon admission, he complained of moderate pain in the hip joints and lumbar spine of a aching nature, disturbing during movement, limitation of movements in the right hip joint, crunching, limping on the right leg.

From the anamnesis: since childhood, suffers from scoliotic spinal disease. Hip pain first appeared about 10 years ago. Exacerbation of the disease notes in the winter. Previously received spa treatment, after which he noted an improvement that lasted about six months.

From a concomitant pathology, the patient revealed thoracic and lumbar osteochondrosis.

Objective status: normal nutrition (height - 172 cm, weight - 73 kg). General condition is satisfactory. The skin and mucous membranes are clean. Lymph nodes are not enlarged, painless. Heart sounds are clear, the rhythm is correct, 52 beats / min. Blood pressure 110/70 mm RT. Art. In the lungs, vesicular breathing, no wheezing. The abdomen on palpation is soft, painless. Pronounced right-sided scoliosis of the spine in the lower thoracic and lumbar regions, smoothness of the lumbar lordosis, a significant defan of the rectus muscles of the right. Compensatory misalignment of the pelvis to the right. Imaginary shortening of the right lower limb by 1.5 cm, malnutrition of the muscles of the right buttock. On palpation, there is no pain in the joints. Movements in the hip joints cause pain and crunch, more pronounced on the right. Restriction of movements in the right hip joint due to incomplete abduction, adduction, flexion.

X-ray examination of the joints: subchondral sclerosis of the roof plate of the acetabulum, small marginal growths of the plate of the roof of the acetabulum. The articular fissures are narrowed, more to the right. The right hip joint is higher than the left. Flattening the head of the right femur. Conclusion: osteoarthritis of the hip joints, stage II.

Biochemical blood parameters before treatment: sialic acids - 2.68 mmol / L (with a norm of 1.9-2.5 mmol / L), ceruloplasmin - 447 mg / L (with a norm of 280-400 mg / L), catalase - 43 , 2 μcatal / L (with a norm of 4.5 - 30.3 μcatal / L), malondialdehyde - 4.2 mmol / L (with a norm of <3.8 mmol / L).

Immunological blood counts before treatment: T-lymphocytes - 32% (with a norm of 40-68%), B-lymphocytes - 9% (with a norm of 12-32%), immunoglobulins of class A (Ig A) - 3.6 g / l (with a norm of 1.5-3.5 g / l), immunoglobulins of class G (Ig G) - 18.5 g / l (with a norm of 8.4-18.0 g / l), circulating immune components (CEC ) - 130 conv. units (at a rate of 38-95 conventional units).

The treatment was carried out in accordance with the claimed method. From the day of admission to the clinic, the patient was prescribed succinic acid at a dose of 0.5 g 3 times a day after meals, which the patient continued to take throughout the course of treatment. From the third day of the patient’s stay at the Tomsk Scientific Research Institute of Balneology and Physiotherapy, the medical complex includes applications of peat type “cowards” with a temperature of 40 ° C, a duration of 20 minutes in 1-3 procedures, 30 minutes on the following days of treatment, dispensed daily at 9.00, on course 9 procedures; EHF therapy from the Stella-1 apparatus, carried out daily at 11.00 by exposure to BAT G-29, G-30, G-41, 3E-5 with EHF radiation at a frequency of 40-43 GHz, exposure for one BAP 5 min the total duration of the procedure is 20 minutes, 9 treatments per course; total sodium chloride baths with a concentration of 30 g / l, temperature 36 ° С, duration 10 minutes, dispensed daily at 15.00, for a course of 9 procedures.

The patient tolerated the treatment well. Clinical manifestations of balneoreaction were not recorded. No sharp fluctuations in the vegetative indices characterizing the vegetative security and reactivity were found.

The adaptation reaction, regarded before treatment as a reactivation reaction, after completion of the treatment course was within the reaction of calm activation of a high level of reactivity.

At the end of the treatment course, the pains in the left hip joint stopped, in the right hip joint and lumbar spine they significantly decreased, the range of movements in the right hip joint increased (flexion from 80 ° to 95 °, abduction from 25 ° to 30 °, reduction from 15 ° up to 20 °).

