RU2349356C1 - Method of osteoarthrosis treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, particularly rheumatology and rehabilitation medicine, and treatment of degenerative joint diseases. It involves application of "Artro-aktiv" calefacient oil balm on affected joint area. Immediately after balm application the same area is affected by ultrasound. For shoulder, elbow and radiocarpal joints intensity comprises 0.4 to 0.8 Wt/cm², for small wrist joints intensity comprises 0.6 Wt/cm², for foot joints - 0.8 Wt/cm², for knee joints - 0.6-0.8 Wt/cm², for ankle and coxofemoral joints - 0.8-1.2 Wt/cm². Each location is affected for 5-8 minutes, not more than 4 fields are included in one session. Therapy course is 10-12 daily sessions.

EFFECT: pain syndrome arrest, prevention of morning stiffness and contractures, reduced severity of pathological reaction.

2 ex

Description

The invention relates to medicine, in particular to rheumatology and rehabilitation medicine, namely to the treatment of patients with degenerative diseases of the joints and can be used in medical institutions.

Osteoarthrosis (OA) - the most common joint disease - is one of the main causes of temporary disability and disability, and a more important factor in limiting the level of physical activity than heart disease, hypertension, and diabetes. Active introduction into the medical practice of drugs with chondroprotective properties that can stop structural changes in cartilage, and selective non-steroidal drugs [V. Lyalina Consilium Medicum, 2006, Volume 8, No. 8, pp. 24-28], which have anti-inflammatory and analgesic properties, significantly improved the prognosis of patients with OA. However, the search for new effective and safe treatments remains relevant.

Known methods of treating patients with osteoarthritis with physical factors, for example, using sinusoidal modulated currents, infrared laser radiation, a constant and pulsed magnetic field, hydrogen sulfide baths, cryotherapy [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: slowing the progression of the degenerative process, reducing pain and synovitis, preventing disability, improving the quality of life of patients, and reducing the risk of exacerbations.

The closest in technical essence to the proposed method for the treatment of patients with osteoarthritis is the method of treatment with ultrasound, which consists in the fact that they affect the area of the affected joints with ultrasound. The ultrasound intensity when acting on the shoulder, elbow, wrist joints is 0.2-0.6 W / cm ² , on the knee joints - 0.4-0.6 W / cm ² , on the ankle and hip joints - 0.6- 0.8 W / cm ² . The procedures are carried out continuously, according to a labile technique, lasting 5-10 minutes, an average of 8-10 procedures per treatment course [Handbook of physiotherapy, under. ed. Yasnogorodsky V.G., M., Medicine, 1997, 345 p.]. The disadvantages of the prototype are that ultrasound, causing local expansion of the vessels of the microvasculature and changing the functional properties of the thermomechanically sensitive structures of the tendons and ligaments, helps to reduce muscle spasm and weaken contractures, but does not significantly affect the activity of the inflammatory process in the joints, does not have a sufficient analgesic effect .

The technical result of the proposed method for the treatment of patients with osteoarthritis is the relief of pain, the restoration of functional insufficiency of the musculoskeletal system, the increase in daily activity, increasing the effectiveness of treatment.

SUMMARY OF THE INVENTION The specified technical result is achieved by the fact that after preliminary application of the balm of oil “Arthro-active” warming on the affected joint area, ultrasound exposure of intensity from 0.4 to 1.0 W / cm ² depending on the localization of the pathological process, according to the labile technique, contact the method, in continuous mode, around the affected joint, lasting 5-8 minutes for each joint, not more than 3-4 joints in one procedure, per course of 10-12 daily procedures.

In this method, the ultrasound intensity is selected taking into account the area of damage to osteoarthrosis. The intensity of ultrasound when exposed to the shoulder, elbow, wrist joints is 0.4-0.8 W / cm ² for small joints of the hands - 0.6 W / cm ² , feet - 0.8 W / cm ² , on the knee joints - 0.6-0.8 W / cm ² , on the ankle and hip joints - 0.8-1.0 W / cm ² . According to the results of physical and chemical studies, such an exposure regimen is optimal for the phonophoresis of the balm oil "Arthro-active" warming than exposure in the traditional range. The increase in the permeability of the skin, blood vessels and other histohematological barriers caused by ultrasound, the activation of the microvasculature creates favorable conditions for the penetration of balsam molecules through them. At the same time, the therapeutic effects of the warming oil balm “Arthro-active” are added to the mechanisms of the biological action of ultrasonic vibrations. Ultrasonic vibrations, enhancing the pharmacodynamics and pharmacokinetics of the warming oil “Artro-active” balm, potentiate its therapeutic effects.

Description of the method of treatment

The method is as follows: in a sitting position (when acting on the shoulder, elbow, wrist joints) or lying down (when acting on the ankle, knee, hip joints) on the surface of the body to be exposed, a thin layer with a spatula applied Arthro-active oil balm warming, after which, without a time interval, ultrasound therapy was performed according to a labile method, by contact, in a continuous mode, from the UZT-101 apparatus (reg. No. 78 / 1261-33, MGP EMA plant, Moscow). The duration of exposure was 5-8 minutes for each joint, not more than 3-4 joints in one procedure. The procedures were performed daily, 10-12 procedures were prescribed for the course. Exposure was prescribed around the affected joint.

