RU2677190C1 - Method for treating pathology of total tear secretion in patients with rheumatoid arthritis - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, specifically to ophthalmology. For the treatment of pathology of total tear secretion in patients suffering from rheumatoid arthritis, basic therapy of rheumatoid arthritis is performed with the determination of total tear secretion using a Schirmer’s test. If a Schirmer’s test index is less than 15 mm, a treatment course is carried out for three months: 0.1 % solution of diclofenac is introduced into both eyes, followed by instillation of a 1 % solution of emoxypine after five minutes. Marked drugs are administered 3 times a day.EFFECT: method does not require large material costs, is simple, easy to perform and can be used to prevent the onset of severe forms of dry eye syndrome.1 cl, 3 ex

Description

The invention relates to medicine, namely to ophthalmology and rheumatology, and is intended for the treatment of pathology of total tear production in patients suffering from rheumatoid arthritis.

In rheumatoid arthritis, symptomatic dry eye syndrome (CVH) develops, associated with impaired secretion of lacrimal fluid. Rheumatoid arthritis (RA) is a chronic disease registered in the population on average about 1%. Dry eye syndrome is registered in 15-25% of cases among patients with rheumatoid arthritis [Rheumatology. Rheumatic diseases with ophthalmic manifestations in adults: monograph / L.F. Rudneva, I.V. Medvedev, M.N. Ponomareva, E.Yu. Ponomareva. Tyumen: RIC "Aivex", 2017. 464 s; Ponomareva M.N., Verbina A.V., Andrievskikh O.A. A clinical case of early diagnosis of dry eye syndrome and other ophthalmic manifestations in rheumatoid arthritis / Point of view. East West. No 3 2017 from 121-123; http://www.eyepress.ru/sbornik.aspx].

According to other authors, CVD in rheumatic diseases occurs in 86% of cases [Savina E.E. The severity of dry eye syndrome in rheumatic diseases Bulletin of the Bashkir State Medical University No. 3, 2017 with 101-104]. It is established that the main link in the pathogenesis of the development of the "dry eye" syndrome is a violation of tear production [Brzhesky V.V. Dry Eye Syndrome, http://www.eyepress.ru/section.asp.].

Known methods for the treatment of dry eye syndrome [Patent RU 2126669 from 02.27.1999; Patent RU 2197201 dated 01/27/2003; Patent RU 2336058 from 10.20.2008; Patent RU 2547960 dated 04/10/2015]. 54 patents of the Russian Federation. The authors of these patents do not provide for the treatment of pathology of total tear production in patients with rheumatoid arthritis.

Periodic literature is known which describes methods for treating dry eye syndrome [Herrick R.S. A subjective approach to the treatment of dry eye syndrome // Lacrimal gland, tear film and dry eye syndromes / Ed. Sullivan D.A. - NY.:Plenum Press, 1994 .-- P. 571-576; Yanchenko S.V., Eremenko A.I. Possibilities of using lymphotropic therapy in the treatment of dry eye syndrome // Breast Cancer Clinical Ophthalmology. 2010. No1. P. 20], however, the identification and treatment of the pathology of total tear production is not provided.

So, the analysis of the periodic and patent literature indicates that the treatment of the pathology of tear production in patients with rheumatoid arthritis is not carried out, and in some cases only tear replacement therapy is used, and therefore the treatment of the total tear production in dry eye syndrome with rheumatoid arthritis remains relevant.

To determine the degree of violation of lacrimal formation, use the Schirmer test. With a mild degree of tear formation, the Schirmer test corresponds to 12-14 mm, with an average degree of tear formation, the Schirmer test corresponds to 8-11 mm, with a severe degree of tear formation, the Schirmer test corresponds to less than 8 mm [Patent RU 2251997 of 05.20.2005. Bull. No. 14].

In order to improve the accuracy of surgical intervention in patients with tubular system pathology, a method is proposed for improving the balance of the inflow and outflow of lacrimal fluid [Patent RU 2271151 of 03/10/2006. Bull. No. 7]. This method is difficult to implement. Additional medical instruments are required (blockers for intact intubation of both lacrimal tubules), anesthesia, medications and the skills of an ophthalmologist, and the possibility of using this method in patients with rheumatoid arthritis is not indicated.

So, the prototype corresponding to the purpose of the proposed invention is not calculated.