Normalization of initially changed biochemical and immunological parameters of blood was noted: sialic acid - 2.41 mmol / l, ceruloplasmin - 352 mg / l, catalase - 19.8 mccal / l, malondialdehyde - 3.0 mmol / l, T-lymphocytes - 41%, B-lymphocytes - 15%, Ig A - 2.2 g / l, Ig G - 12.4 g / l, CEC - 90 conv. units

The immediate result of treatment is rated as a significant improvement. Control examinations conducted by the patient after 3, 6, 9 months revealed the preservation of the achieved therapeutic effect throughout the observation period.

Example 3. Patient S., 48 years old, medical history No. 471, was admitted for treatment to the rehabilitation therapy department of the Tomsk Scientific Research Institute of Balneology and Physiotherapy with a diagnosis of primary osteoarthritis of the distal and proximal interphalangeal joints of the hands, Rg stage I-II, joint failure 0.

Upon admission, she complained of pain in the joints of the fingers of the hands during movement, a burning sensation, tingling, “crawling creeps” in them alone, a change in the shape of the joints, morning stiffness for 20-30 minutes, decreased performance, increased fatigue, sweating.

From the anamnesis: considers himself a patient for about 6-7 years. For 20 years working as a plasterer-painter. For the first time, pains in the above joints arose after considerable physical exertion and hypothermia (work on a construction site in winter). The appearance of pain was accompanied by redness, swelling and soreness when touched. It was treated on an outpatient basis (methindole, indovasin gel, electrophoresis of 3% lithium chloride solution on the hands). 3 years ago I noticed the appearance of dense rounded formations the size of a pea in the area of the distal interphalangeal joints of the II, III, V fingers of both hands.

Of the concomitant diseases, the patient was diagnosed with cervical osteochondrosis, chronic obstructive bronchitis in remission, diffuse-nodular goiter of the II degree, chronic autoimmune thyroiditis, euthyroidism.

Objective status: normal nutrition (height - 168 cm, weight - 70 kg). General condition is satisfactory. The skin is clean, moist. Lymph nodes are not enlarged, painless. The thyroid gland is a dense-elastic consistency, enlarged due to the right lobe and isthmus (II degree). Heart sounds are clear, the rhythm is correct, 78 beats / min. Blood pressure 120/80 mm Hg In the lungs, vesicular breathing with a hard tint in the lower parts, no wheezing. The abdomen on palpation is soft, painless. Heberden nodules in the area of the distal interphalangeal joints of the II, III, IV fingers of both hands, pain on palpation of the proximal interphalangeal joints of the II, IV fingers of the right hand. Movement is not limited, moderately painful.

X-ray examination of joints: edge bone growths and racemose enlightenments of a rounded shape in the distal phalanges of the II, III fingers of both hands are determined. Conclusion: osteoarthritis of the distal interphalangeal joints of the II, III fingers, I-II stage.

Biochemical blood parameters before treatment: sialic acids - 2.57 mmol / l (with a norm of 1.9-2.5 mmol / l), ceruloplasmin - 428 mg / l (with a norm of 280-400 mg / l), catalase - 35 4 mccatal / l (with a norm of 4.5-30.3 mccatal / l), malondialdehyde - 4.2 mmol / l (with a norm of <3.8 mmol / l).

Immunological blood counts before treatment: T-lymphocytes - 28% (with a norm of 40-68%), B-lymphocytes - 34% (with a norm of 12-32%), immunoglobulins of class A (Ig A) - 3.6 g / l (with a norm of 1.5-3.5 g / l), immunoglobulins of class G (Ig G) - 18.3 g / l (with a norm of 8.4-18.0 g / l), circulating immune components (CEC ) - 108 srvc. units (at a rate of 38-95 conventional units).

