Method for treating patients with osteoarthrosis

FIELD: medicine, physiotherapy, health resort treatment.

SUBSTANCE: one should affect with balneo-, peloido-, EHV-therapy daily at the following sequence: 9 - 11 a.m. - balneotherapy, 8-10 procedures/course, 11 a.m. - 1 p.m - therapy, 10 procedures/course, 2 p.m. - 4 p.m.- peloidotherapy, 8-10 procedures/course. Moreover, about 2-3 d before this impact one should prescribe a food additive as succinic acid at the dosage of 0.5 g thrice daily after meals for 14 -16 d. The method enables to shorten the frequency of appearance and degree of balneoreactions, shorten therapy terms without any decrease of productivity.

EFFECT: higher efficiency of therapy.

4 cl, 3 ex, 5 tbl

The invention relates to medicine, namely physiotherapy and balneology. There is a method to improve the results pelotherapy by assigning small doses of iodine to limit the functional activity of the thyroid gland [6]. The disadvantages of this method include the inability to control the functional state of the thyroid level hormones produced due to the absence in the vast majority of establishments of sanatorium type required equipment and expensive reagents for the implementation of radioimmunoassay diagnostic undesirability of uncontrolled interference in the processes of functioning of the thyroid gland due to a significant increase in the incidence of cancer and autoimmune diseases last.

There is also known a method of increasing the efficiency and improving the portability of ropeladder taking into account the formation of various reactions in patients on resort factors by assigning them: a) indometacin (indomethacin) - when ostalgie and myalgias, increased arthralgia; b) bellaid (bellataminala) - if you have the original functional instability of the autonomic nervous system [1]. The disadvantages of the method are the large number of side effects and contraindications the use of these pharmacological agents (development W is lubochna-intestinal bleeding in 40-50% of cases, deafness, dizziness, allergic, hematologic reactions, toxic liver and kidneys - in 10-40% of cases, a negative effect on cartilage and subchondral bone with use of indomethacin, loss of use of belloid in organic diseases of the cardiovascular system, especially the occlusal type, diseases of the thyroid gland, the formation of drug dependence with long-term use of the latter), the absence of a specific purposeful influence on the pathogenetic mechanisms of osteoarthritis[3, 4, 9, 11, 14].

The task of the invention is to increase efficiency, improved portability, balneo-, peloid and EHF-therapy and also reduction treatment.

The task is carried out by complex effects of balneotherapy, peloid and EHF-therapy carried out daily in the following sequence: balneotherapy, EHF-therapy, pelotherapy, and for 2-3 days before starting patients prescribed dietary Supplement succinic acid at a dose of 0.5 g 3 times a day after meals, which continue throughout the course of treatment, the duration of the course is 14-16 days. As balneotherapy use common sodium chloride baths concentration of 30-40 g/l, temperature of 36-37°duration 10-12 min, appointed by IED is evno from 9.00 to 11.00, in the course of 8-10 treatments. EHF-therapy apparatus “Stella-1” [10] carried out by exposure to electromagnetic radiation of millimeter range (EHF-radiation) on biologically active points (BAP) with frequency 40-43 GHz, duration of exposure per BAHT 4-5 min, the total treatment time 20-40 minutes, in the course of 10 treatments daily from 11.00 to 13.00. The choice of corporeal BAHT carried out in accordance with the individual manifestations of the disease: G-29, G-30 - in osteoarthritis of the hip joints, M-34, M-35, Le-7 Le-8 - in osteoarthritis of the knee, 3RD-4, Dü-5. Di-5 - in osteoarthritis of the joints of the upper extremities. In addition, all patients realize the impact on the overall point G-41, 3E-5 [2]. As pelotherapy using applications of peat on the affected joints, no more than 2-4 large joints in one procedure and the corresponding reflex zones of the spine temperature of 40-42°duration 20-30 min appointed day from 14.00 to 16.00, in the course of 8-10 treatments.

Example 1. Patient S., 56 years old, medical history, No. 1264, was admitted for treatment in the rehabilitation therapy Department of the Tomsk scientific research Institute of balneology and physiotherapy with a diagnosis of primary bilateral gonarthrosis, Rg stage II, failure of function of the joints I.