The objective of the present invention is to provide a simple, economical and reliable method of treating the pathology of total tear production in patients suffering from rheumatoid arthritis.

The marked goal is achieved on the basis of the impact on the causes of the pathology of the total tear production in rheumatoid arthritis. The goal is carried out on the basis of the use of a complex of drugs with desensitizing, anti-inflammatory, antioxidant, vasoprotective and antiplatelet topical effects of a complex of drugs used on the background of adequate basic therapy for rheumatoid arthritis.

The scientific substantiation of the proposed method was reflected in the chemical-pharmacological action of the following preparations: 0.1% solution of diclofenac and 1% solution of emoxipin.

A solution of emoxypine 1% (the international name of the active substance is methylethylpyridinol). The drug has the properties of an antioxidant, antihypoxant, vasoprotective and antiplatelet agent. Antioxidant properties prevent damage to vital biological molecules - DNA, proteins, enzymes, cell membrane structures, etc. antihypoxant - to prevent oxygen starvation of internal organs and tissues by delivering a greater amount of gas and enhancing its penetration through the vascular wall and cell membrane, vasoprotective property of giving strength, smoothness and elasticity to the vessel wall, at the same time its permeability is reduced, which allows to provide antiplatelet property blood flow improves, that is, its viscosity decreases. In general, emoxipin increases the resistance of body tissues to a lack of oxygen and blood circulation [http://www.tiensmed.ru /news/emoxipin-d9i.html].

The technical result of the proposed method is simple, not requiring large material costs, based on the use of Schirmer's test, which allows to determine the state of the main and reflex tear production in patients, and conduct a course of treatment with 0.1% diclofenac solution and 1% emoxipin solution against the background of basic therapy for rheumatoid arthritis.

The technical result according to the invention is achieved in that a method for treating the pathology of total tear production in patients with rheumatoid arthritis involves conducting basic therapy of rheumatoid arthritis with the determination of total tear production using a Schirmer test, and with a Schirmer test index of less than 15 mm, a course of treatment is carried out for three months: both eyes administer a 0.1% diclofenac solution, followed by instillation in five minutes of a 1% emoxipin solution, the indicated preparations are administered 3 times a day.

The proposed method is carried out in the following ways.

In patients with rheumatoid arthritis, the intensity of the main and reflex tear production is determined using a Schirmer test. When the total tear production is less than 15 mm in 5 minutes, the pathology of the total tear production is diagnosed. Patients are prescribed a course of treatment for 3 months. A 0.1% diclofenac solution is injected into both eyes, followed by instillation after five minutes of a 1% solution of emoxipin. These drugs are administered 3 times a day in the indicated sequence. After 3 months, the intensity of tear production is monitored.

Examples of practical use of the proposed method.

Example 1

Patient A. G. N, female, 50 years old, was treated at the round-the-clock hospital of the rheumatology department of the GBUZ TO OKB No. 1 in Tyumen.

The main diagnosis: Rheumatoid arthritis, advanced stage, medium activity (DAS 28-3.36), stage 2 x-ray. FC 2.

Concomitant diseases: CHD, angina pectoris, (PIKS 07/13/14), Conductivity disorder, AV block 1 tbsp. The duration of the disease is 4 years. The treatment prescribed by the rheumatologist: Methotrexate 10 mg / week, then 15 mg / week (2.5 mg 6 tablets - week. No. 100). Schirmer test: OD 8 mm / OS 9 mm. The patient revealed a pathology of total tear production. An additional treatment was prescribed with a 0.1% diclofenac solution in both eyes, followed by instillation of a 1% emoxipin solution in five minutes. The drugs were administered 3 times a day for 3 months.

After 3 months, Schirmer's test was performed: OD 15 mm / OS 17 mm. The patient showed no pathology of total tear production.

Example 2

Patient G.L. L., female, 53 years old, was treated at the round-the-clock hospital of the rheumatology department of the GBUZ TO OKB No. 1, Tyumen.

