RU2800129C1 - Treatment of urogenic reactive arthritis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to a method of treatment of urogenic reactive arthritis. This method includes physio- and drug therapy with lymphotropic administration of an anti-chlamydial antibiotic into the lower leg, and as physiotherapy, exposure to polarized light from the Bioptron apparatus is used after the administration of the antibiotic for 1–2 hours.

EFFECT: obtaining the method of treatment of urogenic reactive arthritis.

1 cl, 2 ex

Description

The invention relates to the field of medicine, and can be used in the departments of dermatovenereology and rheumatology in the treatment of urogenic reactive arthritis (UReA).

Currently, this pathology is not widespread, there is not enough development on its treatment, but, as statistical studies have shown, it is a common cause of arthritis in men of sexually active age.

A known method for the treatment of urogenic reactive arthritis includes conducting simultaneously with a 20-day course of antibiotics immunomodulatory therapy through autohemotransfusion of ultraviolet irradiated blood in the amount of 5-7 procedures with an interval of 1-2 days. Antibacterial therapy is carried out with antibiotics of the macrolide group, for example, roxithromycin, at a daily dose of 0.2-0.3 g and / or the tetracycline group, for example, doxycycline, at a daily dose of 0.2-0.3 g (RF Patent 2135175, IPC A61K 31/375, publ. 1999).

The disadvantage of this method is the high probability of dysbacteriosis, immunosuppressive effects on the body as a result of long-term oral administration of the drug and a high course dose.

There is a method for the treatment of urogenic reactive arthritis that recommends antimicrobial therapy for a long period of 3 to 6 months with a combination of doxycycline and rifampin or azithromycin and rifampin (Cheeti A, Chakraborty RK, Ramphul K. Reactive Arthritis. 2022 Jun 14. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. PMID: 29763006.).

The disadvantage of this method of long-term antibiotic therapy is the occurrence of frequent side effects from the gastrointestinal tract (including the development of dysbiosis), hepatotoxicity, general immunosuppressive effects on the body and insufficient understanding of the preferred combination of antibiotics.

The closest is a method for the treatment of Reiter's disease, including complex local, physio- and drug therapy with the introduction of an antibiotic, while it is proposed to administer an anti-chlamydial antibiotic lymphotropically into the lower leg, and from the 1st to the 5th day the drug is administered once a day, and starting from the 7th day once every other day, for a total course of 15 injections. The introduction is carried out according to a certain method, which ensures optimal penetration and saturation of the lymphatic system with an antibiotic. To do this, the antibiotic is injected along the midline of the posterior surface of the lower leg at the border of its upper and middle thirds at an angle of 45°, and the antibiotic is diluted with water for injection for a total volume of 7-8 ml, and the rate of drug administration is set to 1 ml per 1 minute. As an antibiotic, abaktal is administered at 400 mg per injection or rifogal at 250 mg per injection (RF Patent 2175550, IPC A61K 31/395, A61K 31/496, publ. 2001).

The disadvantage of this method is a possible undesirable local reaction in the area of drug administration in the form of hyperemia, severe pain (from one to several days) and compaction of the area, as well as if the patient does not follow the recommendations, temporarily exclude physical activity on the lower leg - local inflammation with further fibrosis.

The objective of the invention is to eliminate these shortcomings, increase the effectiveness of treatment, reduce the duration of treatment, by preventing the occurrence of inflammatory infiltrates, improving the penetration of the drug into the lymphatic system and the focus of infection while improving the condition of the joints, skin and the work of the cardiovascular systems, which will reduce the period of temporary disability of the patient, the cost of his stay in the hospital.

The problem is solved by using physio- and drug therapy with lymphotropic administration of an anti-chlamydial antibiotic into the lower leg, from the 1st to the 5th injection daily, and starting from the 7th day every other day. In this case, the antibiotic is injected along the midline of the posterior surface of the lower leg at the border of its upper and middle thirds at an angle of 45°, and the antibiotic is diluted with water for injection to a total volume of 5-7 ml, and the rate of drug administration is set to 1 ml per 1 min. The introduction of an anti-chlamydial antibiotic, starting from the 7th day, is carried out 4-5 times, and as a physiotherapy, the effect of polarized light from the Bioptron apparatus is used after the administration of the antibiotic for 1-2 hours. At the same time, the area of administration of the drug is first irradiated- the exposure time of 8-12 minutes, then on the field of projection of the vascular beam in the inguinal region on both sides- the exposure time of 3-5 minutes on the field, after which on the projection of the bladder- the exposure time is 2-3 minutes, then to the area of the perineum- the exposure time for 3-5 minutes, after which it is on the segmental region at the level of the cross-sized sam S4, paravertebrally, 2-3 minutes on the field.