Upon receipt complained of severe pains in the knee joints aching or Lama is his character, occur during movement, worse after exercise, as well as in the evening and first half of the night, restriction of movements and the crunch in these joints, General weakness, increased sweating, fatigue, decreased performance.

From the anamnesis: the first pain in the knee joints appeared about 5 years ago after hypothermia and significant physical exertion (work in the garden in autumn. Since then, on average 2 times per year marks the exacerbation of the disease. Previously received only outpatient treatment (non-steroidal anti-inflammatory drugs, compresses Dimexidum on the joints, vitamins).

Of comorbidity in a patient diagnosed with cervical degenerative disc disease, chronic parasitic (opisthorchosis) cholecystitis in remission, hypertension stage I.

Objective status: high power (height - 178 cm, weight 90 kg). The General condition is satisfactory. The skin and mucous clean, damp. Lymph nodes are not enlarged, painless. Muffled heart sounds, regular rhythm, 62 beats./min. Blood pressure is 130/90 mm Hg In the lungs vesicular breathing, wheezing no. Abdomen palpation soft, painless. Knee joints strain in the medial departments, palpation is painful. Movement in the joints is somewhat limited due to the incomplete is gibanja, cause pain, crunch.

X-ray examination of the joints pointed mimedecode elevation in both joints. Joint gap narrowed in the middle departments, more to the right. Subchondral sclerosis closing plates of the heads of the bones that form the joints. Small bone growths of the outer condyles of both thighs. Sharp internal corners of both the knee cap, there are osteophytes on the outer contour of both the knee cap. Conclusion: osteoarthritis of the knee, II stage.

Blood biochemical parameters before treatment: sialic acid - a 3.06 mmol/l (at a rate of 1.9-2.5 mmol/l)ceruloplasmin - 496 mg/l (at a rate of 280-400 mg/l), catalase - 37,4 has McCall/l (at a rate of 4,5-30,3 has McCall/l), malonic dialdehyde - 4.3 mmol/l (normal - <3.8 mmol/l).

Immunological parameters of blood before treatment: T-lymphocytes - 34% (the norm 40-68%), b-lymphocytes - 33% (the norm 12-32%), immunoglobulin A (Ig A) - 3.7 g/l (at a rate of 1.5-3.5 g/l), immunoglobulin G (Ig G) of 19.2 g/l (at the rate of 8.4-18.0 g/l), circulating immune components (CEC) - 115 used (the norm 38-95 used).

The treatment was carried out in accordance with the claimed method. From the day of admission the patient assigned succinic acid at a dose of 0.5 g 3 times a day after meals, which the patient continued throughout the course of treatment. From the third day of stay ill the th in the Tomsk scientific research Institute of balneology and physiotherapy in the treatment system includes the application of peat on knee joints and lumbosacral spine temperature of 40° With a duration of 20 min in 1-3 treatments 30 min in the subsequent days of treatment, released daily at 10.00, on a course of 8 treatments; EHF-therapy apparatus “Stella-1”performed daily at 12.00, through the impact on BAT M-34, M-35, Le-7 Le-8, G-41, 3E-5 EHF-radiation frequency 40-43 GHz, the exposure time per one BAHT 5 min, the total duration of the procedure and 30 minutes on a course of 8 treatments; total sodium chloride baths concentration of 30 g/l, temperature 36°duration 10 min released daily at 14.00, on a course of 8 treatments.

Treatment the patient endured well. Clinical manifestations of baldereschi were not recorded. Sharp fluctuations in autonomic indices characterizing autonomic security and reactivity was not detected.

Adaptive reaction regard to treatment response increased activation after treatment was within the reaction peaceful activation, the most favorable for anabolic processes, indicating about the lack of stress adaptation mechanisms and adequacy of therapeutic load.

At the end of the treatment course the patient has no pain in the joints as during movement and at rest, increased range of motion in the right knee joint with 115° to 138°in the 120° to 140°reduced General weakness and sweating.

Normalization of the original modified biochemical and immunological parameters of blood: sialic acid is 2.44 mmol/l ceruloplasmin - 398 mg/l, catalase - 21,4 has McCall/l of malonic dialdehyde - 3.1 mmol/l, T-lymphocytes - 47%, lymphocytes - 23%, Ig And 2.6 g/l, Ig G-17.8 g/l, CEC - 93 usled

The immediate result of the treatment were assessed as a significant improvement. Control tests conducted by the patient after 3, 6, 9 months revealed no episodes of exacerbation during the whole period of monitoring and maintaining therapeutic effect.

