A method for the treatment of patients with osteoarthrosis, acute reactive synovitis

 

(57) Abstract:

The invention relates to medicine, physiotherapy. Affect the area affected and symmetrical knee joint. Carry out the simultaneous impact of the sapropel and magnetic field. Course 9-10 procedures. Reduces the treatment time. table 1.

The invention relates to medicine, namely to physiotherapy.

There is a method of treatment of patients with osteoarthritis of the knee based on the application of a constant magnetic field [1].

Its disadvantage is the limited application in patients with osteoarthritis (OA), complicated reactive synovitis in connection with the development of undesirable side reactions.

The closest to the technical nature of the claimed is a method of treating osteoarthritis with symptoms of reactive synovitis [2], including the effects of medicines, applications of mud and low-frequency magnetic fields.

The disadvantages of this method are the use of silt sulfide mud (often causing a pathological balneoreaction in acute and subacute synovitis), large (25-30 days) duration of treatment, the need ispolzovat in some cases accompanied by a variety of undesirable side reactions.

The General features of the proposed method and the prototype is the use of magnetic fields and mud.

This invention is directed to improving the efficiency of the treatment, in particular to increase the speed of recovery processes and the reduction of adverse reactions in the treatment of patients with osteoarthrosis, acute reactive synovitis.

Distinctive features of the proposed method are used as a mud sapropel low temperature (35-37oC). The magnetic field is carried out on labile technique after 8-10 min from the beginning of the overlay mud during 28-30 seconds as everyone amazed and symmetrical knee, then mud cakes another 10-12 minutes remain on the joints, at the rate of 9-10 procedures.

The rationale for distinguishing features. Simultaneous effects on labile methodology of the magnetic field of permanent magnets and mud chosen to improve the efficiency of these factors. In the experiment on rats with subacute toxic hepatitis we have shown that the magnetization that dirt, only the magnetic field or mud have a less pronounced corrective days-30 sec magnetotherapy and pelotherapy, through 8-10 min from the beginning appliqués, allows to realize the positive properties of each method increases the speed of recovery process in patients with osteoarthritis, acute reactive synovitis, but at the same time prevents the development of undesirable side reactions characteristic of mud therapy and magnetic therapy.

Nonuniform intensity and direction of force lines of the permanent magnetic field formed United on the common ground of the two magnets and addressed to him the opposite poles selected to improve the efficiency of the magnetic field on the deep tissue of the joint, and to reduce the duration of procedures magnetised to 28-30 seconds on each affected joint while maintaining a normal (20 min) duration of application of sapropel.

The relatively small size of the magnets (3x4 cm) allow the magnet on labile technique and form fields provides the ability to impact on all areas affected and symmetrical knee joint with approximately the same magnetic field on the body surface (0,1 T).

Used in the claimed method Leche is TLAT "softer" compared to silt sulfide mud effects on the body and therefore prevent the development of pathological baldereschi, occur in some cases when the mud silt sulfide mud.

The method is as follows. Daily for 9-10 days to the affected areas and symmetrical knee conduct simultaneous impact of sapropel and uniform in intensity and direction of magnetic field lines formed by the United on the common ground of the two magnets and addressed to him the opposite poles. When the magnetic field is carried out by labile methodology, through the mud cake thickness of 2-3 cm with low temperature (35-37oC), 8-10 minutes after the start of the application and shall be held within 30 seconds on the affected and symmetrical knee, and then another 10-12 minutes mud cakes remain on the joints. Treatment - 9-10 procedures. One day the impact is performed on the joint affected reactive synovitis, and symmetric him the joint.

In the complex treatment includes physical therapy in the usual way to increase range of motion while improving the condition of the patient.

Clinical studies were conducted in Tomsk scientific research Institute of balneology and physiotherapy. The study included 36 patients who chicosci all OA patients was complicated by reactive synovitis primarily one, often the knee, joint. In 57.1% of patients with synovitis wore persistent throughout, resistant to drug therapy.

All patients were examined according to the standard scheme of the clinical examination. In addition, conducted a special survey methods in arthrology:

the intensity of joint pain on palpation (in points),

- the intensity of night pain in the joints (in points),

- mobility (in degrees),

the circumference of the joint (in centimeters).

Was also studied immunological parameters: the content of T-lymphocytes, T-definintely (suppressor) T-teilinstitut (helper) lymphocytes, B-lymphocytes, immunoglobulins A, M, G. Additionally analyzed the following parameters: Kerdo index, the index of the heart, allowing to determine necrosociety procedures, as well as biochemical parameters (seromukoidy, ceruloplasmin and erythrocyte sedimentation rate, allowing to judge the severity of the inflammatory process.