The fact that the area of drug administration is subjected to physiotherapy with polarized light by the Bioptron apparatus allows antibiotic therapy to be carried out more effectively, to achieve a decrease in the activity of the existing symptoms of an interdisciplinary disease - urogenic reactive arthritis.

We noted that in patients with UreA, joint damage was observed in 100%, changes in the cardiovascular system (in the form of sinus tachycardia, early repolarization syndrome, incomplete blockade of the Hiss bundle pedicle, etc.) in 80.5%, skin - in 45%.

Against the background of the therapy according to the specified method, a positive trend in the cardiovascular system was noted - the percentage of patients with impaired conduction and rhythm decreased from 80.5% to 20%, while all of them had no previous tachycardia. Manifestations of arthritis were absent in 80%, the remaining group had drug remission within six months. Rashes on the skin and mucous membranes also regressed completely in all patients. Elimination of sexually transmitted infection has also been achieved in 100%.

The implementation of the method is shown on specific clinical examples.

Example 1

Patient D, age 38 years. Diagnosis: urogenic reactive arthritis, 2 tbsp. Conduction disorders (complete AV block). Condition after PEKS.

Complaints and a brief history of the disease at admission: the presence of rashes, joint pain and morning stiffness for 40 minutes in the knee joints, pain and stiffness in the lumbar spine, nagging pain in the groin.

Proeden treatment by the proposed method.

The antichlamydial antibiotic abaktal (pefloxacin) was introduced into the lower leg, from the 1st to the 5th injection daily, and then 4 more injections every other day. In this case, the antibiotic was injected along the midline of the posterior surface of the lower leg at the border of its upper and middle thirds at an angle of 45°, and abactal was diluted with water for injection to a total volume of 7 ml, and the rate of drug administration was set: 1 ml per 1 min.

1 hour after the injection, the exposure to polarized light from the Bioptron apparatus was carried out, while first the area of drug administration was irradiated, the exposure time was 12 minutes, then on the projection area of the vascular bundle in the inguinal region from both sides, the exposure time was 5 minutes on the field. After that, the projection area of the bladder was affected, the exposure time was 3 minutes and the perineum was 5 minutes. The segmental area at the level of the sacral spine S1-S4 was affected paravertebral, 3 minutes per field. The course of treatment was 9 procedures.

During therapy, complete elimination of the sexually transmitted infection was achieved, the existing complaints from the manifestations of urethroprostatitis, pulling pains in the groin area stopped within 12 days, morning stiffness in the joints decreased to 10 minutes in 2 weeks, pain in the knee joints and lower back disappeared within 1 month. Acute-phase parameters elevated before treatment in blood tests normalized (ESR decreased from 12 to 4 mm per hour, CRP from 18 to 5 mg/l). It was also noted that the complex therapy of UReA with lymphotropic administration of the antibiotic abaktal together with the use of physiotherapy with polarized light of patient D. also led to an improvement in the cardiovascular system. Methods of examination by a cardiologist of the cardiovascular system included: ECG, Echo CG, 24-hour ECG monitoring. Based on the statistical analysis of pacemaker parameters (Medtronic control system), it was concluded that there was a pronounced positive trend in the conduction system of the heart. The proportion of ventricular stimulation in relation to the intrinsic heart rate was 99.5% before treatment, and 13% after treatment, a pronounced recovery of atrioventricular conduction was noted against the background of ongoing treatment. The result of daily monitoring confirmed the correct operation of the system and the absence of an ectopic rhythm. Conducted testing of the pacemaker (EX) - rhythm disturbances were not registered, dysfunction was not detected.

Example 2

Patient K., 37 years old. Diagnosis: Urogenic reactive arthritis (monoarthritis, synovitis of the left knee joint, asymmetric sacroiliitis (1 st on the left, 2 st on the right), moderate activity, FC 3; total chlamydial urethritis, hypertrophic colliculitis, morganitis, follicular prostatitis; xerotic balanitis, chronic conjunctivitis).