Example 2. Patient P., 54 years old, medical history, No. 205, arrived for treatment in rehabilitation therapy Department of the Tomsk scientific research Institute of balneology and physiotherapy with a diagnosis of primary bilateral coxarthrosis, Rg stage II, failure of function of the joints I.

Upon receipt complained of moderate pain in hip joints and lumbar spine whining character, disturbing while driving, restriction of motion in the hip joint, crunch, limping on his right foot.

From the anamnesis: from childhood suffers from scoliosis of the spine. Pain in the hip joints first appeared about 10 years ago. Exacerbation of the disease noted in the winter. Previously received a Spa treatment, after Kotor is th marked improvement, continued for about six months.

Of comorbidity in a patient identified in the thoracic and lumbar osteochondrosis.

Objective status: normal power (height - 172 cm weight - 73 kg). The General condition is satisfactory. The skin and mucous net. Lymph nodes are not enlarged, painless. Heart sounds are clear, correct rhythm, 52 beats./min, Blood pressure 110/70 mm RT. Art. In the lungs vesicular breathing, wheezing no. Abdomen palpation soft, painless. A pronounced right-sided scoliosis of the spine in nijaguna and lumbar regions, the smoothness of the lumbar lordosis, significant defense direct the muscles of the back to the right. Compensatory distortion of the pelvis to the right. The perceived shortening of the right lower limb 1.5 cm, wasting of muscles of the right buttock. Palpation tenderness of the joints there. Movement in the hip joints cause pain and crunch, more pronounced on the right. Limitation of motion in the hip joint due to incomplete discharge, casting, bending.

X-ray examination of the joints: subchondral sclerosis reflex plate roofs acetabular hollows, small marginal expansion reflex plate roofs acetabular hollows. Joint gap narrowed more to the right. The right hip is higher than the left. The flattening of the head right b is implemented bones. Conclusion: osteoarthritis of the hip joints, II stage.

Blood biochemical parameters before treatment: sialic acid - 2.68 mmol/l (at a rate of 1.9-2.5 mmol/l)ceruloplasmin - 447 mg/l (at a rate of 280-400 mg/l), catalase - 43,2 has McCall/l (at a rate of 4,5 - 30,3 has McCall/l), malonic dialdehyde - 4.2 mmol/l (normal < 3.8 mmol/l).

Immunological parameters of blood before treatment: T-lymphocytes - 32% (the norm 40-68%), b-lymphocytes - 9% (the norm 12-32%), immunoglobulin A (Ig A) - 3.6 g/l (at a rate of 1.5-3.5 g/l), immunoglobulin G (Ig G) to 18.5 g/l (at the rate of 8.4-18.0 g/l), circulating immune components (CEC) - 130 sm. units (at a rate of 38-95 srvc. units).

The treatment was carried out in accordance with the claimed method. From the day of admission the patient assigned succinic acid at a dose of 0.5 g 3 times a day after meals, which the patient continued throughout the course of treatment. From the third day of stay of the patient in the Tomsk scientific research Institute of balneology and physiotherapy in the treatment system includes the application of peat type “briefs” temperature 40°S, with a duration of 20 min in 1-3 treatments 30 min in the subsequent days of treatment, released daily at 9.00 am, at the rate of 9 procedures; EHF-therapy apparatus “Stella-1”performed daily at 11.00, through the impact on BAT G-29, G-30, G-41, 3E-5 EHF-radiation frequency 40-43 GHz, the exposure time per one BAHT 5 min total duration p is ocedure 20 min, in the course of 9 treatments; total sodium chloride baths concentration of 30 g/l, temperature 36°duration 10 min released daily at 15.00, at the rate of 9 procedures.

Treatment the patient endured well. Clinical manifestations of baldereschi were not recorded. Sharp fluctuations in autonomic indices characterizing autonomic security and reactivity was not detected.

Adaptive reaction regard to treatment response of preactivation, after completion of the treatment was within the reaction peaceful activation of the high level of reactivity.

