RU2329024C2 - Method of osteoarthrosis treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: radon water is applied in concentration 0.37-0.75 kBq/l (10-20 nCu/l). Water temperature is 36-37 degrees C, exposition is 13-15 minutes. Treatment course includes prescribed 12-14 procedures by regimen 2 baths - day of rest.

EFFECT: method provides accumulation of sufficient absorbed radon dose and uniform accumulation of absorbed dose preserved for adaptation periods prior to resort treatment and readaptation after procedures.

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Description

The invention relates to medicine, namely to rheumatology, and may find application in the prevention and treatment of patients with osteoarthritis (OA).

Osteoarthrosis (OA) is a progressive joint disease characterized by degeneration of articular cartilage, the development of osteophytes, changes in the subchondral bone against a background of latent or clearly proceeding synovitis. OA is one of the most common diseases among the adult population and takes first place in the structure of rheumatic pathology. The widespread prevalence of OA is a medical, social and economic problem. So, in people older than 50 years, joint changes are found in 30% of cases, older than 60 years already in 97%. In recent years, there has been a significant tendency to rejuvenate this pathology. The search for new optimal treatment methods for OA using physical factors is quite relevant, because modern studies have shown cartilage damage in conventionally prescribed non-steroidal anti-inflammatory drugs (NSAIDs).

There is a method of treating patients with osteoarthrosis with radon baths with a concentration of 10-20 nCi / l in the amount of 10 procedures per course, a temperature of 37 degrees, lasting 13-15 minutes, applied every other day (Kessel, V.P., Larkina V.A., 1980 .) Method, recom. "The spa phase in the rehabilitation treatment of patients after surgery on the hip joints." Pyatigorsk, 1980. Page 6. That was used as a prototype. However, this method does not eliminate the main manifestations of the disease and does not provide a preventive orientation in the use of resort factors.

The technical result of the proposed method is the earlier onset of the analgesic effect and the improvement of the functional capabilities of the affected joints, the preservation of positive changes for a longer period. The specified technical result is achieved by using radon baths with a concentration of 10-20 nCi / l (0.37-0.75 kBq / l) with a single exposure of 13-15 minutes, the water temperature in the bath is 36-37 degrees, the course is 12- 14 paired procedures according to the scheme 2 baths - rest day.

The method is as follows: the total duration of treatment is 24 days, including 1-2 days of the adaptation period. The medical complex includes a sanatorium-resort regime, a diet, therapeutic massage, exercise therapy, internal intake of mineral water, radon baths with a concentration of 10-20 nCi / l (0.37-0.75 kBq / l) in an amount of 12-14 per course are prescribed, temperature 36-37 degrees C, lasting 13-15 minutes, used according to the scheme: 2 baths - rest day.

The method is illustrated by the following examples.

1. Patient Ch-ova Z.S., 53, medical history No. 234, was admitted with complaints of pain in the knee and ankle joints occurring in the evening and after physical exertion, discomfort in these joints and surrounding muscles with changing weather conditions. Sick for more than 2 years, when joint pain and meteorological dependence first appeared. Heredity is burdened (the mother has early osteoarthrosis). Received outpatient treatment - physiotherapy, non-steroidal anti-inflammatory drugs (NSAIDs) Diclofenac for 2 years with pain.

Objective data: height 158 cm, weight 72 kg, gait relatively free, when examined, the joints are not changed, active and passive movements are preserved, palpation of the knee joints is painful on the medial surface more on the right. After the squat rises with outside help. There are no exudative and proliferative phenomena. Laboratory data: indicators of acute phase reactions without pathological deviations before and after the course of treatment. Biochemical studies: sialic acids before treatment 190 after treatment 170 (No. 135-200 units) fibrinogen before treatment 4.1 after 2.4 (No. 2-4 g / l). Electrocardiography - without features. On the radiograph of the knee joints, the initial signs of osteoarthritis are noted - a moderate narrowing of the joint gap, subchondral osteosclerosis is more on the right. According to type 1 electromyography, positive dynamics are noted. The patient underwent a course of radon baths in the amount of 12 procedures and the base resort complex according to the proposed technique. The immediate result of treatment is improvement. According to subjective data: joint pain and meteopathological reactions disappeared in the first half of the course of treatment (after 7-8 baths). According to objective data, palpation of the joints is painless, the indicators of functionality have improved (gait is free, after squatting it rises without assistance). Body weight decreased by 2 kg.

Long-term results: the patient was admitted to the clinic 13 months after completion of the course of treatment, case history No. 396. Preservation of positive changes is noted within 11 months after discharge, which is expressed in the absence of arthralgia after physical exertion and against the background of changes in weather conditions during the indicated period of drug therapy did not receive. Objectively: on the radiograph of the same joint there are no signs of the progression of the pathological process.

