RU2476248C2 - Method of treating rheumatoid arthritis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely rheumatology, physiotherapy. The method involves drug-induced and drug-free methods of treating. The drug-free methods are high-tone therapeutic procedures. The exposure covers two injured symmetrical joints. From the first to fifth procedures, the exposure length is 45 minutes for each joint. From the sixth to tenth procedures, the exposure length is 30 minutes for each joint. From the eleventh to fourteenth procedures, the exposure length is 15 minutes for each joint. The procedures are daily. The therapeutic course is 14 procedures. The method provides higher clinical effectiveness ensured by differential approach to the procedure length. The first five procedures of 45 minutes provide a maximum analgesic effect with no side effects. The following five procedures of 30 minutes aim at pain syndrome management.

EFFECT: final 15-minute procedures provide nailing down the obtained results, forming activity of the motor system taking into account the changed vital activity environment and maintaining the reached activity level.

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Description

The invention relates to medicine, namely to restorative medicine and rheumatology, and specifically to methods for treating rheumatoid arthritis.

A known method of treatment, including diet, medical treatment regimen, drug and non-drug treatment: physiotherapy, physiotherapy, massage, orthopedic aid (1).

The disadvantage of this method is a significant number of side effects of the drugs used, the use of physiotherapy only with moderate activity of the process and a short remission.

There is also known a method of treating rheumatoid arthritis by combining diet, medical treatment regimen, drug treatment, orthopedic benefits, physiotherapy exercises and massage (2).

The disadvantage of this method is the lack of physiotherapeutic procedures in the treatment complex and the low treatment efficiency.

There is also known a method of treating rheumatoid arthritis, including drug therapy, a balanced diet, quitting smoking and drinking alcohol, maintaining ideal body weight, physiotherapy exercises, orthopedic benefits, thermal or cold treatments, ultrasound, laser therapy with moderate activity of the process (3).

The disadvantage of this method is the rather narrow range of physiotherapeutic methods used and the lack of treatment effectiveness.

There is also known a method of treating rheumatoid arthritis, including drug therapy: non-steroidal anti-inflammatory drugs: aertal, nise, diclofenac and others; cytostatic drugs: methotrexate, azathioprine and others; sulfonamide drugs: sulfasalazine, leflunomide and others; biological products: infliximab, rituximab and others; glucocorticoid hormones: prednisone, methylprednisolone and others; plasmapheresis: a course of plasmapheresis consists of 3-4 procedures with an interval of 3 to 5 days. The removed plasma volumes for 1 plasmapheresis are from 0.25 to 1 volume of circulating plasma, depending on the degree of activity of the process. Isovolemic mode. As plasma substituting solutions, isotonic sodium chloride solution, 6% reopoliglukin solution, 5% albumin solution are used; hemodialysis - hemosorption - the course of treatment consists of 12 procedures performed once a week; hyperbaric oxygenation - treatment in OKA-MT baroappar at an oxygen pressure of 0.5-0.7 ati; session duration 45 minutes; daily 5 days in a row - break 2 days - 5 days in a row, only 10 procedures per treatment course; medical massage - stroking joints, kneading muscles located above and below the joint; physiotherapy: infrared laser therapy - MILTA, RIKTA, UZOR devices, sinusoidally modulated currents - Amplipuls-4, Amplipuls-5, Amplipuls-7, Amplipuls-8, Radius ", Electrophoresis of 2% novocaine solution, 5% analgin solution, 25% dimethyl sulfoxide solution, 3% potassium iodide solution, 5% sodium salicylate -" POTOK "and" RADIUS "devices, low-frequency low-intensity magnetotherapy - devices" POLYUS-1 "," POLIMAG ”,“ GRADIENT ”,“ ATOS ”and others, high-frequency magnetotherapy - inductothermy - apparatus“ IKV-4 ”- in the region adrenal glands in order to stimulate their own hormonal function, ultrasound with hydrocortisone apparatus "UZT-1.01-F", inhalations with herbs - chamomile, eucalyptus, sage and others, radon baths - general water, general dry air, chamber for limbs, mud therapy - mud applications , galvanic mud, DDT - mud, exercise therapy - changing the stereotype of motor activity, special exercises aimed at strengthening muscle strength (4).

The disadvantage of this method is the lack of high-tone therapy in the treatment complex, which allows to achieve in a short time a stable analgesic, decongestant, anti-inflammatory, trophostimulating and metabolic therapeutic effects.

