Treatment often recurrent synovitis of the knee

 

(57) Abstract:

Used in medicine, namely in rheumatology, in the ways local therapy of rheumatic diseases of the joints. After identifying the trigger of infectious agents in the synovial fluid of the joints by polymerase chain reaction, introducing antibacterial and antiviral drugs by the method of constant perfusion of the joint. The method results in high therapeutic efficacy, long-term remission of the disease. table 1.

The invention relates to medicine, namely to methods of local treatment of rheumatic diseases of the joints.

There is a method of treatment often recurrent synovitis large joints, method of irrigation (perfusion) 0.9% solution of sodium chloride, the solution gemodeza. (Belenky, A., intra-Articular and periarticular introduction of corticosteroid drugs for rheumatic diseases. Moscow, 1997; pp. 69 - 72. , Socks, S. M., Dolgova L. N., Krasavina I., Galina L. Y. Long-term perfusion of the joints in the treatment of synovitis in rheumatoid arthritis. The second all-Russian Congress of Rheumatology, Tula, 16 - 18 June, 1997).

The disadvantage of this method is ignoring the etiology of synovitis, and the investigator is etenia is to increase therapeutic efficacy of the method. A theoretical justification of the proposed method is the emergence of literature data and our own observations about the possibility of long-term persistence trigger infectious agents in the synovial tissue of the joints and their involvement in the pathogenesis of chronic autoimmune inflammation. (Panasyuk A. F., S. Soldatov, I., Shubin, S. C., Kolkova N. And., Martynov C. A., pathogenetic aspects urinogenous arthritis associated with chlamydia: the ability of the microorganism to multiply in the cells of the synovial cartilage. Ter. Arch. , 1998., No. 5, S. 45-48.; Wilbrink B., van der Heijden I. M., et al. Detection of bacterial DNA in joint samples from patients with undifferentiated arthritis and reactive arthritis using polymerase chain reaction with universal 16S ribosomal RNA primers. Arthr. Rheum., 1998., Mar; 41(3); 535-543. ; Fendler C., Eggens u, Laitko, S., et al. Longitudinal investigation of bacterium - specific synovial lymphocyte proliferation in reactive arthritis and lyme arthritis. Br. J. Rheum., 1998., Jul; 37(7); 784-788.).

The problem is solved by a method for the identification of the most frequent trigger of infectious agents that can initiate synovitis, by polymerase chain reaction (PCR), using as material for the study of synovial fluid, with subsequent normalization constant perfusion of the affected joint and use along with the standard solutions (pax drugs. After completion of the program perfusion is controlled synovial fluid by PCR for the presence of the pathogen.

The diagnosis of synovitis is verified in accordance with generally accepted criteria. The method of constant perfusion can be performed in patients with recurrent synovitis of the knee regardless of nosological diagnosis, sex, duration of disease, degree of activity of the process. Standard clinical examination supplemented by testing of synovial fluid by PCR to identify the trigger of infectious agents: Chlamydii trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Neisseria gonorrhoeae, Herpes simplex virus type I and II, Cytomegaloviruses, etc. In accordance with the received data, the decision on the feasibility of perfusion of the joint, a Protocol procedure. The Protocol implies the choice of a particular causal therapy (antibiotics, antiviral drugs, their doses, exposure location in the cavity of the joint, the administration frequency), volume, and rate of introduction of non-specific antiseptic (aqueous solution of chlorhexidine 0.02%, furacin 0.02%), infusion solutions (isotonic solution of sodium chloride, gemodez).

The METHOD of DRAINAGE COLINN the conventional methods. Operation under local anesthesia (novocaine solution of 0.25% - 40,0). After local anesthesia, a trocar is used to puncture the top of the inversion of the knee joint from the lateral side. The trocar is injected at the outer edge of the upper pole of the patella and promote perpendicular to the axis of the thigh beneath the tendon of the quadriceps muscle. Through the trocar is introduced into the top of the inversion catheter for intravenous infusion with a diameter of 1.4 mm, the Catheter is sutured to the skin. After local anesthesia, a trocar is used to puncture of the knee joint in the projection of the medial joint space. Through the trocar into the joint cavity is inserted a tube from a single system with a diameter of 5 mm, the Tube is sutured to the skin. Through the catheter in the upper inversion introduces solutions for continuous perfusion of the knee joint that arise from the joint through a second catheter.