An example implementation of the method. Patient A., 52 years old, teacher, was admitted to the hospital with a diagnosis of osteoarthritis of the knee joints (bilateral gonarthrosis), stage II-III, chronic gastritis. At admission, she complained of mechanical pain in the knee joints, restriction of movement, and a decrease in daily activity. The pain intensified after physical exertion, wearing heaviness, when climbing, and especially when descending the stairs. In addition, there were starting pains in the knee joints that appear after a long sitting when trying to get up from a chair or chair, limiting flexion by 15-20 °. She considers herself a patient for more than 8 years, when for the first time short-term pains appeared in the right knee joint after a long standing in front of a blackboard in the classroom, a long walk that took place after a short rest. Subsequently, pain began to appear with greater frequency and intensity, and stopped only with the help of analgesics. 2 years after the debut of the disease, pain began to arise and progress in the left knee joint. With a dynamic x-ray examination of the knee joints over the past three years, an increase in bone changes has been noted. About 3 months ago, morning stiffness appeared in the knee joints lasting up to 20 minutes. To stop the pain syndrome and normalize daily physical activity, he takes non-steroidal anti-inflammatory (NSAIDs) drugs (diclofenac 100-150 mg / day) continuously, in short courses. Due to the appearance of signs of NSAID gastropathy in recent months, he uses the drug meloxicam, in a daily dose of 15 mg, which is better tolerated. Upon examination, the condition is satisfactory. The skin is of normal color. Vesicular breathing. No wheezing. BH 18 in minutes Heart sounds of medium strength, the ratio is correct. HELL 130/90 mm Hg Pulse 76 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 86 kg, with a height of 172 cm.

Status lokalis: Symmetrical deformity and configuration of both knee joints is noted. Palpation of pain in the knee joints along the joint gap, especially on the medial surface, is most pronounced on the right side, as well as in the bursa anserine area on both sides. Hypotrophy of the quadriceps femoris muscle, slight crepitus in the knee joints, flexion contracture (muscle-tendon) on the right 20 °, on the left 15 °.

When analyzing the results of clinical and biochemical studies of blood and urine, pathological deviations were not detected. When radiography of the knee joints was observed narrowing of the joint gap, subchondral osteosclerosis, osteophytosis. An objective physical examination of clinical parameters showed that the severity of pain on a visual analogue scale (VAS) was 6 points, the number of affected joints was 5, the articular index was 11 points, the Womac index was 127 points, and the Lequesne index was 20 points. Morning stiffness in the knee joints lasted up to 20 minutes. The values of such indicators as malaise and assessment of the general condition of the patient, measured by YOUR, were 6 and 5 points, respectively. At the time of admission, over the past 7 days, I took 15 mg of meloxicam daily (Movalis).

The ultrasound generated from the UZT-101 apparatus was applied to the knee joints, on which the “Arthro-active” oil warming balm was previously applied. The effects were carried out sequentially, without a time interval, around the knee joints, in a continuous mode, using a labile technique. The ultrasound intensity was 0.6-0.8 W / cm ² , the duration of exposure was 5 minutes for each knee joint. 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 (according to YOUR) by 43%, the number of affected joints by 29% and the articular index by 31%. A significant decrease in the Womac index (by 39%) and the Lequesne index (by 35%) indicated a decrease in the severity of osteoarthritis, an increase in the functional activity of patients and restoration of locomotor function. Upon completion of the course of treatment, it was possible to reduce the dose of the drug (meloxicam) by 50%.

Example 2. Patient B., 59 years old, a pensioner. Received with a diagnosis: Generalized osteoarthrosis (polyosteoarthrosis), X-ray stage III, common osteochondrosis. Upon receipt, the main complaints were presented for pain in the knee, hip joints, first metatarsophalangeal joints of the feet, first carpal-carpal joints of the hands, intervertebral joints of the cervical and lumbar spine, morning stiffness for 30 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 overweight, hereditary factors. Despite the ongoing pharmacotherapy (analgesics, non-steroidal anti-inflammatory drugs, muscle relaxants), the disease progressed over the past 5 years, the appearance of pain, and movement restrictions in the cervical and lumbar spine. For the relief of pain, it takes up to 4 g per day of acetaminophen, with insufficient analgesic effects - up to 400 mg of celebrex. For more than three years, he has been systematically receiving chondroprotectors (structure, alflutop). 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 18 in minutes Heart sounds are muffled, the ratio is correct. HELL 140/100 mm Hg Rhythmic pulse 84 beats. in minutes The liver is not enlarged, the abdomen is soft, painless on palpation. Pasternatsky’s symptom is negative. Weight 94 kg, with a height of 174 cm.