At the end of the treatment of pain in the left hip joint was stopped in the right hip and the lumbar spine was significantly reduced, increased range of motion in the right hip joint (flexion with 80° to 95°lead with 25° to 30°, bringing with 15° to 20°).

Normalization of the original modified biochemical and immunological parameters of blood: sialic acid - 2,41 mmol/l ceruloplasmin - 352 mg/l, catalase - 19,8 has McCall/l of malonic dialdehyde - 3.0 mmol/l, T-lymphocytes - 41%, lymphocytes - 15%, Ig A - 2.2 g/l, Ig G - 12.4 g/l, CEC - 90 sm. units

The immediate result of the treatment were assessed as a significant improvement. Control tests conducted by the patient after 3, 6, 9 months, you the wheelie maintaining therapeutic effect during the entire period of observation.

Example 3. Patient S., 48 years old, medical history, No. 471, arrived for treatment in rehabilitation therapy Department of the Tomsk scientific research Institute of balneology and physiotherapy with a diagnosis of primary osteoarthritis of the distal and proximal interphalangeal joints of hands, Rg stage I-II, failure of function of the joints 0.

At admission were filed complaints: pain in joints of fingers when moving, burning, tingling, crawling in them alone, changing the shape of the joints, morning stiffness for 20-30 min, decreased performance, fatigue, sweating.

From the anamnesis: considers himself sick about 6-7 years. For over 20 years working as a plasterer and painter. For the first time pain in the above joints occurred after significant physical stress and hypothermia (work on a construction site in the winter). The pain was accompanied by redness, swelling and soreness at durgiana. Were outpatients (indomethacin, innovatively gel electrophoresis of 3% solution of lithium chloride on hands). 3 years ago noticed the appearance of a dense rounded formations pea-sized in the region of the distal interphalangeal joints II, III, V fingers of both hands.

Of comorbidities, the patient was diagnosed with cervical degenerative disc disease, chronic obstructive bronchitis in f is ze remission, diffuse-nodular goiter II degree, chronic autoimmune thyroiditis, autres.

Objective status: normal power (height - 168 cm, weight 70 kg). The General condition is satisfactory. Skin clean, moist. Lymph nodes are not enlarged, painless. The thyroid gland photoelasticity consistency, increased at the expense of the right lobe and isthmus (II degree). Heart sounds are clear, correct rhythm, 78 beats./min. Blood pressure is 120/80 mm Hg In the lungs vesicular breathing with a hard tone in the lower divisions, no wheezing. Abdomen palpation soft, painless. Heberden's polyarthritis in the area of the distal interphalangeal joints II, III, IV fingers of both hands, the tenderness of the proximal interphalangeal joints II, IV fingers of the right hand. Movement is not restricted, moderately painful.

X-ray examination of the joints are determined by the marginal bone growth and racemose enlightenment rounded distal phalanges II and III fingers of both hands. Conclusion: osteoarthritis of the distal interphalangeal joints II, III fingers, I-II stage.

Blood biochemical parameters before treatment: sialic acid - 2.57 mmol/l (at a rate of 1.9-2.5 mmol/l)ceruloplasmin - 428 mg/l (at a rate of 280-400 mg/l), catalase - 35,4 has McCall/l (at a rate of 4,5 - 30,3 has McCall/l), malonic dialdehyde - 4.2 mmol/l (but the IU < 3.8 mmol/l).

Immunological parameters of blood before treatment: T-lymphocytes - 28% (the norm 40-68%), b-lymphocytes - 34% (the norm 12-32%), immunoglobulin A (Ig A) - 3.6 g/l (at a rate of 1.5-3.5 g/l), immunoglobulin G (Ig G) of 18.3 g/l (at the rate of 8.4-18.0 g/l), circulating immune components (CEC) - 108 srvc. units (at a rate of 38-95 srvc. units).

