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KoHrpecu, cuMno3iyMu, wKonu / Congresses, Symposiums, Schools
TE3M MIMHAPOflHOrO CMMnO3IYMY «3AXBOP№BAHHfl KICTKOBO-MA3OBOI CMCTEMM TA BIK >, m. flbBÎB, 5-7 TpaBHfl, 2015
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ANDRUSHA A.
Kharkiv National Medical University, Kharkiv, Ukraine
Clinical and Prognostic Significance of Serum Uric Acid as a Marker Complicated Course of Gout on the Background Pathology of Digestive Tract
Introduction. According to statistics, gout — the most common cause of arthritis in men older than 30 years. At present, the disease is considered not only as clinicians recurrent monoarthritis, but as a systemic disease with severe visceral manifestations. It is therefore timely diagnosis of gout and its visceral manifestations, early and appropriate treatment of the main nosology and related pathologies has clinical and social importance for these patients.
The aim of our study was to investigate the features of primary gout against pathology of the gastrointestinal tract (GIT), depending on the level of serum uric acid (SUA).
Materials and methods. 25 patients with gout complicated by GIT pathology were examined. The investigation of patients included general clinical and laboratory methods (including assessment of articular syndrome, SUA level by uricase method), radiographic (joint X-ray). According to history, we detailed the duration of gout (first of all specific joint syndrome), frequency (last 12 months) and duration of exacerbations, the number of affected joints and tophi in the course of the disease and at the time of inspection. The intensity of pain joint syndrome evaluated on a ten visual analogue scale (VAS). Gastrointestinal pathology was diagnosed according to the criteria relevant diagnostic nosology.
Results. Patients had different clinical gout variants: asymptomatic hyperuricemia, intermittent gout, chronic gout. Tophi were found in 6 patients. SUA level varied in the range from 360 to 731 mmol/l. To investigate the influence of SUA on the course of gout and gastrointestinal pathology, patients were divided into 2 subgroups according to the degree of hyperuricemia: the first subgroup (12 patients) with hyperurice-
mia greater than 600 mmol/l, the second subgroup (13 people) with moderate hyperuricemia 360—600 mmol/l. The severity of the disease was caused by a large number of affected joints (minimum 3, maximum 10) and the number of inflamed joints at inspection (2 to 6), high frequency of exacerbations joint syndrome during the year (min — 2, max — 8 times a year), duration last exacerbation (4—10 days). Localization arthritis was the following: the first metatarsus-pha-langeal joints, ankle, knee and elbow joints, small joints of hands. The painful articular syndrome patients assessed with VAS scale from 5 to 10 points.
Radiographic changes in affected joints were presented as following: the moderate local osteoporosis, vacuole-like bone defects with a rim of sclerosis; small erosion on the articular surfaces; consolidations and thickening of soft tissue, calcifications in soft tissues, signs of secondary os-teoarthritis. These features correspond to the simultaneous existence of phenomena of degradation, degeneration and regeneration. The phenomena of osteoporosis were discovered in patients with chronic gout, while as erosive changes detected at high hyperuricemia and tophi gout.
Pathology of the digestive tract was presented by gastroesophageal reflux disease with esophagitis (24.0 %) and without esophagitis (32.0 %), gastritis and/or duodenitis (16.0 %) and chronic colitis (28.0 %). Erosive changes in the mucosa of the gastrointestinal tract were observed at high hyperuricemia and tophi gout (24.0 %).
Conclusion. At gout complicated by gastrointestinal disorders, there is a severe course of articular syndrome caused by a large number of affected joints and a high index of severity of gout. X-ray picture of the affected joints and en-doscopic findings in the gastrointestinal tract characterized by changes, the severity of which depends on the degree of hyperuricemia. At high values of uric acid (> 600 mmol/l) there are erosive changes and phenomena of inflammatory erosive changes in the gastrointestinal tract mucosa.
BAKALYUK T.G.
Ternopil State Medical University named after I.Ya. Gorbachevsky, Ternopil, Ukraine
Application of Natural Factors for Prophylaxis and Treatment of Patients with Osteoarthritis with Low Bone Density
Introduction. Osteoarthritis (OA) — a chronic progressive disease of the joints, which revealed not only in losing ofjoint cartilage but also changes in bone tissue. Proved combination of influence of osteoarthritis and osteodefi-ciency on each other as the state of bone mass of the skele-
ton affects the clinical manifestations and reflects on course of osteoarthritis. Nevertheless there are some differences in the issues of etiology and pathogenesis of OA, there is no doubt about the perspectives of a comprehensive treatment of OA by finding medication and environmental factors that can influence the basic mechanisms of pathological process — a violation of bone and cartilage tissues. One of the most effective treatment methods of degenerative-dystrophic diseases of the musculoskeletal system is sulfide balneotherapy. The mechanism of therapeutic action of hydrogen sulfide treatment in OA is mediated by activation of protective and adaptive forces (primarily the immune and
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KoHrpecu, cMMno3iyMM, WKonu / Congresses, Symposiums, Schools
pituitary-adrenal systems), and increased local blood and lymph circulation, improve metabolic and trophic processes, activation of regenerative factors.
Aim of the studying — to study biochemical markers of bone metabolism in patients with osteoarthritis with reduced bone density using of sulphide balneotherapy in the rehabilitation period.