The main diagnosis: Rheumatoid arthritis, seropositive variant, advanced stage, high activity (DAS 28-5,7), x-ray stage 2. ADC +. Secondary osteoarthrosis of large joints (gonarthrosis on the right, x-ray stage 3, coxarthrosis, x-ray stage 1). Condition after prosthetics of the left knee joint (2016). Osteoporosis of complex origin. FC 3. Anemia of mild degree of complex origin. The duration of the disease is 24 years. Treatment prescribed by a rheumatologist: Ca-rich diet (fermented milk products). Leflunomide 20 mg / day. Methylprednisolone 4 mg / day. Ca preparations 1 tab / day, vitamin D preparations 1 tab / day. To determine the pathology of the total tear production, a Schirmer test was performed: OD 2 mm / OS 1 mm, which indicates a pronounced pathology of tear production. An additional treatment was prescribed with a 0.1% diclofenac solution in both eyes, followed by instillation of a 1% emoxipin solution in five minutes. The drugs were administered 3 times a day for 3 months.

After 3 months, Schirmer's test was performed: OD 14 mm / OS 15 mm. The patient has significant positive dynamics in the right eye - a slight insufficiency of the total tear production, the pathology of the total tear production was not revealed in the left eye.

Example 3

Patient K. L. N., a 56-year-old female patient, was undergoing treatment in a round-the-clock inpatient unit of the rheumatology department of GBUZ TO OKB No. 1 in Tyumen. Diagnosis: Rheumatoid arthritis, polyarthritis, erosive, seropositive (RF58.5), positive ACCP over 500 units / ml, late stage, high activity (DAS28-6.24), X-ray stage 4, FC2.

Concomitant diseases: secondary osteoarthrosis of large (coxarthrosis 3 on the right, 2 on the left) and small joints. Condition after knee replacement, osteoporosis of complex origin without pathological fractures. COPD without exacerbation. DN 0-1. AG 3st „3st, risk 4. CHF1, FC2. The disease is 13 years old. Treatment: methotrexate 17.5 mg once a week, metipred 4 mg in the morning Sulfasalazine 500 mg, 2 tons 2 r / d, Meloxicam 15 mg / day for pain. To identify the pathology of tear production, a Schirmer test was performed: OD 7 mm / OS 5 mm.

A severe form of pathology of tear production was established. An additional treatment was prescribed with a 0.1% diclofenac solution in both eyes, followed by instillation of a 1% emoxipin solution in five minutes. The drugs were administered 3 times a day for 3 months.

The patient did not conduct topical therapy, she did not bury a drop. After 3 months, Schirmer's test was repeated: OD 1 mm / OS 2 mm. A severe form of tear production failure was identified.

These examples indicate that against the background of rheumatoid arthritis, a concomitant disease occurs, accompanied by a violation of tear production and the development of severe forms of the dry eye disease. Conducting a course of treatment with 0.1% diclofenac solution and 1% emoxipin solution against the background of basic therapy for rheumatoid arthritis is effective to restore normal tear production.

Examination of 90 patients with rheumatoid arthritis revealed a violation of the total tear production according to Schirmer's test (7.03 ± 5.2 mm). A set of pre-made test strips from Baush & Lomb was used. In the group by gender, women predominated - 83 (92.2%), men -7 (7.8%). The average age of the patients was 51.6 ± 21.8 years. Patients with revealed pathology of total tear production were divided into two groups: The first group of 50 people with a Schirmer breakdown of 7.01 + 5.3 mm underwent treatment according to the proposed method, and the second group of 40 people with a Schirmer breakdown of 7.06 ± 6.1 mm of the proposed method were not treated. After 3 months in the first group, the Schirmer test parameters were 15.02 ± 2.02 mm, and in the second group, 6.02 ± 3.59 mm. In the first group of patients, recovery of total lacrimal production was noted, and in the second group of patients, pathology of total lacrimal production was observed.

The proposed method for treating the pathology of total tear production in patients with rheumatoid arthritis does not require large material costs, it is simple, easy to implement and can be used to prevent the occurrence of severe forms of dry eye syndrome, which will improve the quality of life of patients. The method has been introduced into the work of the rheumatology department of the GBUZ TO OKB No. 1 and the ophthalmological department of the GBUZ TO OKB No. 2 of Tyumen.

Claims (1)

A method for treating the pathology of total tear production in patients with rheumatoid arthritis involves performing basic therapy of rheumatoid arthritis with the determination of total tear production using a Schirmer test, and with a Schirmer test index of less than 15 mm, a course of treatment is carried out for three months: a 0.1% solution is injected into both eyes diclofenac, followed by instillation after five minutes of a 1% solution of emoxipin, the indicated drugs are administered 3 times a day.