26 patients were treated by the claimed method. Along with this, the observations were performed in 10 patients (control group), who were appointed by the same sapropel with the above exposure parameters without the use of minicamera is ecene by the claimed method in comparison with the initial level was decreased intensity of nocturnal joint pain and tenderness to palpation. In addition, significantly (36%; P < 0,01) decreased the circumference of the affected joint while increasing its mobility (35%; P < 0,02). Along with the improvement of clinical and functional parameters was observed a positive effect of treatment by the claimed method and parameters of the immune system. So, the content of T-lymphocytes increased by 41.6%, T-suppressors - 15.4%, and the level of immunoglobulin G decreased by 17.4%.

Analysis of the dynamics we use other indicators also testified to the normalizing effect of the applied complex. Patients at the end of treatment by the claimed method, there was an increase of reduced Kerdo index (average -20 to -8), some decrease moderately elevated index of the heart (an average of 109% to 85%), indicating that neugroschel procedures and normalizing influence on the tone of the autonomic nervous system. In addition, a significant decrease in erythrocyte sedimentation rate (from 25.8 1.9 mm/h to 16.3 1.1 mm/h, P < 0,001), ceruloplasmin (from 484 to 14.6 mg/l to 412 of 11.3 mg/l, p < 0,001).

Compared with the control (treatment native sapropel) treatment of the claimed way more pronounced normalized all the studied parameters (see table). Thus, in the control group to the Agen joint decreased only by 12.3%, and the mobility increased by 16%, whereas in the treatment by the claimed method is 36.2% and 35.6%, respectively. In addition, in the control group in 20% of patients experienced a deterioration of clinical and laboratory symptoms of synovitis under the influence of pelotherapy (which necessitated discontinuation of treatment), which is not observed in the treatment of the claimed method. The effectiveness of the treatment in the control group was 50%, and in the treatment by the claimed method - 88,4%. Taking into account these data, we can conclude that the simultaneous application of magnetic and pelotherapy on the affected joints can greatly enhance the effectiveness of treatment of patients with OA reactive synovitis.

Compared with the prototype treatment by the claimed method resulted in a more pronounced normal levels of immunoglobulin G and increased the content of T-suppressors. In addition, taking into account the duration of treatment by the claimed method (9-10 days, and in the prototype 25-30 days), it can be concluded that the treatment of the inventive method significantly accelerates recovery processes in the body and the joints of patients with OA, complicated reactive synovitis.

Example 1. Patient E., 59 years of age, was treated with a primary diagnosis of Osteoarthritis, stage III, fu admission the patient complained of severe pains in the movement and at night in the knee joints (mostly the right side), the crunch in these joints during movement, change of gait (limp). From the anamnesis it is established that suffers from OA for 6 years, but in the last 2 years has increased the intensity of pain syndrome especially in the knee joint, there was swelling in the region of the lateral edge of the patella of the knee joint was significantly reduced functional capability. Various therapeutic measures (medication, compresses, rubbing, and so on) brought temporary relief.

Objective examination: limp when walking and it is difficult to move the stairs. Severe pain and crepitus with active and passive movement in the right, the less pronounced in the left knee joints. Palpation pain (2 points) in the area of the lateral edge of the patella of the right knee joint, here swelling and hyperthermia. The circumference of the right knee joint is 43.5 cm, left - 41 see the Mobility of the right knee joint is limited (flexion - 95onorm - 140o).

When x-ray examination of the knee revealed a narrowing of the joint space, more pronounced on the right, osteosclerosis of the articular surfaces, tapering mimimally vozny were treated by the claimed method, namely 10 daily procedures on the affected and symmetrical knee joints. The effect of nonuniform intensity and direction of force lines of the magnetic field was carried out by labile methodology within 28 seconds through the mud cake thickness 2-3 cm, at a temperature of 37 degrees C. the magnetic field was carried out in 10 min from the beginning of the application within 30 sec on each affected joint, then mud cakes remained on the joints within 9 minutes.

Portability procedures was good. 4 the procedure, the patient improved health and mood, decreased the intensity of night pain in the joints (from 3 to 2 points), resulting in improved sleep. 7 procedure, a decrease in the intensity of pain in the right knee joint during movement and palpation (from 2 to 1 point), which contributed to the increase in the mobility of this joint 15 degrees. By the end of treatment virtually disappeared nocturnal joint pain, decreased significantly with movement and palpation. The circumference of the right knee joint decreased by 2 cm and amounted to 41.5 see there was an improvement in gait.

