RU2349354C1 - Method of osteoarthrosis treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, rheumatology, and can be applied inosteoarthrosis treatment. It involves preliminary application of "Artro-aktiv" calefacient oil balm on affected joint area. Immediately after that articulate cleft projection is affected by 80 Wt infrared radiation with "Svetovit" device at distance of 3-4 cm from skin to device for 10-15 minutes for each joint. The whole procedure comprises not more than 30 minutes. A single procedure covers not more than 2-3 joints. Therapy course is 10-12 daily procedures.

EFFECT: possible elimination of muscular spasm, contracture relief, pain syndrome arrest, recovery of functional musculoskeletal system insufficiency improving clinical course of osteoarthrosis.

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Description

The invention relates to medicine, in particular to rheumatology and restorative medicine, namely to the treatment of patients with osteoarthritis and can be applied in medical and rehabilitation institutions.

Osteoarthrosis (OA) is the most common joint disease and has disabling symptoms in approximately 10% of the population over 55 years old, a quarter of whom develop severe functional impairment. The use of painkillers and anti-inflammatory drugs, as well as the timely appointment of drugs with chondroprotective properties, can achieve positive results in the treatment of osteoarthritis [Jordan K.M., Arden N.K., Doherty M. et al. EULAR Recommendations 2003: Ann. Rheum. Dis. 2003, 62: 1145-1155]. However, the search for new effective and harmless treatment methods remains relevant.

Known methods of treating patients with osteoarthritis with physical factors, for example, using a constant and alternating magnetic field, sinusoidal modulated currents, decimeter-wave electromagnetic waves, radon baths, mud applications, paraffin [Balneology and physiotherapy, under. ed. Bogolyubova V.M. M .: Medicine, 1996, 605 p.].

However, none of these methods fully satisfies the principles of treating OA: reducing pain, eliminating tendon-muscle contractures, improving the function of the affected joint and reducing disability, preventing or slowing the progression of the disease and its complications.

The closest in technical essence to the proposed method for the treatment of patients with osteoarthritis, is a method of treatment with a Minin lamp, which consists in the fact that they affect infrared radiation on the area of affected joints. The distance from the irradiator to the area of the body (joint) to be irradiated is 30-50 cm. The intensity of the exposure is adjusted to a moderate heat sensation. The duration of infrared irradiation carried out once a day is from 15 to 30 minutes, the course of treatment is 15-20 procedures [Technique and methods of physiotherapeutic procedures. Directory. M., 2002, 403 pp.]. The disadvantages of the prototype are that the intensity of exposure is controlled by the distance, according to the patient's sensation of moderate heat, which he informs the nurse. Inadequate exposure can cause intense thermal erythema in the localized area. The action of infrared rays initiates the activation of the microvasculature, increase vascular permeability, stimulate reparative and regenerative processes, and reduce pain sensitivity. However, they do not have a significant effect on the state of tendon-muscle contractures, reflex spasm of muscles, causing restriction of movements in the affected joint.

The technical result of the proposed method for the treatment of patients with osteoarthritis is to reduce muscle spasm, weaken contractures, improve the functional properties of tendons and ligaments, relieve pain, restore functional insufficiency of the musculoskeletal system.

SUMMARY OF THE INVENTION The specified technical result is achieved by the fact that after the preliminary application of the balm of oil-warming “Arthro-active” on the affected joint, they are exposed to infrared radiation. The distance to the irradiator is 3-4 cm, the radiation power is 80 W (I mode), which causes a sensation of moderate heat. The impact on one field is carried out from 10 to 15 minutes (total not more than 30 minutes) depending on the number of fields. The course is prescribed for 10-12 daily procedures.

In this method, the intensity of infrared radiation remains stable, which eliminates the appearance of severe thermal erythema. A new method of energy transfer implemented in the Svetovit infrared therapy apparatus - due to the design features of the emitter and the use of a silicon light filter - increases the permeability of infrared waves. This allows you to reduce the exposure time on 1 field to 10-15 minutes, cover 2-3 joints in one procedure, shorten the course of treatment to 10-12 procedures. In addition, under the combined effects of the Artro-Active oil warming balm and infrared therapy, two different factors act as synergists: the influence of infrared radiation, increasing the temperature of the irradiated zones by 1-2 degrees, causes local thermoregulatory reactions of the superficial vascular network. These reactions are manifested by a change in the tone of the capillaries and the functional properties of thermomechanically sensitive afferent skin conductors. Activation of the microvasculature and increased vascular permeability enhances the pharmacodynamics and pharmacokinetics of the constituent elements of the “Artro-active” oil-warming balm.