The treatment was carried out in accordance with the claimed method. From the day of admission to the clinic, the patient was prescribed succinic acid at a dose of 0.5 g 3 times a day after meals, which the patient continued to take throughout the course of treatment. From the second day of the patient’s stay at the Tomsk Scientific Research Institute of Balneology and Physiotherapy, the application includes “high gloves” peat applications with a temperature of 40 ° C, a duration of 20 minutes in 1-3 procedures, 30 minutes on the following days of treatment, dispensed daily at 11.00, per course 10 procedures; EHF therapy from the Stella-1 apparatus, carried out daily at 13.00 by exposure to BAT M-34, M-35, Le-7, Le-8, G-41, 3E-5 EHF radiation with a frequency of 40-43 GHz , exposure for one BAHT 5 minutes, the total duration of the procedure is 30 minutes, for a course of 10 procedures; total sodium chloride baths with a concentration of 30 g / l, temperature 37 ° C, lasting 10 minutes, dispensed daily at 16.00, for a course of 10 procedures.

The patient tolerated the treatment well. Clinical manifestations of balneoreaction were not recorded. No sharp fluctuations in the vegetative indices characterizing the vegetative security and reactivity were found.

The adaptation reaction, regarded before treatment as a reaction of calm activation of a low level of reactivity, after completion of the treatment course was within the reaction of calm activation of a high level of reactivity.

At the end of the treatment course, the pain in the interphalangeal joints and the feeling of morning stiffness disappeared, weakness and sweating decreased.

Normalization of the initially changed biochemical and immunological blood parameters was noted: sialic acid - 2.03 mmol / l, ceruloplasmin - 314 mg / l, catalase - 9.7 mccal / l, malondialdehyde - 1.5 mmol / l, T-lymphocytes - 40%, B-lymphocytes - 22%, Ig A - 1.8 g / l, Ig G - 15.3 g / l, CEC - 85 conv. units

The immediate result of treatment is rated as a significant improvement. Control examinations carried out by the patient after 3, 6, 9 months, revealed the preservation of the achieved therapeutic effect throughout the observation period.

The use of common sodium chloride baths in the present method is due to their pronounced positive effect on various stages of inflammation, trophic and reparative processes, microcirculation, immune status, etc.

In order to enhance the anti-inflammatory effect of balneotherapy, regional blood flow and metabolic and trophic processes in the joint tissues of patients with osteoarthritis, mud (in this case peat) applications are applied to the affected joints and the corresponding reflexogenic zones of the spine.

Traditionally, mineral baths and mud applications are prescribed every other day or (less often) two consecutive days with the next day of rest. In the claimed method of application of therapeutic peat and total sodium chloride baths are prescribed daily in order to reduce treatment time without worsening the therapeutic effect.

The temperature and exposure of the mud application and mineral bath are selected in accordance with the range that is most often used in medical practice.

The duration of the treatment course is determined taking into account the fact that positive changes in the clinical condition of patients appear on average after 5-7 procedures for balneopeloid therapy [6]. This fact determines the choice of the lower limit of the duration of the course of treatment in 8 procedures, with 1-2 effects added to consolidate the therapeutic effect. At the 11-12th procedures, an increase in the frequency of asthenovegetative disturbances (weakness, increased fatigue, pronounced adrenergic reactions) was noted, which determined the choice of the upper limit of the number of balneo, peloizdaniya in 10 procedures.

The time of peloid therapy procedures is selected taking into account the circadian daily biorhythms of the pathological process. Studies [13] conducted by L.G. Tereshina (2002) showed that in patients with osteoarthritis a steady rhythm of pain in joints with acrophase is detected at 17.40, therefore, therapeutic effects carried out several hours before acrophase can achieve faster and pronounced therapeutic effect. So, in patients treated with mud applications, only after peloid therapy after 14 hours its anti-inflammatory, antioxidant and immunomodulating effects are most fully manifested.

Considering that in the claimed method, both peloid and balneotherapy are prescribed to patients every day, the time of the procedures was chosen: from 9 a.m. to 11 a.m. for vacation of balneotherapy, from 2 p.m. to 4 p.m. for vacation of peloid procedures.

In addition to balneopeloid therapy, the claimed method uses exposure to a physical factor, namely, electromagnetic radiation of the millimeter range (EHF radiation).