This method is taken as a prototype.

The aim of the invention is to increase the effectiveness of treatment of patients with rheumatoid arthritis, reducing treatment time, lengthening remission.

This goal is achieved by the fact that, as a non-drug method, high-tone therapy procedures are applied to the area of two affected symmetrical joints lasting from the first to fifth procedures for 45 minutes per joint; from the sixth to the tenth procedure, 30 minutes for each joint; from the eleventh to fourteenth procedures, 15 minutes for each joint; in the amount of 14 procedures per treatment course.

The proposed method is implemented as follows. The patient is prescribed medication: non-steroidal anti-inflammatory drugs: aertal, nise, diclofenac and others; cytostatic drugs: methotrexate, azathioprine and others; sulfonamide drugs: sulfasalazine, leflunomide and others; biological products: infliximab, rituximab and others; glucocorticoid hormones: prednisone, methylprednisolone and others; non-medicinal methods in the form of inductothermy on the adrenal gland in a low-temperature dose - 3-4 steps of intensity and physiotherapy exercises by changing the stereotype of physical activity, special exercises aimed at strengthening muscle strength, and additionally carry out high-tone therapy procedures from the Hi-TOP METABOL apparatus on the area of two affected symmetrical joints with a transverse arrangement of moistened electrodes, fixing them with elastic bands. The intensity of the current supply "to the sensation of a slight tingling of the skin." Duration from the first to the fifth procedure of 45 minutes for each joint; from the sixth to the tenth procedure, 30 minutes for each joint; from eleventh to fourteenth procedures - 15 minutes for each joint. Procedures are performed daily. The number of procedures per treatment course is 14. The sequence of high-tone therapy procedures:

1. Fasten the elastic tape with Velcro under the joint requiring treatment;

2. Before applying electrodes to the skin, insert them into hydrophilic pads moistened with warm tap water;

3. We fix the electrodes so that they are located between the skin and the elastic tape, transverse to each other; while the black side of the electrodes are facing the skin;

4. We fix the electrodes with a second elastic tape with Velcro for uniform contact between the pad and the skin;

5. Connect one of the electrodes to the black plug, the second electrode to the white plug of the distribution cable;

6. Turn on the device using the main switch. The text appears on the display: “Increase intensity to visible muscle contraction”;

7. Turn the intensity control clockwise until you feel a slight pinching on the skin. The treatment has begun.

8. At the end of the procedure in the area of one joint, we carry out the same sequence of actions in the area of the symmetric joint.

The duration of the procedure was not chosen by chance. Syndromic-pathogenetic and clinical-functional approaches presuppose the appointment of therapeutic physical factors, taking into account their predominant effect on the main pathological processes and body systems, and a targeted selection of factors whose action is aimed at resolving the pathological process, eliminating its residual manifestations, regenerating damaged tissues; and restoration of impaired functions of various organs and systems (Physiotherapy. National leadership. Edited by Professor G.N. Ponomarenko, Moscow. “GEOTAR-Media”, 2009, p. 39). In the development of any disease, acute, subacute and a period of remission are traced. In the acute period of rheumatoid arthritis, when the patient is worried about severe joint pain, severe swelling and a significant limitation of joint function due to pain and swelling, the dosages of the physical factor should be selected so that the pain is stopped during the first 3-5 procedures, since before the disappearance pain, anti-inflammatory therapy is less effective. The management of patients with rheumatoid arthritis for 26 years and their use in the treatment complex for the last 3 years of high-tone therapy allows me to conclude that it is advisable to use this method in the first 5 procedures for exactly 45 minutes, since it is during this time that the procedure shows the maximum analgesic result when there are no side effects, and medication and inductothermy prescribed in parallel to the adrenal gland on average only show their anti-inflammatory and analgesics by the fifth day tive action. The following 5 procedures for 30 minutes are explained by the weakening of the pain syndrome as a result of the potentiating effect of inductothermy, drug and high-tone therapy, and is a necessary and sufficient dosage at this stage of treatment. In the final phase, the choice of the physical factor and its dosage is aimed at consolidating the effects of the previous therapy that have already been achieved, as well as at creating a functional motor system that adapts to the changing conditions of the body’s vital activity, at fully or partially compensating for the movement functions decreased during the disease and maintaining a sufficient level of activity. Against the background of supportive drug therapy, inductothermy to stimulate the hormones of the adrenal glands, physiotherapy exercises to increase the motor activity of the joints, the use of high-tone therapy from 11 to 14 procedures for 15 minutes daily corresponds to the syndromic-pathogenetic and clinical-functional approaches and is fixing and sufficient at this stage treatment.