Description of the treatment method.

The method is as follows: in a sitting position or lying on the surface of the body to be exposed, a thin layer was applied with a spatula using an oil warming balm “Arthro-active”, after which, without a time interval, the projected joint space was exposed to infrared radiation from the Svetovit infrared therapy apparatus (TU 9444-005-17664661-2004, OJSC Plant of Environmental Engineering and Ecological Nutrition "Diode"). The distance to the irradiator was 3-4 cm, the radiation power was 80 W (I mode). The effects were carried out for 10-15 minutes for each joint, not more than 30 minutes (2-3 joints) in one procedure. The course was prescribed 10-12 daily procedures.

Example 1 of the method. Patient A., 53 years old, laboratory assistant, was admitted to the hospital with a diagnosis of osteoarthritis of the knee joints: bilateral gonarthrosis, stage III, common osteochondrosis. Upon admission, she complained of mechanical pain in the knee joints, aggravated by exertion, with movements, sometimes appearing at night. There was a restriction of movements in the knee joints, a pronounced spasm of the surrounding muscles, a slight flexion contracture. Pain occurred when walking, especially when descending and climbing stairs, and passed at rest. In addition, there were starting pains in the knee joints that appear after a long sitting when trying to get out of the chair, limiting bending by 18-20 °. Considers herself a patient for more than 12 years, when pain first appeared in the anterior part at the beginning of the right, then the left knee joint during extension, especially when climbing and descending stairs. An X-ray examination of the knee joints shows subchondral osteosclerosis, a significant narrowing of the joint spaces, multiple ostephitis. To stop the pain syndrome and normalize daily physical activity, he takes non-steroidal anti-inflammatory (NSAIDs) drugs (nimesulide up to 200 mg / day) constantly, in short courses. Upon examination, the condition is satisfactory. The skin is of normal color. Vesicular breathing. No wheezing. BH 16 per minute. Heart sounds of medium strength, the ratio is correct. HELL 125/80 mm Hg Pulse 78 beats. in minutes, rhythmic. On palpation, the liver is not enlarged, the abdomen is soft, slightly painful in the epigastric region. Pasternatsky’s symptom is negative from 2 sides. Weight 90 kg, with a height of 175 cm.

Status lokalis. Joint deformation due to bone growths, atrophy of the thigh muscles, and deviation of the knee joints are noted. On palpation, local pain, compaction of the bag of the joint, intra-articular crunch are determined. Instability of the right knee joint, flexion contracture (muscle-tendon) on the right at 20 °, on the left at 18 ° are observed. Palpation of paravertebral points along the spine is painful in the cervical and thoracic regions. Symptom of Schober is 16 cm, Forestier - 5 cm, chin-sternum distance - 7 cm.

When analyzing the results of clinical and biochemical studies of blood and urine, pathological deviations were not detected. An objective study of clinical indicators showed that the severity of pain on a visual analogue scale (VAS) was 8 points, the number of affected joints was 4, the articular index was 14 points, the Womak index was 136 points, and the Lequesne index was 22 points. Morning stiffness in the knee joints lasted up to 15 minutes. The value of such indicators as malaise and assessment of the general condition of the patient, measured by YOUR, were 7 points, respectively. At the time of admission, over the past 10 days I took 200 mg of nimesulide daily.

Infrared radiation was generated from the Svetovit apparatus on the knee joints and on the lumbar spine, on which the warming oil “Arthro-active” was previously applied. Infrared irradiation was carried out sequentially, without a time interval, with a power of 80 W, with a gap of 3-4 cm, on the projection area of the joint space of the knee joints and along the spinal column in the lumbar spine, lasting 10 minutes per field. The course of treatment was 12 procedures.

After treatment with the claimed method, clinical improvement was observed, which was expressed in a significant decrease in pain intensity (by YOUR) by 47%, the number of affected joints by 35%, and the articular index by 38%. A significant decrease in the Womak index (by 43%) and the Lequesne index (by 45%) indicated a decrease in the severity of osteoarthritis, an increase in the functional activity of patients and restoration of locomotor function. There was a restoration of range of motion in the knee joint due to elimination of flexion contracture and muscle spasm, and in the lumbar spine: Schober’s symptom decreased to 6 cm. After 2 weeks after completion of the course of treatment, the dose of background drug therapy (nimesulide) was reduced by 50%.