The inclusion of EHF radiation into the treatment complex is based on the known properties of this physical factor to increase the nonspecific resistance of the body to various factors of a chemical, physical and biological nature, normalize the altered activity of the autonomic nervous system, and provide analgesic and immunomodulating effects.

In addition, the study of the complex use of EHF exposure in experiment and in the rehabilitation of patients with degenerative-dystrophic joint pathology found that millimeter-wave electromagnetic radiation causes an improvement in microcirculation, leads to a decrease in pain intensity, an increase in initially reduced muscle tone, an increase in range of motion in interested joints and increase their tolerance to physical activity [5].

The duration of the EHF-therapy course in 8-10 procedures was determined by some researchers by monitoring the effectiveness of treatment of patients [5]. With a decrease in the duration of the course, the effectiveness of treatment decreased, and with its lengthening, it did not increase.

The use of succinic acid in the medical complex increases the body's resistance to stressful effects, increases the ability of the metabolism to maintain the state of homeostasis in a wider range of conditions. Succinic acid is involved in the correction of disorders of energy metabolism as a very powerful source of protons and adenosine triphosphate, its oxidation processes play a central role in the energy supply of brain tissue. In addition, both therapeutic and nutritional doses of succinic acid provide a decrease in metabolic acidosis, which is one of the signs of stress formation, and normalization of transaminases, which also reflects an improvement in energy metabolism.

Another form of adaptive correction of metabolism to stress is the antioxidant effect of succinic acid, which manifests itself in a decrease in lipid peroxidation processes, also related to common signs of metabolic disturbance by pathogenic effects. Succinic acid, possessing the highest antioxidant activity, enhances the antioxidant and protective effect of other therapeutic effects [12].

Finally, it should be noted that succinic acid has the ability to stabilize some unstable compounds, in particular ascorbic acid, B vitamins, which, perhaps, is the basis for its stabilization of ATP level in the mitochondria of cells when their respiration is excluded as a result of adverse environmental influences [7, 8].

The clinical implementation of the above effects is manifested in an improvement in the activity of the liver, heart, brain, and, therefore, the whole organism as a whole, which is subjectively assessed by patients in improving well-being, mood, improving performance, normalizing sleep, etc.

For the first time, an intensive method of treating osteoarthritis with a duration of 8-10 procedures was proposed, and the procedures are prescribed at a strictly defined time, daily and in the indicated sequence. The treatment is carried out while taking succinic acid.

The proposed method treated 34 patients. The control group consisted of 31 patients who also received complex daily balneotherapy, peloid, EHF-therapy, but did not take succinic acid supplement. The obtained results convincingly prove that the treatment according to the claimed method allows to improve the tolerability of treatment, reduce the incidence and severity of balneoreaction (Table 1), achieve more significant positive dynamics from the main manifestations of the disease (Table 2), significantly reduce the incidence of altered biochemical and immunological parameters of blood (table. 3) compared with the control group (I), which did not take the dietary supplement succinic acid.

In addition, complex treatment with the inclusion of a succinic acid food supplement contributes to the formation of conditions close to optimal, under which the processes of sanogenesis and responses of the energy supply system in the body of patients with osteoarthritis proceed more mildly than those in the absence of succinic acid. This is indicated by a 1.8-fold decrease in the frequency of development of reactions of increased activation of low reactivity (RPA NUR), called reactivation reactions and bordering on the stress reaction (Table 4), satisfactory balance between pools of cells with high and low succinate dehydrogenase activity (SDH) (coefficient A), an increase in the number of cells with hypernormal enzyme activity (coefficient E), normal values of the coefficient of variation (V) throughout the observation period, the absence of the phenomenon of latent activation of LDH (Q) (t bl.5).

Treatment according to the claimed method is carried out in 14-16 days, which allows to reduce the time of the traditional duration of treatment in institutions of the spa type by 8-10 days without reducing its effectiveness. The immediate effectiveness of treatment of patients of the main (II) group was 92% versus 75% in the control (I).

Sources of information

1. Aleinikov V.K. The study of comparative effectiveness in rheumatism of spa treatment and treatment complexes with the leading role of brine, peloid therapy / V.K. Aleinikov: Abstract. dis ... cand. honey. sciences. - Odessa, 1979. - 17 p.

