RU2449285C1 - Method of predicting risk of arterial hypertension development in patients with primary osteoarthrosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention can be used for prediction of risk of development of arterial hypertension in patients with primary osteoarthrosis (POA). Invention is based on determination of duration in years (DKS) and intensity (VASH) of pain syndrome, calculation of number of desquamated endotheliocytes in blood (DEC) with further calculation of coefficient by formula K= DKS*DEC*VASH)/100. If coefficient value is more than 1, conclusion about high risk of arterial hypertension development is made. If coefficient value is lower than 1, probability of AH development is relatively low.

EFFECT: application of the method makes it possible to predict development of AH in said category of patients with high reliability and take adequate prophylactic and therapeutic measures in due time.

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Description

The invention relates to medicine, namely to rheumatology, and can be used to predict the risk of developing hypertension in patients with primary osteoarthritis (POA).

The problem of the frequent combination of PAO with cardiovascular diseases (CVD) is one of the most important, since it is this aspect that determines the possibility of an adequate and safe treatment of POP, and the prognosis for this category of patients [1, 2, 3]. In this regard, in recent years, more and more works have appeared in the literature on the problems of damage to the cardiovascular system in rheumatic diseases, among which POA occupies a leading position [4]. According to various authors, its prevalence in the population varies from 8% to 20% [5, 6]. It was found that OA is often combined with CVD, and the mortality rate of patients with POA from vascular catastrophes is higher than in people without it in similar age groups. So many authors pay attention to a significant (more than 60%) prevalence of arterial hypertension among patients with POA [7]. Long-term pain syndrome, chronic inflammation and the need for periodic course administration of non-steroidal anti-inflammatory drugs (NSAIDs) create pathogenetic prerequisites for the development of arterial hypertension (AH) in such patients. At the same time, in a number of studies it was found that even minor vascular and metabolic changes have a pronounced effect on the severity of clinical manifestations and functional insufficiency of the joints in PAA [8].

A known method for predicting the development of gestational hypertension, based on the ultrastructural determination of the presence of activated monocytes, lymphocytes and neutrophils [9]. The presence of activated forms in two or more subpopulations of the white blood of a pregnant woman is prognostically unfavorable. There is a method for predicting nephrogenic hypertension in chronic pyelonephritis, which involves the calculation of biomedical and clinical and laboratory parameters, such as a history of perinatal and genealogical history, blood type, the presence of concomitant pathology, the level of daily uricosuria and proteinuria, specific gravity of urine, ESR, urea content and blood creatinine, the level of glomerular filtration and tubular reabsorption, such as hemodynamics and bladder function [10].

However, these methods are time consuming, time consuming and not available for wide clinical use. Moreover, we are talking about predicting secondary hypertension, the development mechanisms of which are specific to each specific disease.

As a prototype, a method for predicting the development of arterial hypertension during anti-inflammatory therapy in patients with rheumatoid arthritis is taken by determining the concentration of nitrite ions in red blood cells [11]. This method allows to predict an increase in systolic blood pressure above 140 mm Hg. in 100% of cases, with a nitrite ion level below 1.82 mmol / L, and with a nitrite concentration of 1.82 mmol / L or higher, normal blood pressure occurred in 94% of cases. The sensitivity and specificity of the method are quite high. However, the method is not accurate enough, since the authors evaluate the vasoregulatory ability of the endothelium by one indicator, which, as you know, varies widely and varies in different directions under the same conditions depending on the period, activity, form of the process [9, 10, 11] . Thus, due to the presence of unaccounted factors, including biochemical (information about the state of endothelial function) and clinical data, the diagnostic value of the results is reduced.

To increase the accuracy and specificity of predicting the development of hypertension in patients with POA, the duration of the clinical symptoms of the disease (in years), the intensity of pain, the amount of desquamated endotheliocytes (DEC) in the blood are determined and the coefficient is calculated, which is the product of the three above indicators, expressed as a percentage:

K = (DKS * DEC * YOUR) / 100, where

DKS - the duration of the clinical symptoms of the disease (in years);

DEC - the amount of desquamated endotheliocytes in the blood;

YOUR - pain intensity on a visual analogue scale (in centimeters).

The magnitude of the coefficient judges the degree of risk of hypertension in patients with POA. With a coefficient value of more than 1, there is a high risk of developing hypertension. With a coefficient value of less than 1, the likelihood of developing AH is relatively low.

The method is as follows.

A general clinical examination of patients with PAA is carried out, an anamnesis of the disease is collected in detail with a clarification of the duration of pain and its intensity on a visual analogue scale [12].

Then, venous blood is sampled from the ulnar vein in the morning on an empty stomach in the amount of 5 ml into a test tube with sodium citrate in a ratio of 1: 9, and the number of desquamated endotheliocytes is calculated according to the Hladovec J. method [13].

Calculate the risk factor for the development of hypertension in patients with POA according to the formula:

K = (DKS * DEC * YOUR) / 100, where

DKS - the duration of the clinical symptoms of the disease (in years);

DEC - the amount of desquamated endotheliocytes in the blood;

YOUR - pain intensity on a visual analogue scale (in centimeters).