The treatment was carried out in accordance with the claimed method. From the day of admission the patient assigned succinic acid at a dose of 0.5 g 3 times a day after meals, which the patient continued throughout the course of treatment. With the second day of the stay of the patient in the Tomsk scientific research Institute of balneology and physiotherapy in the treatment system includes the application of peat type high glove temperature of 40°S, with a duration of 20 min in 1-3 treatments 30 min in the subsequent days of treatment, released daily at 11.00, in the course of 10 treatments; EHF-therapy apparatus “Stella-1”performed daily at 13.00, through the impact on BAT M-34, M-35, Le-7 Le-8, G-41, 3E-5 EHF-radiation frequency 40-43 GHz, the exposure time per one BAHT 5 min, the total duration of the treatment 30 min, in the course of 10 treatments; total sodium chloride baths concentration of 30 g/l, temperature 37°duration 10 min released daily at 16.00, in the course of 10 treatments.

Treatment the patient was well tolerated. Clinical manifestations of baldereschi were not recorded. Rez is their fluctuations vegetative indexes, characterizing autonomic security and reactivity was not detected.

Adaptive reaction regard to treatment response tranquil activation low level of responsiveness after treatment was within the reaction peaceful activation of the high level of reactivity.

At the end of treatment pain in the interphalangeal joints and the feeling of morning stiffness disappeared, decreased weakness and sweating.

Normalization of the original modified biochemical and immunological parameters of blood: sialic acid - 2.03 mmol/l ceruloplasmin - 314 mg/l, catalase - 9,7 has McCall/l of malonic dialdehyde - 1.5 mmol/l, T-lymphocytes - 40%, lymphocytes - 22%, Ig And - 1.8 g/l, Ig G and 15.3 g/l, CEC - 85 srvc. units

The immediate result of the treatment were assessed as a significant improvement. Control tests conducted by the patient after 3, 6, 9 months, revealed the preservation of the achieved therapeutic effect during the entire period of observation.

The use of common sodium chloride baths in the present method due to their strong positive impact on the different stages of inflammation, trophic and reparative processes, circulation, immune status, etc.

In order to enhance anti-inflammatory effects of balneotherapy, regional blood flow and metabolic and trophic PR the processes in the synovial tissue of patients with osteoarthritis in the affected joint and the corresponding reflex zones of the spine impose mud (in this case peat) applications.

Traditionally, mineral baths and mud packs are appointed through the day or (rarely) two days in a row with the subsequent day of rest. In the present method the application of peat and total sodium chloride baths are assigned daily to reduce treatment time without compromising therapeutic effect.

Temperature and exposure mud application and mineral baths are selected in accordance with the range that is most often used in medical practice.

The duration of treatment is determined taking into account the fact that positive changes in the clinical condition of the patients appear in the middle after 5-7 procedures balneopelotherapy [6]. This fact is due to the choice of the lower limit of the duration of treatment in 8 treatments, with 1-2 effects added to consolidate the curative effect. On 11-12 procedures are increasing in number asteno vegetative disorders (weakness, fatigue, expressed adrenergicheskie reaction)that determined the choice of the upper limit of the number of balneo-, palaeobotany 10 procedures.

The time of the procedure pelotherapy selected based oxalosuccinic biorhythms of the pathological process. Research [13]conducted Lghteriigi (2002)showed that in patients with osteoarthritis revealed a steady rhythm of pain syndr the mA in joints with acrophase at 17.40, therefore, therapeutic effects, held for several hours before acrophase allow you to achieve a more rapid and pronounced therapeutic effect. Thus, patients treated with the use of mud applications, only for pelotherapy after 14 hours most fully manifest its anti-inflammatory, antioxidant and immunomodulatory effects.

Given that in the present method, patients are assigned daily as peloid-and balneotherapy, was chosen as the time of the procedure: from 9.00 to 11.00 for a vacation balneological treatment, from 14.00 to 16.00 for vacation paleoplacer.

In addition balneopelotherapy in the present method uses the physical impact factor, namely electromagnetic radiation of millimeter range (EHF radiation).

Inclusion in the medical complex short-wave radiation is based on the known properties of this physical factor to increase nonspecific resistance of the organism to various factors chemical, physical and biological nature, to normalize the modified activity of the autonomic nervous system, to provide analgesic and immunomodulatory actions.

In addition, the study of complex use of EHF-influence in the experiment and in the rehabilitation of patients with degenerative-dystrophic diseases of joints detected by the ILO that the electromagnetic radiation of millimeter range causes the improvement of microcirculation, reduces the intensity of pain, improve source of reduced muscle tone, increase range of motion in the involved joints and increase their tolerance to physical activity [5].