By the end of treatment significantly decreased erythrocyte sedimentation rate (41 mm/h to 21 mm/h, the norm - 15 - 400 mg/l), immunoglobulin G (from 18.5 g/l to 16.4 g/l, normal to 17 g/l). Observed improvement in the tone of the autonomic nervous system (Kerdo index increased from -32 to -13, normal 0 2). By the end of treatment decreased the index of the heart (91,8% to 75.9%).

Given a set of positive change clinical, functional and laboratory indicators of treatment outcome indicated the patient was regarded as a "significant improvement". During the course of treatment were observed pathological baldereschi.

Thus, the treatment by the claimed method OA patient with reactive synovitis contributed to a significant reduction of its manifestations, resulting in a relatively short period (10 days) with good endurance and neugroschel procedures improved functional ability of joints.

Example 2. Patient I., 55 years. Has been treated with a primary diagnosis of Osteoarthritis, stage II, functional disorders of the joints of the II degree. Reactive synovitis of the left knee". Upon receipt of a complaint of pain during movement and at rest in the knee joints (more pronounced on the left), limiting the mobility of the left knee, a crunch in joints during movement, poor sleep Uchenie state from the left knee joint was observed in the last 3-4 months. Conducted therapeutic measures (anti-inflammatory drug therapy, rubbing, herbal medicine) were ineffective.

An objective examination revealed tenderness in the knee joints with active and passive movement, especially in the left. In the region of the lower pole of the patella and the medial edge of the joint is determined by swelling, painful to palpation (3 points). Marked limitation of motion of the left knee, mainly flexion. On radiographs of the knee: left narrowing of the joint space, osteosclerosis of the articular surfaces, expressed tapering mimimally elevations, osteophytes in the area of the edges of the articular surfaces of the tibia and the poles of the patella; on the right are determined by the initial manifestations of osteoarthritis in the form of osteosclerosis of the articular surfaces and moderate narrowing of the joint space.

The patient treated by the claimed method, namely 9 daily procedures magnetograph application on the affected and symmetrical knee joints. The magnetic field was carried out by labile methodology through the mud cake, heated to 35 degrees C. the Influence of a magnetic field nachinalos the chickpeas mud application continued to be on the joints.

The middle of the course of treatment, the patient improved health and mood. The observed decrease night pain in the joints (from 3 to 2 points), which contributed to the improvement of sleep. By the end of treatment pain in the left knee joint was significantly reduced both at rest and during movement. Palpation pain in this joint is decreased from 3 to 1 point. Decreased swelling in the left knee joint, as evidenced by the decrease in the circumference of the joint with 42.5 cm to 40 cm Detected an increase in the mobility of the left knee at 25 degrees (flexion before treatment was 80 degrees. after - 105 degrees). Along with clinical improvement have been some positive changes and by laboratory parameters. So, ESR decreased to 18 mm/h (reference 27 mm/HR), the content of ceruloplasmin to 412 mg/l (source - 447 mg/l, the rate of 400 mg/l). Decreased content of immunoglobulin G 19,0 g/l up to 16.5 g/l (normal up to 17 g/l) and T-suppressor (16.1%).

In addition, the identified improvement Kerdo index (source - 18, became - 9), the index of the heart (original 109,2%, was - 85,4%), indicating that neugroschel procedures and normalizing influence on the tone of the autonomic nervous system.

The advantages of the proposed method are as follows. The ability to treat patients with osteoarthritis, acute reactive synovitis, without prior drug treatment, without unwanted side reactions and in a shorter period of time (9-10 days) compared to the prototype.

Sources of information

1. A. C. 1639663 A1 (USSR) A 61 N 2.12. The treatment method of deforming arthrosis of knee joints. // Century. And. Grotowski, N. R. Lukyanchuk. - publ. 07.04.91. - Bull. N 13.

2. Integrated phased-in treatment of patients with osteoarthrosis with symptoms of reactive synovitis. // Resort rheumatology. Sat. the scientific. works, Pyatigorsk, 1986, S. 54-57.

A method for the treatment of patients with osteoarthrosis, acute reactive synovitis, including course mud therapy, magnetic therapy, exercise therapy, characterized in that mud spend sapropel temperatures of 35 - 37oC, and the magnetic field are carried out by the labile technique after 8 - 10 min from the beginning of the imposition of dirt within 28 - 30 on the affected and symmetrical knee joint, at the rate of 9 - 10

 

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