2. Vogralik V.G. Acupuncture / V.G. Vogralik, M.V. Vogralik // Gorky, 1978. - p.216-217.

3. Dvorkin E.B. The effect of NSAIDs on renal function in patients with rheumatoid arthritis / E.B. Dvorkin, Yu.V. Muravyev // Rheumatology, - 1991, - No. 2. - p. 28-30.

4. Karateev D.E. Non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis / D.E.Karateev // Russian Medical Journal. - 1997. - T.5, No. 15, - p. 962-965.

5. A comprehensive study of EHF effects in the experiment and in the rehabilitation of patients with degenerative-dystrophic pathology of large joints / A.G. Polyakova, T.V. Buinova, D.Ya. Aleinik et al. // Millimeter waves in biology and medicine. - 1999. - No. 13. - p.22-27.

6. Leshchinsky A.F. Peloid and pharmacotherapy for inflammatory diseases / A.F. Leshchinsky, Z.I. Zuza. - Kiev: Health`, 1985. - p.136-138.

7. Lukyanova A.D. Bioenergy mechanisms of the antihypoxic effect of a succinate-containing derivative of 3-hydroxypyridine mexidol / L.D. Lukyanova, R.E. Atabaeva, S.Yu. Shepelova // Bulletin of experimental biology and medicine. - 1993. - No. 3. - p. 259.

8. Mayevsky E.I. Anaerobic succinate formation and ATP resynthesis in mitochondria of rat tissues / E.I. Maevsky, E.V. Grishina // Pharmacological correction of hypoxic conditions. - M .: Publishing house of the Academy of Medical Sciences of the USSR, - 1980. - p. 80.

9. Mashkovsky M.D. Medicines / M.D. Mashkovsky. - Moscow, 1993. - T.2 - p. 522.

10. Passport КС 941526.001 ПС ТУ 9444-002-28833138-96 to the apparatus of EHF-IR therapy “Stella-1” (portable two-channel with five replaceable radiators). Tomsk, 2000.

11. Polunina T.E. Hepatotoxic effect of non-steroidal anti-inflammatory drugs / T.E. Polunina, V.I. Fomichev, A.P. Vasiliev // Therapeutic Archive, - 1994, - No. 5, - p. 79-80.

12. Sahakyan M.R. Correction of disturbances in the internal environment of the mechanism by food additive of succinic acid in animals and humans / M.R.Saakyan, M.N. Kondrashova, I.V. Vysochina // Izvestia A.N., biological series. -1994. - IN AND. - p. 596-604.

13. Tereshina L.G. Chronobalne- and chronophysiotherapy - a methodology for optimizing the treatment of osteoarthritis and related diseases / L.G. Tereshina: Author. dis ... doc. honey. sciences. - Ekaterinburg, 2002 .-- 42 p.

14. Frolov D.N. Rheumatology lives de facto / D.N. Frolov // Russian Medical Journal. -1997. - T.5, No. 15, - p. 1016-1017.

Table 1
Distribution of patients by severity of balneoreaction (in%) Groups I (n = 31) II (n = 34) Severity Is absent 45.5 62.5 Easy 42 37.5 Moderate 12.5 0 * Note: * - significance of differences between groups table 2
The dynamics of the severity of subjective manifestations of the disease during treatment (in points) Symptoms Groups I (n = 31) II (n = 34) d / l s / l d / l s / l Joint pain during movement 1.44 ± 0.125 0.56 ± 0.06 *** 1.27 ± 0.18 0.27 ± 0.09 *** ^{^} Joint pain at rest 0.23 ± 0.14 0.09 ± 0.09 0.64 ± 0.11 0.21 ± 0.14 * Joint movement restriction due to pain 0.57 ± 0.08 0.42 ± 0.16 0.49 ± 0.07 0.16 ± 0.07 * ^ Asthenovegetative manifestations 0.81 ± 0.25 0.13 ± 0.13 * 1.09 ± 0.18 0.27 ± 0.09 *** Note: * - significance of differences in the group p <0.05;
** - significance of differences in the group p <0.01;
*** - significance of differences in the group p <0.001;
^ - significance of differences between groups