Biological and physiological substantiation of this method.

The basis of the development of the pathological process in the joints with rheumatoid arthritis is autoimmune inflammation, most affecting the synovial membrane of the joint. The formation of an ectopic focus of connective tissue hyperplasia leads to the destruction of articular cartilage and subchondral bone. Given the close functional relationship of the individual elements of the joint, even their slight damage leads to the involvement of other structural elements in the pathological process and significantly disrupts the function of the joint. Studies have shown that edema of inflammatory origin and macrophage-lymphoid infiltration induce the development of vascular and avascular connective tissue, and subsequently destruction of the joint, osteoporosis, osteonecrosis and ankylosis.

Drug treatment is prescribed to relieve the symptoms of the disease - pain, stiffness, swelling of the joints, suppression of the inflammatory process and prevention of joint destruction. It has a general effect on the body. So, non-steroidal anti-inflammatory drugs have analgesic and anti-inflammatory effects, while not inhibiting the progression of joint damage and often cause side effects from the gastrointestinal tract. The use of glucocorticoid hormones allows you to achieve a quick, but short-term suppression of the activity of the inflammatory process; it also does not prevent the progression of joint damage. Basic anti-inflammatory drugs - cytostatic and sulfanilamide - help to improve joint function and slow the progression of their destruction, but they are very toxic and do not give prolonged remission. The mechanism of action of biological drugs is associated with the suppression of the activity of the pro-inflammatory cytokine - TNF - alpha. Their side effect is the generalization of concomitant infections and dissemination of tuberculosis infection. In this case, the cessation or reduction of doses of drug therapy inevitably leads to a relapse of the disease. Hi-TOP therapy from the Hi-TOP METABOL device is a combination of pulsed and low-frequency currents - complexly modulated low-frequency currents that have anti-inflammatory, hypoalgesic, regenerative - reparative, metabolic and daphibrosing effects on damaged joint tissues - local effects on the joint. High-tone therapy is a therapeutic effect on the body with low-frequency currents, modulated in amplitude and frequency. By their physical nature, they have a greater depth of effective action on various tissue components than other known low-frequency pulsed currents. Such currents brought to joint tissues cause significant conduction currents in underlying tissues that excite nerve and muscle fibers.

The neuromyostimulating effect of complexly modulated low-frequency currents parametrically depends both on the repetition rate of the "train" of current packets and on the depth of their modulation. The lower the frequency of the current modulation, the longer the series of its oscillations. With increasing modulation frequency, the duration of a series of oscillations decreases. The greater the depth of the amplitude modulation of the alternating current, the more likely ion channels are involved in the excitation process, not only with low, but also with high thresholds. Along with muscle and visceral afferents, vegetative fibers are also involved in the excitation process, which leads to the activation of microcirculation of ischemic tissues, a decrease in venous stasis and perineural edema, which often cause pain. Activation of trophic fibers restores the functions of internal organs during their dystrophic changes and stimulates reparative regeneration. Due to the structural polarization of cell membranes, metabolic processes in the tissues of the joint are activated, which, after prolonged exposure, forms a “structural trace” in the form of low molecular weight proteins, which are trophogens and stimulators of anabolic processes in cells.

Previously, high-tone therapy in combination with drug treatment, inductothermy and exercise therapy for the treatment of rheumatoid arthritis has not been used.

Thus, low-frequency complex-modulated electrotherapy - high-tone therapy - has neuromyostimulating, hypoalgesic, vasodilating, trophostimulating and metabolic therapeutic effects.

In the process of implementing our claimed method, a new technical result of treatment was revealed: high-tone therapy according to the treatment scheme presented by us with a course of 14 daily procedures for two symmetrical joints affected, the first 5 procedures for 45 minutes for each joint, 6-10 procedures for 30 minutes for each joint 11-14 procedures for 15 minutes per joint, increases the bioavailability of drugs to the pathological focus by improving microcirculation, reduces the drug load on the liver, kidneys and gastrointestinal tract due to its own analgesic effect, cumulating from procedure to procedure, and, as a result, reduces the number of side effects from oral medication and the number of medications taken according to the treatment regimen presented by us. High-tone therapy procedures are not carried out against the background of drug treatment and non-drug methods - inductothermy and physiotherapy exercises. This is a new, previously unknown technical result, which is clinically confirmed.