Example 2. Patient B., 58 years old, teacher. Received with a diagnosis of:

Polyosteoarthrosis, X-ray stage III, common osteochondrosis. Upon receipt, the main complaints were presented for pain in the knee, hip joints, distal interphalangeal joints, intervertebral joints of the cervical and lumbar spine, morning stiffness for 20 minutes, limitation of range of motion in the joints and spine, crunch. Notes intensification of pain during physical exertion and their subsidence at rest. Considers herself a patient for more than 15 years. The cause of the disease was probably static stress, overweight, and hereditary factors. Despite the ongoing pharmacotherapy (analgesics, non-steroidal anti-inflammatory drugs, muscle relaxants), the disease progressed over the past 7-8 years, chronic pain, limited movement in the cervical and lumbar spine. To stop the pain, it takes up to 2.5 g per day of acetaminophen. Short courses (10-14 days) receive Movalis at 15 mg per day. For more than five years, he has been systematically receiving oral chondroprotectors (don, structure). An X-ray examination at the time of admission to the clinic revealed a moderate narrowing of the joint gap in the affected joints, multiple osteophytes.

Upon examination, the condition is satisfactory. The skin and mucous membranes are normal in color. With auscultation in the lungs vesicular breathing, no wheezing. BH 20 per minute. Heart sounds are muffled, the ratio is correct. HELL 130/95 mm Hg Rhythmic pulse 82 beats. in minutes The liver is not enlarged, the abdomen is soft, painless on palpation. Pasternatsky’s symptom is negative. Weight 98 kg, with a height of 176 cm.

Status lokalis. On examination, varus deformity of the knee joints, palpation pain in the knee joints along the joint gap, flexion contracture up to 20 ° are determined. In the right hip joint, there is a limitation of internal rotation (10 °) and flexion (90 °). There is deformation and configuration of the distal interphalangeal joints of the hands, the presence of Heberden nodules. Palpation of paravertebral points along the spine is painful in the cervical and thoracic regions. Symptom of Schober is 12 cm, Forestier - 3 cm, chin-sternum distance - 4 cm.

In a clinical examination, the severity of pain on a visual analogue scale was 10 points, the number of affected joints was 9, the articular index was 18 points, the Womak index was 148 points, and the Lequesne index was 20 points. Morning stiffness in the affected joints lasted an average of 20 minutes. The value of such indicators as malaise and assessment of the general condition of the patient, measured by YOUR, were 8 and 7 points, respectively. When analyzing laboratory test data, pathological abnormalities were not detected. When radiography of the affected joints was observed moderate narrowing of the joint space, multiple osteophytes, which corresponded to stage III ostearthrosis according to Kellgren and Lawrence. Upon admission to the clinic, she took drug therapy (moval 15 mg / day), the dose of which remained unchanged during the treatment period.

Infrared radiation was generated from the Svetovit apparatus on the right knee and right hip joint and on the lumbar spine, on which the warming oil “Arthro-active” was previously applied. Infrared exposure was carried out sequentially, without a time interval, with a power of 80 W, with a gap of 3-4 cm, on the projection area of the joint space and along the spinal column in the lumbar region, lasting 10 minutes per field. The course of treatment was 12 procedures.

The course of treatment caused clinical improvement, which was manifested in an increase in the range of motion in the right hip (rotation 15 °, flexion 110 °) and right knee (flexion contracture - 5 °) joints due to the weakening of contractures and elimination of muscle spasm. The same dynamics was observed in the lumbar spine:

Schober’s symptom was reduced to 6 cm. A significant decrease in pain intensity (VAS) was achieved by 32%, the number of affected joints by 35% and the articular index by 33%. There was a significant decrease in the Womak index (by 44%) and the Lequesne index (by 38%).

Thus, after treatment with the claimed method, there was a normalization of functional disorders of the locomotor apparatus, an increase in daily physical activity, a decrease in the intensity of joint pain, an increase in the range of motion in the affected joints.

