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DOI: http://dx.doi.org/10.20534/ESR-16-11.12-38-40
Saodat Ubayevna Asilova, TMA Department of Traumatology and Orthopedics and MFS with NS UzRITO Department of Orthopedics E-mail: [email protected] Abror Mirkhakimovich Azizov, E-mail: [email protected]
Evaluation of clinical signs of rheumatoid coxitis according to the desease stage
Abstract: The article explains the clinical evaluation of rheumatoid coxitis by its stage. Clinical assessments were conducted depending on several aspects. 85 patients were surgically treated in 2 partner clinical bases. After the calculating the clinical symptoms of rheumatoid coxitis we came to conclusion that this desease has 4 stages. But only patients in III and IV stage needed surgical treatment, i. e. — total hip replacement. On third month after surgery and physical rehabilitation the analysis of dynamic motion of 83 hip joints showed significant improvement of movement amplitude. 2 were with poor results.
Keywords: rheumatoid coxitis, hip joint, hip replacement, coxitis stages.
Affection ofhip joint ofpatients with rheumatoid arthritis occurs rarely compared with other joints. After a few years the involvement of the joint into pathological process occurs. Both of hip joints are not involved into the process simultaneously, oftenly a single-joint start, i. e. gradual affection of joints is observed. Therefore, one patient has different degrees of severity of clinical signs in the proccess.
We observed 85 patients with rheumatoid coxitis in III and IV stage, which were surveyed from 2010 to 2016 in the Department of Orthopedics of UzRITO and in the Department of Traumatology and Orthopedicsof RCH № 1.
Clinically, all patients with rheumatoid coxitis had constant pain, which intensified during the night. Pain also intensified at the
walking, standing and slightly decreased at a rest 31 (36.47%) of patients had pain in the groin. Pain in rear side of pelvis troubled 36 (42.35%) patients and 19 (22.35%) patients had pain in the lateral part of femur. Another sign of rheumatoid coxitis was limiting of flexion in the hip joint at stage III up to 50-65 0 and extension up to 15 0. At stage IV the flexion of the hip joint was less than 50 0 and the extension less than 15 0 (Table 1).
Abduction and adduction of the hip joint at stage III were up to 50; at stage IV were respectively 0. Quadriceps muscle force was greater at stage III than at stage IV and reached 40% vs. 30%. Force of hip biceps muscle at stage IV was less than 25%.
Table 1. - Clinical signs depending on the stage of the disease
The signs Norm 0 Stage 1 Stage 2 Stage 3 Stage 4
1. Pain No pain Pain under a load Pain at a rest Pain under a load and at a rest Constant pain
2. Flexion in the hip joint >1000 85-95° 70-80° 50-65° <50 °
3. Deficiency of extension in the hip joint No deficiency 5 ° 10 ° 15 ° >15 °
4. Abduction in the hip joint >15° 15° 10 ° 5 ° 0 °
5. Adduction in the hip joint >15° 15° 10 ° 5 ° 0 °
6. Force of quadriceps muscle of hip >70% 60% 50% 40% <30%
7. Force of hip biceps (% of quadriceps muscle) >60% 50% 40% 30% <25%
8. Rising from «semi-erect» position, sm >25 15-24 10-24 5-9 <5
9. Rising/sitting down 35 sm (sofa) 40 sm (seat of car) 45 sm (simplechair) 50 sm >55 sm
10. Speed of walking (m/s) >1,4 1,0-1,3 0,7-0,9 0,5-0,6 <0,5
11. Activity in everyday life There are no limiting Patient can perform all type of motions in sitting position Patient needs additional devices to help put on shoes; can't do pedicure Patient needs someone's assistance to put on shoes and socks Assistance in everything
Rising from «semi-erect» position and rising/sitting down at stage III reached 5-9 cm and 50 cm respectively, and at stage IV <50 and> 55 cm. Speed of walking at stage III was 0.5-0.6 m/s, at stage IV was <0.5 m/s. Patients' activity in everyday life at stage III was limited and
they needed someone's assistance at putting on socks and shoes. Patients at stage IV of rheumatoid coxitis needed constant care of relatives.
Patients with rheumatoid coxitis, especially with bilateral form become severe invalids. Their activity at walking reduces, self-service
Evaluation of clinical signs of rheumatoid coxitis according to the desease stage
becomes more difficult, and they need in assistance of others, because they can't service themselves.
There are examples from practice. The patient S.D of 55 years old, admitted into the Department ofOrthopedics ofUzRITO with diagnosis: Juvenile rheumatoid arthritis, articular type, slow-progressive course, medium activity, stage III, JFI-3, left femoral head aseptic necrosis, secondary protrusional coxarthritis III.
Complaints on the admission: stiffness in all joints, pain in the right hip joint. Motions in the right hip joint are painful and limited.
Flexion in the hip joint is 50', extension is 15°. Abduction and adduction are 5°. The patient walks with crutches, needs assistance of others. Atrophy of femoral muscles is observed, shortening of healthy inferior limb by 5 cm owing to pelvis disalignment.
Evaluation of the functional state of the hip joint by our 12 scoring method reached 6 points before surgery. Sign of left hip joint space narrowing is visible on radiographs, lateraloproximal segment of the head is destructed, high-grade osteoporosis revealed. Left hip replacement was performed in 2015 with the cemented endoprosthesis.
After 12 months from the surgery the patient walks without assistance, motions in right hip joint are in full. Flexion in the hip joint is 90°, extension is 180°, abduction and adduction are 15°, all movements are painless. Long distance walks do not require additional support.
Evaluation of functional state ofhip j oint after surgery was 10 points. Evaluation of functional state of hip joint is qualified as good. This patient is to have the left hip replacement for full satisfaction oftreatment.
Thus rheumatoid coxitis depending on clinical signs has four stages, and also characteristics of pain, limiting of flexion, exten-
sion, abduction and adduction, reduction of hip muscles force with changes of rising from "semi-erect" position and rising/sitting down, walking speed and decreasing of daily life activity.
Conclusions:
1. Clinical symptoms of rheumatoid coxitis have 4 stages.
2. Severity of clinical signs depends from stage of disease.
3. Rheumatoid coxitis of stage III and IV leads to profound disability and becomes an indication to the replacement of the hip.
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DOI: http://dx.doi.org/10.20534/ESR-16-11.12-40-43
Ashirmatova Hatira Seidrahimovna, Senior researcher, Department o f eye diseases, Tashkent Medical Academy, E-mail: [email protected] Karimova Muyassar Hamitovna, Tashkent Medical Academy, Department of eye diseases, Professor, Doctor of Medical Sciences, E-mail: [email protected] Boboev Kadirjon Tuhtabaevich, Head of Medical Genetics Laboratory, Institute of Heamatology and Blood Transfusion, Doctor of Medical Sciences, E-mail: [email protected]
Genetic polymorphism of coagulation factors in patients with retinal vein thrombosis
Abstract: The frequency of genetic polymorphism of coagulation factors in patients with retinal vein thrombosis was investigated.) The study revealed the prevalence of homozygous genotype "T677T MTHFR gene" in the main group of patients and higher rate of incidence in men than in women.
Keywords: genetic polymorphism, allele, genotype, retinal vein thrombosis.