During this period, pain was absent, the patient did not take NSAIDs and other medications, did not notice meteopathological reactions, did not apply for a sick leave regarding temporary disability in connection with acute respiratory infections, acute respiratory viral infections and exacerbation of chronic digestive diseases. The indicators of joint functions improved - long walking and physical activity were not accompanied by the appearance of pain. Body mass returned to its original parameters.

Observation 2. Patient I-kin N.V., 46 years old, No. of medical history 887.

Received complaints of pain and "crunching" in the knee, hip joints, fast muscle fatigue, starting discomfort and stiffness in the knee joints, difficulty descending the stairs. He considers himself ill for about 3 years, when pain in the knee joints and difficulty in descent first appeared. It was treated on an outpatient basis, twice inpatiently (over the last year) with the use of NSAIDs, vascular therapy, chondroprotectors. The risk factor is overweight.

Objectively: height - 164, weight 101 kg, gentle walk. The knee joints are moderately configured due to proliferative changes, in the area of the left knee joint a moderate increase in local temperature relative to the right joint. Squat from a standing position without outside help can not.

Laboratory indicators of acute phase reactions without pathological changes before and after spa treatment. Biochemical studies: sialic acids 190 after treatment 135 (No. 135-200 units); fibrinogen before treatment 3.8 after 2.3 (No. 2-4 g / l). ECG - without pathology before and after spa treatment. On the radiograph of the knee joints, there are signs of osteoarthritis - narrowing of the joint gap, subchondral osteosclerosis more on the left, sharpening of the intercondylar elevations, single osteophytes of the tibia and patella, which corresponds to the 1-2 radiological stage. Electromyography - type 1 EMG - before treatment with a significant decrease in the electrical oscillations of the flexors and extensors of the lower leg; after treatment, these indicators with a clear improvement.

The patient underwent a course of radon baths in the amount of 14 procedures and the basic resort complex according to the proposed technique. The immediate result of treatment is improvement. According to subjective data: joint pain disappeared in the first half of the course of treatment (after 7-8 baths), the parameters of functional capabilities improved - difficulty in descent decreased, gait became freer, squats on its own (lifting with help), proliferative decreased significantly and exudative phenomena disappeared . According to objective data, palpation of the joints is painless. Body weight decreased by 5 kg.

The study of these long-term results showed the persistence of positive changes for 12 months. In this period, pain was noted once after significant physical exertion and hypothermia, the patient received NSAIDs in a short course (within 3 days). A significant reduction in the number of colds and their milder course after a course of spa treatment is noteworthy. Temporary disability was not noted. The indicators of joint functions improved - long walking and moderate physical activity were not accompanied by the appearance of pain. Body weight continued to decline for a month after the complex treatment. Thus, the registered weight loss over 1 year according to the assessment of long-term results was 9 kg without the use of other methods of weight loss.

Treatment according to the proposed method was carried out in 15 patients with significant osteoarthritis with initial radiological manifestations in the presence of risk factors and 30 patients by the prototype method. The dynamics of the articular manifestations in patients with osteoarthritis according to two methods are presented in table 1.

Table 1. The dynamics of the main indicators of articular manifestations in patients with osteoarthrosis. INDICATOR Group Indicator dynamics The proposed method n = 15 Improvement No change Worsening Abs. number % Abs. number % Abs. number % Joint pain fifteen one hundred - - - - Morning stiffness fourteen 93.3 one 6.6 - - Walking 13 86.6 2 13.3 - - Ability to crouch 12 80 3 twenty INDICATOR Group Indicator dynamics By the method of the prototype n = 30 Improvement No change Worsening Abs. number % Abs. number % Abs. number % Joint pain 26 86.6 four 13.3 - - Morning stiffness 25 83.3 5 16.7 - - Walking 24 80 5 16.7 one 3.3 Ability to crouch 17 60 eleven 36.7 one 3.3

Thus, the table shows that low-concentration radon baths according to the proposed method with a change in the number and arrangement of procedures showed a higher result in terms of pain parameters and functional capabilities of the affected joints, which can be explained by the level of absorbed dose of radon and its daughter products (DPR). It is known that in radon procedures, radon penetrates the body tissues with the formation of DPR, which also have a radiation effect due to their radiation properties. The effect obtained to a certain extent depends on the value of the absorbed radiation dose (dose-effect). Dosimetric studies indicate that with aqueous radon baths the patient’s skin is exposed to the main radiation, and the irradiation of all internal organs, compared with the skin, does not exceed 1%.

To determine the value of D EQ. The following parameters were taken into account:

- concentration (C) of radon in water in nCi / l (kBq / l)

- total activity (A) introduced into the body in µCi

- the average content in the irradiating medium of the DPR (N) in the form of the number of alpha-decays of these isotopes “hidden” in 1 liter of medium

- total duration (T) of procedures per treatment in minutes

- patient body weight (P) in kg

- the surface of the skin of the patient (S) in sq.m.