The duration of the course of EHF-therapy in 8-10 procedures defined by some researchers by monitoring the effectiveness of treatment of patients [5]. Decreasing the duration of the course of treatment effectiveness was decreased, and when the elongation is not increased.

Use in treatment of complex food additives succinic acid increases the body's resistance was bred impacts, increases the ability of the metabolism to the holding state of homeostasis in a wider range of conditions. Succinic acid is involved in the correction of disorders of energy metabolism as a very powerful source of protons and ATP, the processes of oxidation plays a Central role in energy supply of the brain tissue. In addition, both treatment and food dose of succinic acid reduce metabolic acidosis, which is an evidence of the formation of stress, and normalization of transaminase levels, which also reflects the improvement of energy metabolism.

Another form of adaptive adjusting the AI metabolism to stress is the antioxidant effect of succinic acid, which is manifested in the reduction processes of lipid peroxidation, also related to the General characteristics of the metabolism of pathogenic influences. Succinic acid with high antioxidant activity, enhances antioxidant and protective effects of other therapeutic effects [12].

Finally, it should be noted that succinic acid has the property to stabilize some volatile compounds, in particular ascorbic acid, b vitamins, which possibly underlies stabilize its level of ATP in the mitochondria of cells with the exception of their breathing due to the adverse effects of the environment [7, 8].

Clinical implementation of the above effects is manifested in the improvement of liver, heart, brain, and thus the whole organism, which is subjectively evaluated patients in improving mood, increasing efficiency, normalization of sleep, etc.

First proposed intensive method of treatment of osteoarthritis of the duration of 8-10 treatments, and procedures designate a certain time, every day and in the specified sequence. The treatment is carried out on a background of reception of succinic acid.

The proposed method treated 34 patients. The control group consisted of 31 patient who also received a comprehensive daily is second-to-date information peloid-, UHF-therapy, but did not take dietary Supplement succinic acid. The obtained results prove that the treatment by the present method allows to improve the tolerability of treatment, to reduce the incidence and severity of balneology (table 1), to achieve more significant positive dynamics in the major manifestations of the disease (table. 2)significantly reduce the frequency of occurrence of altered biochemical and immunological parameters of blood (table. 3) compared with control group (I), not taking dietary Supplement succinic acid.

In addition, combined treatment with the inclusion of food additives succinic acid contributes to the formation of conditions close to the optimum, in which the processes of sanogenesis and response of the power supply system in the organism of patients with osteoarthritis are more gently than those in the absence of succinic acid. This is indicated by a decrease of 1.8 times the incidence of reactions increased activation of the low level of reactivity (RPA NUR), named reactions preactivation and bordering reaction stress (PL. 4), a satisfactory balance between pools of cells with high and low activity of succinate dehydrogenase (LDH) (factor A), the increase in the number of cells with hypernormal activity of the enzyme (the ratio is), normal values of the coefficient of variation (V) over the whole observation period, no phenomenon of hidden activation SDG (Q) (table 5).

Treatment by the present method is for 14-16 days, which allows you to shorten the traditional duration of treatment in establishments of sanatorium type for 8-10 days without reducing its effectiveness. Direct the effectiveness of treatment of patients with primary (II) group was 92% vs. 75% in the control (I).

Sources of information

1. Aleynikov VK study of the comparative effectiveness of rheumatism Spa treatment-and-prophylactic complexes with the leading role of repo-, pelotherapy / Vlkolinec: author. dis... Kida. the honey. Sciences. - Odessa, 1979. - 17 S.

2. Vohralik VG Acupuncture/ Wegfahrt, Mavahali// Bitter, 1978. - s-217.

3. Dvorkin E.B. Effect of NSAIDs on renal function in patients with rheumatoid arthritis / Aboderin, Wavev// Rheumatology, - 1991, No. 2. - p.28-30.

4. Karataev CU Nonsteroidal anti-inflammatory drugs in the treatment of osteoarthritis / Dearation// Russian medical journal. - 1997. - V.5, No. 15, - s-965.

5. A comprehensive study of EHF-influence in the experiment and in the rehabilitation of patients with degenerative-dystrophic pathology of large joints / Agibalova, Tview, Djaelani etc.// Millimeter waves in Biol the GII and medicine. - 1999. No. 13. - s-27.