The magnitude of the coefficient judges the degree of risk of hypertension in patients with POA. With a coefficient value of more than 1, there is a high risk of developing hypertension. With a coefficient value of less than 1, the likelihood of developing AH is relatively low.

We found that the most pronounced decrease in the number of DEC in the blood of patients with POA occurs with a disease duration of more than 5 years, the severity of the pain syndrome changes unidirectionally (table 1)

Table 1 Change in the number of DEC and pain intensity depending on the duration of the disease, (M ± SD) Indicator DEC × 10 ⁴ / L Pain according to YOUR cm AH risk factor OA duration <5 years, 4.0 ± 1.2 4.8 ± 2.3 0.7 ± 2.8 n = 42 OA duration> 5 years, 6.0 ± 1.8 6.1 ± 2.6 2.2 ± 0.6 n = 31

Based on the studies and the results of multivariate step-by-step regression analysis (10 independent parameters were included in the model, which showed the highest coefficients during correlation analysis), the following factors were most significant for predicting the development of arterial hypertension in patients with PAA: duration and severity of pain syndrome, as well as the number of desquamated endotheliocytes in the blood (table 2).

table 2 Regression coefficients in a multifactorial model for predicting endothelial dysfunction in patients with OA Indicator M ± SD Correlation coefficient, r Regression coefficient, beta P Standard Model Estimation Error Anamnesis of the disease
niya 5.4 ± 2.5 0.4 0.23 0.006 1,6 p = 0.03 DEC 5.5 ± 2.2 0.5 0.24 0.004 0.2 p = 0.003 Motion pain (YOUR) 6.6 ± 1.5 0.7 0.46 0.0001 0.7 p-0.00003

Example 1

Patient N., 38 years old, came in January 2006 with complaints of pain in the knee, ankle, metatarsophalangeal joints of the I fingers of both feet during movement and prolonged static load, morning stiffness up to 15-20 minutes. From the anamnesis it was found that these complaints have been disturbing for 3 years. She was treated independently, periodically took NSAIDs with a good, but short-lived effect. The condition worsened over the past two months, pain intensified, and began to bother at rest and at night. Objectively: the condition is satisfactory, the consciousness is clear, the constitutional type is normostenic (BMI 21), the skin is of normal color. Peripheral lymph nodes are not enlarged, no edema. The thyroid gland is not enlarged. When examining bones and joints, the smoothness of the contours of the knee joints is determined, more to the right; hallux valgus deformity of the metatarsophalangeal joints of the I toes of both feet. Palpation along the joint gap of the knee and ankle joints is painless. The volume of active and passive movements in the knee joints is limited due to severe pain (80 mm according to YOUR). Respiratory organs without pathology. The apical impulse is palpated in the fifth intercostal space 2 cm inwards from the midclavicular line, localized, of ordinary strength. The borders of the heart are not shifted, rhythmic tones, heart rate of 74 beats per minute, blood pressure 120/80 mm Hg Pathology of the gastrointestinal tract was not detected.

During laboratory and instrumental examination: a general blood test and acute phase indicators within normal values, an x-ray of the knee joints are signs of osteoarthrosis II tbsp. (marginal epiphyseal osteosclerosis, narrowing of the joint space, single osteophyte of the right knee joint). The amount of desquamated endotheliocytes in the blood was determined (7 × 10 ⁴ / L), and the risk factor for the development of arterial hypertension was calculated, which amounted to 1.7, which indicates a high risk of hypertension in this patient. The treatment of osteoarthritis is prescribed: recommendations are given on nutrition, physiotherapy exercises, lifestyle; Aertal in a dose of 100 mg × 2 times a day for 14 days, arthra according to the scheme 1 capsule × 2 times a day for 3 weeks, then 1 time per day for 3 months, with a repetition of the scheme 2 times a year; Prestarium at a dose of 2 mg × 1 time per day constantly. When conducting this therapy in a patient after 5 days, the severity of pain according to YOUR decreased to 50 mm. In the next 3 years she was treated according to the scheme, adhered to the recommendations. After 3 years, X-ray data of the knee joints without negative dynamics, the intensity of the pain syndrome within 30 mm, the number of DECs 4 × 10 ⁴ / l, thus the value of the risk factor for the development of arterial hypertension is 0.7. There are no episodes of increased blood pressure. It is recommended to continue taking arthra in 1 capsule × 1 time per day for 3 months every six months.