The proposed method for the treatment of osteoarthritis was tested in the arthrology department of the Russian Center for Reconstructive Medicine and Balneology of the Russian Health on 60 patients, of which women predominated (88.3%). The average age of the subjects was 53.7 ± 3.1 years. In 20% of patients, the duration of joint disease did not exceed 5 years, in 1/4 of the part - 10 years. In more than 50% of patients, the duration of OA exceeded 10 years. When verifying the diagnosis in 66.7% of cases, polyostearthrosis (POA) was verified. Among patients with POA, in 49% of cases, the clinical picture of the disease was dominated by gonarthrosis (GA), 40% of cases of coxarthrosis (CA), and in 11% of cases, nodular OA. Among patients with GA in 38% of cases, a unilateral lesion was recorded, in the rest - bilateral. Among patients with CA in 38% of cases, the pathological process was bilateral in nature, in other cases it was one-sided. In 63.3% of patients dorsopathy of various localization was registered.

The clinical condition of the patients was evaluated on the basis of complaints, anamnestic data and the results of a direct examination of the joints. The following clinical indicators were studied to determine the effectiveness of treatment before and after the course of treatment: pain on a 100 mm visual analogue scale (VAS), the number of swollen joints, the number of painful joints, the Ritchie index, which includes an assessment of 53 joints, the duration of morning stiffness in the joints, estimated in minutes, a general assessment of his condition by the patient according to YOUR; malaise assessed by YOUR; Lequesne index, which includes an assessment of pain at rest and when walking, the maximum distance traveled and daily activity; Womac index, designed for self-assessment (by YOUR) of the patient the severity of pain (at rest and when walking), stiffness (duration and severity) and functional impairment in everyday activities; Schober test - a modified test to determine mobility in the lumbar spine in centimeters; chest tour - a test to determine the volume of respiratory movements in cm, indicating the mobility of the thoracic spine; Symptom Forestier and the distance of the chin-sternum - to determine mobility in the cervical spine in centimeters.

The cardinal clinical symptom of OA in the examined patients was mechanical pain in the affected joints, aggravated by exertion, with movements, sometimes appearing at night. An objective study determined such clinical manifestations as palpation of the joints, their configuration and deformation, tenderness of the paravertebral points in the involved segments of the spine. Crepitus was observed when moving in the affected joint, which, in the progressive stage of OA, turned into a rough “crunch”. Arthralgia was often combined with morning stiffness (in 81.7% of patients), which, unlike morning stiffness in rheumatoid arthritis, was localized only in the affected joint. There was a restriction of movements in the affected joints in connection with the existing pain and reflex spasm of the muscles, up to the formation of tendon-muscle contractures. So in 55% of patients extensor contractures were observed. Some patients (31.7%) complained of inflammatory pain in the affected joints.

After treatment with the proposed method in patients with osteoarthritis, there was a decrease in the number of painful joints in 52 of 60 cases, a decrease in the period of morning stiffness in 43 cases out of 49, a decrease in pain intensity in 56 out of 60 cases, an increase in the range of motion in the joints in 43 out of 49 cases a drop in the articular index in 57 out of 60 cases, an increase in the motor function of various segments of the spine in 32 out of 36 patients, elimination of contractures in 27 out of 33 patients. The results of repeated tests revealed significant positive dynamics of ind ksa Womac and Lequesne index, indicating a decrease in the severity of osteoarthritis and an increase in the functional activity of the musculoskeletal system.

Based on the foregoing, it should be noted that the proposed method is a clinically highly effective, reasonable and safe method of treating patients with osteoarthritis, as it helps to improve the clinical course of the disease, namely, eliminates muscle spasm, weaken contractures, relieve pain, reduce the period of morning stiffness, restore functional insufficiency of the musculoskeletal system, increasing the daily activity of patients. The claimed method favorably affects the general state of health, improves the prognosis of the disease; the method is simple to perform, can be carried out in a hospital, clinic, rehabilitation center.

Claims (1)

A method of treating patients with osteoarthritis, including exposure to infrared radiation on the affected joint area, characterized in that the “Arthro-active” balm is applied to the affected joint area first, and then, without a time interval, the Svetovit apparatus is irradiated with 80 W radiation power with a distance of 3-4 cm from the irradiator, lasting from 10 to 15 minutes per localization, no more than 30 minutes in total for one procedure, per course of 10-12 daily procedures