Calculation of the absorbed dose of radon and DPR from an aqueous radon medium during the course application of radon baths with a concentration of 10-20 nCi / l for various tissues and the body as a whole according to the formula D-equiv. = D ₁ · η ₁ +, D ₂ · η ₂ (And . I. Gusarov, 2000).

These formulas are used to calculate the absorbed dose from aqueous radon baths of various concentrations. The D-equivalent value for the course of radon baths with a concentration of 10-20nCi / l (10 baths, 12 and 14 baths) in Table 2

table 2 The absorbed dose for a different number of radon baths Indicator DECV (mber) 10 baths (prototype) 12 baths (1 group) 14 baths (2 group) Leather 34 41 48 Whole organism 1.3 1,56 1.82

Thus, the level of the absorbed dose of radon and its DPR increases with an increase in the number of procedures, which correlates with an improvement in the results obtained (dose-response relationship).

The dynamics of the clinical manifestations of osteoarthritis was evaluated in points before and after the course of spa therapy and is presented in table 3.

Table 3 The dynamics of the clinical signs of osteoarthritis (in points) in patients of the main group and by the method of the prototype. Indicator The proposed method n = 15 According to the methodology of the prototype n = 30 Before treatment M ± m After treatment, M ± m R Before treatment M ± m After treatment, M ± m R Range of motion 2.16 ± 0.4 1.4 ± 0.4 <0.05 2.07 ± 0.3 1.3 ± 0.17 0.05 Joint circumference 1.85 ± 0.07 0.74 ± 0.02 <0.05 2.3 ± 0.26 1.98 ± 0.26 <0.1 Pain index 1.61 ± 0.41 0.8b ± 0.2 <0.05 1.98 ± 0.21 1.03 ± 0.22 = 0.05 Inflammatory index 0.73 ± 0.12 0.12 ± 0.22 <0.05 1.83 ± 0.18 1.38 ± 0.24 > 0.3 Joint index 1.62 ± 0.24 1.03 ± 0.31 = 0.05 1.77 ± 0.22 1.5 ± 0.28 > 0.1

In the presented table on the prototype method, the shifts are reliable only in two parameters (range of motion and pain index), while in the group according to the proposed method, all indicators are reliable. According to laboratory studies, no negative trends were detected in any of the groups, and according to indicators of acute phase reactions (C-reactive protein), a significant decrease in the level in the main group was revealed (P <0.01). Fibrinogen also decreased in the main group without achieving a significant difference before and after the course of treatment (P> 0.1). Marked both by the method of the prototype, and by the proposed method, the decrease in body weight 82.03 + -79.2 P <0.001 remains within 6-12 months after the spa treatment.

The data presented in table 2 with a high degree of reliability indicate the advantage of the claimed methodology, which may be explained by the accumulation of the absorbed dose (34 mber and 41-48 mber with an increase in the number of procedures). In addition, the increase in efficiency by the proposed method can be explained by the arrangement of procedures, because the irritant and its effects persist within 1 day. The method of exposure to a physical factor every other day actually occurs against the background of the initial level of clinical and physiological parameters. The proposed technique of two paired procedures realizes the effect of summation, which contributes to a more effective sanogenetic effect.

The overall effectiveness in the groups according to the set of clinical and laboratory data was as follows: in the main group, improvement was in 93.3% of patients with osteoarthrosis, a slight improvement was in 6.7%; no change and deterioration - not noted. In the prototype group, improvement was 75%, a slight improvement was 11.6%; unchanged - in 6.7%; worsening - in 6.7% of patients.

Thus, the use of radon baths of low concentration in optimizing the number and arrangement of procedures is more pronounced compared to the control. As a result of the application of the proposed method in patients, a decrease in pain in the affected joints, a decrease in proliferative processes, an improvement in the functionality of the musculoskeletal system, a decrease in body weight, an increase in the general non-specific resistance of the body were observed. prevention of exacerbation of chronic diseases of other organs and systems, improving the quality of life. The duration of the preservation of positive changes on average with both methods is from 7 to 12 months with an advantage in the main group (10-11 months). About 80% of patients in both groups were able to completely refuse to take NSAIDs, 20% of patients took them periodically.

The method is effective and can be used at the stage of spa treatment.

Claims (1)

A method for the treatment of patients with osteoarthritis, including the use of radon baths with a concentration of 0.37-0.75 kBq / l (10-20 nCi / l), the water temperature in the bath 36-37 ° C, the exposure time is 13-15 minutes, characterized in that the course of treatment is prescribed 12-14 procedures according to the scheme 2 baths - rest day.