Example 2

Patient P., 40 years old, was admitted to the rheumatology department, complained of pain in the shoulder and elbow joints, swelling of the right shoulder joint, morning stiffness up to 20 minutes. Increased blood pressure up to 160/90 mm Hg Two years ago, the patient was consulted on an outpatient basis, then from the anamnesis it was found out that he had been suffering from osteoarthritis since 32, he is not regularly treated. Then the patient was determined the amount of desquamated endotheliocytes in the blood, the severity of pain (70 mm) and calculated the risk factor for the development of arterial hypertension, which was 4.4. On radiographs of the shoulder joints, single osteophytes, marginal osteosclerosis, and pronounced narrowing of the joint gap were revealed. Considering that the coefficient value testified to a high risk of developing hypertension, the patient, along with anti-inflammatory and chondroprotective drugs, was prescribed a minimum dosage ACE inhibitor for prophylactic purposes. In addition, recommendations are given on nutrition and lifestyle. Over the past 2 years before admission to the hospital, the patient was not treated regularly, did not adhere to recommendations, and when taking pain, he took NSAIDs. In the past 6 months, the condition worsened, the intensity of pain increased to 80 mm according to YOUR, there were episodes of increased blood pressure to 160/90 mm Hg, accompanied by headaches. Objectively: the condition is satisfactory, the consciousness is clear, the constitutional type is normostenic (BMI 24), the skin is of normal color. Peripheral lymph nodes are not enlarged, no edema. The thyroid gland is not enlarged. When examining bones and joints, the configuration of the right shoulder joint is determined due to synovitis. Palpation along the joint space of the shoulder and elbow joints is painful. The volume of active and passive movements is limited due to severe pain (90 mm according to YOUR). Respiratory organs without pathology. The apical impulse is palpated in the fifth intercostal space 2 cm inwards from the midclavicular line, localized, of ordinary strength. The boundaries of the heart are not shifted, rhythmic tones, heart rate of 78 beats per minute, blood pressure of 150/80 mm Hg Pathology of the gastrointestinal tract was not detected.

During laboratory and instrumental examination: general blood test: ESR 20 mm / h, acute phase parameters: CRP 6 mg / l, DEC 8 × 10 ⁴ / l, radiograph of the shoulder joints - without negative dynamics. The calculated risk factor for the development of arterial hypertension was 7.2. With BPMD, episodes of increased blood pressure during the day and an insufficient decrease at night were detected. Based on this, the patient was diagnosed with hypertension as a concomitant disease of osteoarthritis, and two-component antihypertensive therapy was prescribed.

Example 3

Patient K., 36 years old, went to the clinic with complaints of pain and morning stiffness for up to 10-15 minutes in the distal interphalangeal and wrist joints. These symptoms are noted for 3 years. I did not seek medical help. The last 2 months of pain intensified, subcutaneous nodules appeared in the distal interphalangeal joints of the IV-V right and V fingers of the left hand. Objectively: the condition is satisfactory, the consciousness is clear, the constitutional type is normostenic (BMI 22), the skin is of normal color. Peripheral lymph nodes are not enlarged, no edema. The thyroid gland is not enlarged. Palpation of the interphalangeal joints is painful, Heberden's nodules are determined. Palpation along the joint space of the right radiocarpal joint is painful. The volume of active and passive movements is not limited. Pain with active movement of 40 mm along YOUR. Respiratory organs without pathology. The apical impulse is palpated in the fifth intercostal space 2 cm inwards from the midclavicular line, localized, of ordinary strength. The boundaries of the heart are not shifted, rhythmic tones, heart rate of 65 beats per minute, blood pressure 110/70 mm Hg Pathology of the gastrointestinal tract was not detected.

During laboratory and instrumental examination: general blood test: ESR 16 mm / hour, acute phase parameters: CRP 4 mg / l, DEC 6 × 10 ⁴ / l X-ray of the hands - II tbsp. (narrowing of the joint space, subchondral osteosclerosis, Heberden nodules). The calculated risk factor for the development of arterial hypertension was 0.7. Given the normal risk factor for the development of arterial hypertension (K <1) and moderate pain, the patient recommended a set of special exercises and a chondroprotective drug was prescribed as a monotherapy for osteoarthritis. In dynamics, after 3 years, no progression of the disease was noted on the control radiograph, the pain syndrome was almost stopped (20 mm according to YOUR). Blood pressure is normal. The risk factor for the development of arterial hypertension is 0.6 (K <1).

The method was tested on 73 patients with PAA. The average age of the examined was 41.5 ± 4.1 years. This group was dominated by patients with I and II radiological stage of the disease (36% and 49%, respectively), stage III was diagnosed in 15% of cases.

Diagnostic capabilities of the coefficient:

Sensitivity - 84%

Specificity - 92%

Predictive value of a positive result - 88%

Predictive value of negative result - 79%

Information sources:

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Claims (1)

A method for predicting the risk of developing arterial hypertension in patients with primary osteoarthritis, including a blood test, characterized in that the amount of desquamated endotheliocytes in the blood is counted, the duration and intensity of the pain syndrome are determined, and the risk factor for the development of arterial hypertension is calculated by the formula:
K = (DKS · DEC · YOUR) / 100,
where BCS is the duration of the clinical symptoms of the disease, in years; DEC - the amount of desquamated endotheliocytes in the blood; YOUR - pain intensity on a visual analogue scale, cm, and with a coefficient value of more than 1, a high risk of developing hypertension is predicted.