Materials and methods. We observed 56 individuals (women) with osteoarthritis of the knee joints with reduced bone density, age 43—72 years (average 55.92 ± 1.05 yrs), disease duration 2—18 years (7.76 ± 0.60). All patients were in menopausal period, menopausal duration from 1 to 18 years (6.89 ± 0.64 yrs) had not concomitant pathology that could affect the metabolism of bone tissue. X-ray stage of OA determined according to the classification of J.N. Kell-gren and J.S. Lawrence (I stage — 12 patients, II stage — 38, III stage — 6). In a serum of blood samples were detected indicators of mineral metabolism (total content of calcium and inorganic phosphorus) and markers of bone formation (alkaline phosphatase, parathyroid hormone (PTH)). Indicators of bone mineral density (BMD) were determined by using double-photon X-ray densitometer (Dual Energy X-Ray Absorptiometry — DXA) Lunar corp. company (Madison, WI) — Lunar DPX-A. In 39 patients were diagnosed osteopenia, in 17 — osteoporosis. All patients were at the sanatorium stage of rehabilitation and by the method of randomization were divided into two groups. Treatment com-
BAKALYUK T.G., MYSULA I.R., KVASNITSKA O.S., SALAYDA I.M.
Ternopil State Medical University named after I.Ya. Gorbachevsky, Ternopil, Ukraine
Efficiency of Physiotherapy in Treatment of Severe Pain Syndrome in Elderly Patients with Coxarthrosis
Introduction. Successful treatment and rehabilitation of patients with osteoarthritis remains an important medical, social and economic problem for today. Pain is one of the most burdensome feelings that determines the severity of suffering and changing the quality of patients' life. Therefore, purposeful therapy is a priority in patients with osteoarthritis. In elderly people reducing of life expectancy depends on the intensity of pain more than the presence or absence of threatening the life diseases. Severity of pain does not always correspond to the degree of inflammation and radiological changes in the joints. It was investigated that the effect of acupuncture on bone receptors has a 20 times greater therapeutic effect than the impact on skin receptors, and the electricity is the best stimulus for bone receptors. Therefore, we used the method of osteoperiosteal electrical stimulation to affect the subchondral part of bone.
Aim — to investigate the effectiveness of osteoperiosteal electrical stimulation in elderly patients with coxarthro-sis with chronic pain.
Materials and methods. Under our supervision there were 36 patients (age 64.48 ± 0.71 years) with osteoarthritis of the hip joints II clinical radiological stage, functional insufficiency of joints second stage. Criteria for including:
plexes in two groups includes procedures of spa — treatment and differed by using of balneofactors: in the first group were used hydrogen sulfide baths, a concentration of 80 mg/L for 15 minutes at a temperature of 36—37 °C, at the course of 8 treatments; in the second group — sodium chloride bath concentration of 25 g/L, for 15 minutes at a temperature of 36—37 °C, at the course of 8 treatments.
Results. Indicators of mineral metabolism in patients with OA had not significant changes after treatment and accurate dynamics of these parameters in both groups were not observed. The level of alkaline phosphatase under the influence of sulphide balneotherapy compared with medical complex using sodium chloride baths decreased (from 142.39 ± 2.18 U/l to 124.71 ± 3.60 U/l in group I, group II in 135 57.00 ± 1.79 U/l), PTH levels also had positive dynamics under the influence of hydrogen sulfide baths (with 78.9 ± 3.8 pg/ml to 63.2 ± 2.9 pg/ml and group II in group to 77.9 ± 4.3 pg/ml), which suppose to think about a slowdown of bone remodeling processes under the influence of sulphide balneotherapy.
Conclusion. Treatment complex with the inclusion of hydrogen sulfide baths in patients with osteoarthritis with low bone density has not only analgesic effect but also allows you to impede the bones mass loss and, therefore, can be used not only for the treatment of osteoarthritis with reduced bone density but also for the prevention of osteoar-thritis and osteoporosis.
age of patients over 60 years, the level of pain on a visual analogue scale (VAS) at least 60 mm. Continuous dull night joint pain or constant aching pain round the clock was the main complaint of patients. Periarticular bone structures' pain observed on palpation. Patients were divided into 2 groups: a control group (n = 16) used traditional complex treatment; main group of patients (n = 20) in addition to the standard treatment received osteoperiosteal electrical stimulation (sterile needle supplied to painful on palpation of bone structures; the influence of high-frequency pulse current on periosteal receptors damaged joint was performed through a needle for 20 minutes. Amperage picked focusing on «light» patient's feeling. Treatment course depend on the number of affected joints and consists of 5—8 procedures.
Results. Complex clinical, laboratory and instrumental studies were conducted all patients before treatment and after 10 days. Questionnaire to determine Lequesne index was used, and also determining the speed of walking and range of motion in the joints. After analyzing the research data obtained the following results: indicators of pain on a VAS-scale reduced to 27.5 ± 0.6 in the main group, in the control group to 49.3 ± 0.8. It was also observed an increase in range of motion in the hip joint and speed walk in the main group. Significant changes in these parameters were not observed in the control group.
Conclusion. Studies have shown that exposure to low-frequency pulse current to the subchondral part of bone have pronounced analgesic effect, relieve spasms periarticular structures and enables more accurately rehabilitation.
№ 2 (18), 2015
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