Table 3
The dynamics of the frequency of occurrence of initially altered biochemical and immunological blood parameters during treatment (in%) Indicator Groups I (n = 31) II (n = 34) d / l s / l Δ% d / l s / l Δ% Ceruloplasmin fifty fifty 0 45.5 18.2 * -27.3 ^ Catalase 57.1 85.7 * +28.6 40 eleven* -29 T lymphocytes 71,4 42.9 -28.5 81.8 45.5 -36.3 B lymphocytes 14.3 49.2 +34.9 18.2 0 -18.2 ^ IgA 16.7 40 +23.3 36,4 18.2 -18.2 ^ CEC 60 fifty -10 54.6 18.2 * -36.4 ^ Note: * - significance of differences in the group;
^ - significance of differences between groups Table 4
Distribution of patients of groups I and II by types of adaptive reactions and levels of reactivity before and after treatment (in%) Type of adaptive reaction Reactivity level Groups I (n = 31) II (n = 34) d / l s / l d / l s / l Workout reaction 25 0 18.2 0 Tall fifty 100* 0 0 Low fifty 0 0 0 Calm activation reaction 12.5 fifty* 27.3 36,4 Tall 100 100 66.7 100 Low 0 0 33.3 0 Increased activation reaction 62.5 fifty 54.5 63.6 Tall 80 fifty* 66.7 71,4 ^ Low twenty fifty* 33.3 28.6 ^ Note: * - significance of differences within groups;
^ - significance of differences between groups

Table 5
The effect of intensive shortened courses of rehabilitation treatment of patients with osteoarthritis on the activity of blood lymphocyte LDH (M / m) Indicator Group I (n = 31) Group II (n = 34) Before treatment Mid treatment After treatment Before treatment Mid treatment After treatment Q Without activators

Glutamate

Isocytrate

A Without activators

Glutamate

Isocytrate

E Without activators

Glutamate

Isocytrate

V Without activators

Glutamate

Isocytrate

Note: M is the average value of the indicator; m is the average error; Q is a typical enzymatic activity of LDH; A is the asymmetry coefficient of the distribution of cells with low and high activity of LDH; E - coefficient of excess (number of cells with typical activity of LDH); V is the coefficient of variation of lymphocytes by the activity of LDH; ** - significance of differences within the group, P <0.001.

Claims (5)

1. A method of treating patients with osteoarthritis by the combined effects of balneotherapy, peloid, EHF-therapy, characterized in that the said complex effect is carried out daily in the following sequence: from 9.00 to 11.00 balneotherapy, for a course of 8-10 procedures, from 11.00 to 13.00 EHF therapy, for a course of 10 procedures, from 14.00 to 16.00, peloid therapy, for a course of 8-10 procedures, while 2-3 days before it is started, a succinic acid supplement is prescribed at a dose of 0.5 g 3 times a day after meals for 14-16 days. 2. The method according to claim 1, characterized in that as the balneotherapy using common sodium chloride baths with a concentration of 30-40 g / l, a temperature of 36-37 ° C, lasting 10-12 minutes 3. The method according to claim 1, characterized in that the EHF-therapy is carried out at biologically active points at a frequency of 40-43 GHz, the duration of exposure to 1 biologically active point is 4-5 minutes, the total procedure time is 30-40 minutes. 4. The method according to claim 1, characterized in that as a peloid therapy using peat applications on the affected joints, not more than 2-4 large in one procedure, and the corresponding reflexogenic zones of the spine with a temperature of 40-42 ° C, lasting 20- 30 minutes. 5. The method according to claim 1, characterized in that with osteoarthritis of the hip joints affect the points G-29, G-30; with osteoarthritis of the joints of the upper extremities at points 3E-4, Dü-4, Dü-5, Di-5; with osteoarthritis of the knee joints at points M-34, M-35, Le-7, Le-8, all patients undergo exposure to common points G-41, ZE-5.