EXAMPLE 1. Patient D., 37 years. Diagnosis: Reactive arthritis, urogenital form (arthritis of the left knee, urethritis, bilateral sacroiliac II, simpatic, prostatitis), HLA B 27(-), activity II, NSF I. Sick for 2 months, the main clinical manifestation of the disease is recurrent synovitis of the left knee. At the outpatient stage 3 medical diagnostic puncture of the joint from evacuation recurrence of synovitis after 5 7 days. During the comprehensive examination in the synovial fluid by PCR identified antigens Chlamydii trachomatis. It was decided to hold a constant perfusion of the left knee. The operation carried out 27.10.97 according to the standard established constant perfusion joint for 16 h per day. Drawn up procedures using standard solutions: isotonic sodium chloride solution (800 ml/day, gemodez 400 ml/day, an aqueous solution of chlorhexidine 400 ml/day; specific for Chlamydia trachomatis antibacterial drugs: daily were administered a solution of Rovamycine 1.5 million UNITS, dissolved in 20 ml of physiological solution with an exhibition in the joint cavity 8 hours In this case, the perfusion joint lasted 5 days. After the procedure the following positive trends were recorded, mild synovitis of the left knee, reduction of inflammatory disease activity in erythrocyte sedimentation rate of 30 mm/h up to 18 mm/h, the lack of control study of synovial fluid by PCR DNA Chlamydii trachomatis. The patient was discharged in satisfactory condition, disability restored.

EXAMPLE 2. Patient K., aged 60. Diagnosis: Rheumatoid arthritis, arthritis with systemic manifestations (reumatoidea the knee joint. Secondary systemic osteoporosis. The disease duration of 18 years. One of the manifestations of the underlying disease causing the severity of the patient's condition, namely the failure of function of the joints, was synovitis of the left knee, which is the last 7 years is continuously recurrent in nature. In outpatient treatment and diagnostic puncture performed with an interval of 2 - 3 weeks. Synovitis was resistant to standard local (prolonged corticosteroids and systemic pathogenetic therapy. When surveyed in synovial fluid by PCR identified antigens Chlamydii trachomatis. It was decided to hold a constant perfusion of the left knee. The operation was carried out 22.12.97 according to the standard established constant perfusion of the knee joint for 16 h per day, duration of treatment 10 days. Drawn up procedures using standard solutions: isotonic sodium chloride solution 400 ml/day. , chlorhexidine aqueous solution of 0.02% - 400 ml/day. , furatsilin 0,02% - 400 ml/day., gemodez 400 ml/day., as well as specific antibacterial drugs: erythromycin 0,1 pre-diluted in 20 ml of sterile physiological solution with BA

After completion of procedures following positive trends were recorded: mild synovitis of the left knee joint, expansion of the volume of active movements, reduction of inflammatory activity in erythrocyte sedimentation rate of 50 mm/h to 32 mm/h, lower titers of rheumatoid factor in serum from 1:1600 to 1:800 in the control study of synovial fluid by PCR DNA Chlamydii trachomatis were not found. The patient was discharged in satisfactory condition. Continued during the year: no recurrence of synovitis.

EXAMPLE 3. Patient L., aged 26. Diagnosis: Reactive arthritis, urogenital form (prepatellar bursitis right, podpjatochnoj bursitis, left, bilateral sacroiliac II, urethritis), HLA B 27(-), activity II, NSF I. Sick 5 weeks. The main clinical manifestation of the disease is recurrent prepatellar bursitis. In outpatient treatment and diagnostic puncture was performed 4 times with the evacuation of 100 - 150 ml of synovial fluid and the introduction of long-acting corticosteroids. Bursitis residenrial after 2 to 3 days. During the comprehensive examination in the synovial fluid by PCR revealed a Ureaplasma urealyticum antigen, Herpes simplex type II. It was decided to conduct perfusion prepatellar Bursa. The surgery is and just 10 days. Drawn up procedures using standard solutions: isotonic sodium chloride solution 400 ml/day., gemodez 400 ml/day., chlorhexidine 0.02% - 400 ml/day., furatsilin 0.02% - 400 ml/day., specific antibacterial and antiviral drugs, namely: the first five days erythromycin 0,1, dissolved in 20 ml of saline solution twice a day with an exhibition in the joint cavity 2 h, the next five days rovamycin 0.75 million IU dissolved in 20 ml of saline, twice a day of exposure and joint cavity 2 h, 3, 4, 5, 6, 7 day. virolex 125 mg dissolved in 20 ml of physiological solution, once with exposure in joint cavity 2 h, 6, 7, 8, 9, 10 day. introduced gordox 10 ml (100.000 IU) with exposure in joint cavity 8 hours After the procedure the following positive trends were recorded: mild bursitis, restoring volume of active movements, reduction of inflammatory activity in erythrocyte sedimentation rate of 34 mm/h up to 12 mm/h, in the control study joint fluid by PCR Ureaplasma urealyticum, Herpes simplex type II was not determined. The patient was discharged in satisfactory condition, disability restored.

As an illustration for proof way to pemeriksaan the effectiveness of therapy by the method of constant perfusion of the knee joints.

The developed method allows to significantly optimize treatment often recurrent synovitis of the knee with a wide range of rheumatic diseases. The focus of therapy trigger against infectious agents seems to us the most important, because it allows one to talk about etidronate impact. Thus it becomes possible to avoid frequent injection in the joint cavity prolonged corticosteroids are currently the most commonly used method of treatment of such conditions.

Treatment often recurrent synovitis of the knee, including specific antibacterial and antiviral therapy on the basis of the detection trigger infectious agents in synovial fluid, characterized in that as a method of identifying these agents use the polymerase chain reaction, and antibacterial and antiviral drugs administered by continuous perfusion of the joint.

 

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