6. Leszczynski A.F. Peloid and pharmacotherapy in inflammatory diseases / Affluence, Shizuta. - Kiev: Health, 1985. - s-138.

7. Lukyanova A.D. Bioenergetic mechanisms antihypoxic action succinatecontaining derived 3-oksipiridina Mexidol / Ldeucom, Reateva, Shulepov// Bulletin of experimental biology and medicine. - 1993. No. 3. - s.

8. Majewski H. Anaerobic formation of succinate and the resynthesis of ATP in the mitochondria of rat tissues / Eyisi, Avichina// Pharmacological correction of hypoxic conditions. - M.: Publishing house of the Academy of medical Sciences USSR, 1980. - P80.

9. Mashkovsky PPM Medicines/ Medmaravis. - Moscow, 1993. - Vol.2 - s.

10. Passport KS 941526.001 PS THE 9444-002-28833138-96 to the apparatus EHF-IR therapy “Stella-1” (portable dual with five replaceable emitters). Tomsk, 2000.

11. Polunin I.E. Hepatotoxic effect of nonsteroidal anti-inflammatory drugs / Theologia, Weaponized, Aphsilia// Therapeutic archive - 1994, No. 5, - s-80.

12. Sahakyan MR Correction of violations of the internal environment of the mechanism dietary Supplement succinic acid in animals and humans / Mrican, Menandrou, Ivison// Izvestiya AN., biological series. -1994. - VI - s-604.

13. Tereshina L.G., Grenoble and hronofizioterapiya - methodology of optimization of treatment the Oia osteoarthritis and related diseases/ Lgeria: author. dis... Doc. the honey. Sciences. - Ekaterinburg, 2002. - 42 S.

14. Frolov DMITRY. Rheumatology lives de facto / Dneprov// Russian medical journal. -1997. - V.5, No. 15, - s-1017.

Table 5 The impact of shortened intensive rehabilitation treatment of patients with osteoarthritis on the activity of LDH blood lymphocytes (M/M)
Index	Group I (n=31)	Group II (n=34)
Before the treatment	The middle of the treatment	After the treatment	Before the treatment	The middle of the treatment
Q	Without activators
Glutamate
Isocitrate
A	Without activators
Glutamate
Isocitrate
E	Without activators
Glutamate
Isocitrate
V	Without activators
Glutamate
Isocitrate
Note: M - mean value; m - medium error; Q is a typical enzymatic activity of LDH; a is the coefficient of skewness of cells with low and high activity of LDH; F - coefficient of kurtosis (the number of glue is OK with typical LDH activity); V - coefficient of variation of lymphocyte activity SDG; ** - significance of differences within the group, P<0,001.

1. A method for the treatment of patients with osteoarthrosis by the integrated effect of balneotherapy, peloid-, UHF-therapy, characterized in that the integrated effect spend every day in the following sequence: from 9.00 to 11.00 balneotherapy, in the course of 8-10 treatments, from 11.00 to 13.00 EHF-therapy, a course of 10 treatments, from 14.00 to 16.00 pelotherapy, in the course of 8-10 treatments for 2-3 days before starting the prescribed dietary Supplement succinic acid at a dose of 0.5 g 3 times a day after meals for 14-16 days.

2. The method according to claim 1, characterized in that as balneotherapy use common sodium chloride baths concentration of 30-40 g/l, temperature of 36-37°duration 10-12 minutes

3. The method according to claim 1, characterized in that the EHF-therapy on biologically active points when the frequency 40-43 GHz, the exposure duration of 1 biologically active point 4-5 min, the total treatment time 30-40 minutes

4. The method according to claim 1, characterized in that as pelotherapy using applications of peat on the affected joints, no more than 2-4 large one procedure, and the corresponding reflex zones of the spine temperature of 40-42°With a duration of 20-30 minutes

5. The method according to claim 1, characterized in that in osteoarthritis is isobutene joints affect the point G-29, G-30; in osteoarthritis of the joints of the upper limbs at points 3RD-4, Dü-4, Dü-5, Di-5; in osteoarthritis of the knee at point M-34, M-35, Le-7 Le-8, all patients spend their impact on the overall point G-41, SE-5.