Complaints and a brief medical history at admission. Complaints of pain and swelling in the left knee joint, making it difficult to walk, slight pain in the hip joints, enlarged inguinal lymph nodes, nagging moderate pain in the groin area, the presence of rashes on the mucous membrane of the glans penis. Sick for about a year, when 3 weeks after sexual infection pain and swelling appeared in the knee joint, reddened eyes, and then rashes appeared on the penis. Periodically noted evening subfebrile condition, general weakness and palpitations. He was treated symptomatically by therapists, by a urologist (including oral antibiotic treatment for 1 month) with a temporary insignificant effect. There were pains in the lumbar region, pain in the knee did not allow to lead the usual work and household lifestyle.

Treatment was carried out according to the proposed method, similar to that described in example 1. This used the drug rifampicin.

The introduction of this antichlamydial antibiotic was carried out in the lower leg, from the 1st to the 5th injection daily, and then another 5 injections every other day. An antibiotic was administered as described in example 1, with rifampicin diluted with water for injection to a total volume of 5 ml. The number of injections of rifampicin was 10 injections. In this case, physiotherapy with polarized light was carried out as follows.

2 hours after the injection, the exposure to polarized light from the Bioptron apparatus was performed, while first the area of drug administration was irradiated, the exposure time was 8 minutes, then on the projection area of the vascular bundle in the inguinal region from both sides, the exposure time was 3 minutes on the field. After that, the projection area of the bladder was affected, the exposure time was 2 minutes and the perineum was 3 minutes. The segmental area at the level of the sacral spine S1-S4 was affected paravertebral, 2 minutes per field. The course of treatment was 10 procedures.

Result: on the background of therapy, a significant improvement, pain in the joints does not bother (the number of painful joints is 0, the number of swollen joints is 0, enthesitis is 0, Thomayer's test is negative), there is no feeling of morning stiffness in the knee joints, the functional class of arthritis decreased to 1, there are no signs of activity; normalization of the shape and consistency of the prostate gland was noted, elimination of chlamydial infection was noted, the titer of chlamydia heat shock protein in the blood decreased; body temperature returned to normal, the phenomena of conjunctivitis disappeared, when examined by an ophthalmologist after a course of therapy, no pathology of the organ of vision was detected; completely regressed xerotic rashes on the penis, when examining the skin by direct immunofluorescence, IgG in the reticular layer was not detected (before treatment it was detected with an intensity level of 2 +); the existing sinus tachycardia of 87 per minute decreased to a normal rate of 64 per minute; there is no existing inguinal lymphadenopathy; normalized acute phase parameters in the blood ESR 2 (before treatment 8 mm per hour), CRP 2 (before treatment 32 mg/l).

The proposed method was treated 17 patients, 16 men and 1 woman, aged 19-47 years. Results: 100% elimination of chlamydial infection, clinical remission of arthritis within a month in 80%, within 6 months - in 20%, cure of inflammation of the urinary organs in 100% of patients, regression of skin rashes in 100% of patients within 3 weeks in 75% of those who had them, within 4 weeks - in the remaining 25%. The existing tachycardia stopped in all patients. Normalization of body temperature and general weakness (subfebrile condition was present in 40%) - in 100% of cases.

The proposed method is comfortable for the patient, since it maximally prevents and reduces unpleasant painful sensations at the injection sites, shortens the hospital stay to 2 weeks, the activity of the functional class of the existing arthritis quickly decreases to indicators that allow you to take care of yourself, lead an active lifestyle and be able to work.

Claims (1)

A method for the treatment of urogenic reactive arthritis, including physio- and drug therapy with lymphotropic administration of an antichlamydial antibiotic into the lower leg, from the 1st to the 5th injection daily, and starting from the 7th day - every other day, while the antibiotic is administered along the midline of the posterior surface of the lower leg at the border of its upper and middle thirds at an angle of 45 °, the antibiotic is diluted with water for injection to a total volume of 5-7 ml, and the rate of drug administration is set 1 ml per 1 min, characterized in that the introduction of an anti-chlamydial antibiotic, starting from the 7th day, is carried out 4-5 times, as a physiotherapy, exposure to polarized light from the Bioptron apparatus is used after the administration of the antibiotic for 1-2 hours, while first the area of drug administration is irradiated, the exposure time is 8-12 minutes, then on the area of the projection of the vascular bundle in the inguinal region from both sides, the exposure time is 3-5 minutes on the field, after that on the projection area of the bladder, exposure time 2-3 minutes, then on the perineum area, exposure time 3-5 minutes, then on the segmental area at the level of the sacral spine S1-S4, paravertebral, 2-3 minutes per field.