Status lokalis: On examination, varus deformation of the knee joints, palpation of the knee joints along the joint gap, flexion contracture up to 30 ° are determined. In the right hip joint there is a limitation of internal rotation (10 °) and flexion (100 °). There is a deformation and configuration of the first metatarsophalangeal joints of the feet, the first metacarpal joints of the hands. Palpation of paravertebral points along the spine is painful in the cervical and thoracic regions. Symptom of Schober is 15 cm, Forestier - 4 cm, chin - sternum distance - 5 cm.

In a clinical examination, the severity of pain on a visual analogue scale was 8 points, the number of affected joints was 9, the articular index was 16 points, the Womak index was 138 points, and the Lequesne index was 22 points. Morning stiffness in the affected joints lasted an average of up to 30 minutes. The values of such indicators as malaise, and the assessment of the general condition of the patient, measured by YOUR, were 8 and 6 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 (celebrex 200 mg), the dose of which remained unchanged during the treatment period.

The ultrasound generated from the UZT-101 apparatus was performed on the I metatarsophalangeal joint of the right foot, on the lumbar spine and on the right knee joint, on which the “Arthro-active” oil was applied before warming. The effects were carried out sequentially, without a time interval, around the affected joints and paravertebrally to the lumbar spine, in a continuous mode, according to a labile technique. The intensity of ultrasound was 0.6-0.8 W / cm ^{2 the} duration of exposure of 5 minutes for each location. The course of treatment was 12 procedures.

The course of treatment caused clinical improvement, which was expressed in an increase in the range of motion in the cervical and lumbar spine: Schober’s symptom decreased to 8 cm. Forestier - to 2 cm, chin-sternum distance to 2 cm. A significant decrease in pain intensity was achieved (by YOUR) by 35%, the number of affected joints by 32% and the articular index by 38%. There was a significant decrease in the Womac index (by 41%) and the Lequesne index (by 37%).

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, a regression of local signs of an inflammatory reaction.

The proposed method for the treatment of osteoarthrosis 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 (71.7%). The average age of the subjects was 51.3 ± 2.4 years. Of these, 88% were patients with a diagnosis of polyostearthrosis (POA). Among patients with POA, in 55% of cases, the clinical picture of the disease was dominated by gonarthrosis (GA), 24% of cases of coxarthrosis (CA), and nodular OA in 21% of cases. Among patients with GA in 58% of cases, a unilateral lesion was recorded, in the rest - bilateral. Among patients with CA in 42% of cases, the pathological process was bilateral in nature, in other cases it was one-sided. Among patients with nodular OA, the number of patients with a predominant lesion of the distal and / or proximal interphalangeal joints of the hands was approximately equal. In 36.3% of patients dorsopathy of various localization was registered.

Evaluation of the clinical status of patients was carried out on the basis of patient complaints, medical history and results of a direct examination of the joints. To evaluate the effectiveness of treatment before and after the course of treatment, the following clinical indicators were evaluated: pain according to a 100 mm visual analogue scale (VAS), the number of swollen joints, the number of painful joints, the Ritchie index - including 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 main complaints were presented with mechanical pain in the affected joints and / or parts of the spine, morning stiffness lasting no more than 30 minutes, restriction of active and passive movements, swelling of the joint due to a small exudate. An objective study determined palpation of the joints, their configuration and deformation, tenderness of the paravertebral points in the involved segments of the spine, reduction of goniometric indicators. In 48.3% of patients, extensor contractures were observed. In 18.3% of cases, synovitis of the knee joints was recorded.

After treatment with the proposed method in patients with osteoarthritis, there was a decrease in the number of painful joints in 53 out of 60 cases, a decrease in the period of morning stiffness in 34 out of 40 cases, a decrease in pain intensity in 54 out of 60 cases, an increase in range of motion in the joints in 43 out of 49 cases, a drop in the articular index in 57 of 60 cases, an increase in the motor function of various segments of the spine in 35 patients out of 38, the elimination of contractures in 21 patients out of 29. 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 for the treatment of patients with osteoarthritis, as it helps to improve the clinical course of the disease, namely, relieves pain, reduces the period of morning stiffness, eliminates contractures, restores functional deficiency of support motor apparatus, increasing the daily activity of patients, reducing the severity of the pathological reaction. 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, sanatorium, rehabilitation center.

Claims (1)

A method of treating patients with osteoarthritis, including the use of an “Arthro-active” oil balm, warming the affected joints, characterized in that immediately after applying the balm, ultrasound is applied to the same area without a time interval, and when exposed to the shoulder, elbow, and wrist joints, the intensity of exposure is from 0.4 to 0.8 W / cm ² , on small joints of the hands 0.6 W / cm ² , feet 0.8 W / cm ² , on the knee joints 0.6-0.8 W / cm ² , on ankle and hip joints of 0.8-1.2 W / cm ^2, lasting t 5 to 8 minutes per location, not more than 4 fields for one procedure, a course of 10-12 daily procedures.