Clinical example. Patient K., 49 years old, applied for clinically and laboratory confirmed rheumatoid arthritis with a primary lesion of the knee joints, moderate activity. She was prescribed medication: Nise 100 mg, 1 tab. at 8.00 and at 20.00; metipred 4 mg, 1 tab. at 8.00; methotrexate 2.5 mg, 2 tab. at 8.00 and at 20.00; dexamethasone 16 mg intravenously in 200 ml of 0.9% sodium chloride solution; omeprazole 20 mg, 1 capsule on an empty stomach, and an additional course of high-tone therapy was carried out on the area of the knee joints. The procedure was carried out alternately for each joint.

The duration of the procedure is from 1 to 5 procedures - 45 minutes for each joint, from 6 to 10 - 30 minutes for each joint, from 11 to 14 - 15 minutes for each joint. In total, 14 daily high-tone therapy procedures were released. Reducing exposure time is associated with relief of pain and improving well-being. After a course of treatment according to the proposed methodology, 14 days after the start of the use of high-tone therapy, the following clinical picture is noted: a significant reduction in pain; pain visual analogue scale at the beginning of treatment - 77 mm, after a course of treatment with high-tone therapy - 18 mm; a decrease in the circumference of the knee joints by 1.5 cm to the right and 1.7 cm to the left; an increase in bending angles in the knee joints, respectively, by 20 degrees to the right and 25 degrees to the left. Thermometry: from 1 to 4 days, body temperature at 17.00 - 37.2 degrees, from 5 to 7 days - 37 degrees, from 8 to 10 - 36.8 degrees, from 10 to 14 - 36.6. In the general analysis of blood at admission ESR = 32 mm / h, before discharge from the hospital - 20 mm / h. The patient was discharged with a significant improvement in health.

In the Samara Regional Clinical Hospital. In the Department of Reconstructive Medicine, using the Hi-TOP-METABOL high-tone therapy apparatus, M. I. Kalinin treated 67 patients with a confirmed diagnosis: rheumatoid arthritis. In 63 patients, a significant improvement in general clinical and laboratory parameters was revealed after a course of treatment using high-tone therapy.

Thus, the proposed method for the treatment of rheumatoid arthritis is highly effective. The invention is possible and appropriate to use in the work of physiotherapy departments of hospitals and clinics.

Information sources

1. National leadership "Rheumatology" under the editorship of Acad. RAMS E.A. Nasonova and Acad. RAMS V.A. Nasonova. M., GEOTAR-Media, 2008.

2. The standard of care for patients with rheumatoid arthritis (in the provision of specialized care). Approved by Order of the Ministry of Health - Social Development of the Russian Federation No. 41 dated January 17, 2007

3. Clinical recommendations "Rheumatology", approved by the Association of Rheumatologists of Russia. 2006, ed. Corr. RAMP E.L. Nasonova.

4. Medical and technological protocols for the provision of inpatient care in the section “Injuries and diseases of the musculoskeletal system”. 11/11/0001-2002. Introduced 01.01.2003 by the Department of Health of the Administration of the Samara region. CSH (clinical and statistical group) 121076 (M 05 Seropositive rheumatoid arthritis; M 06 Other rheumatoid arthritis).

5. The device for high-tone therapy "Hi-TOP METABOL". User manual. Gbo Medizintechnic AG2006; Kleiststrasse 6 DE 64668 Rimbach. Germany. 2006 year

6. Low-frequency complex-modulated electrotherapy of patients with injuries of the capsule-ligamentous apparatus of the knee joint. Manual for doctors. Ponomarenko G.N. Ed. prof. Razumova A.N., 2004.

Claims (1)

A method of treating rheumatoid arthritis, including drug and non-drug methods, characterized in that high-tone therapy procedures for the area of two affected symmetrical joints lasting from the first to fifth procedures for 45 minutes for each joint, from the sixth to tenth procedures for 30 are used as a non-drug method min for each joint, from the eleventh to fourteenth procedures - 15 minutes for each joint, procedures are carried out daily, in an amount of 14 per treatment course.