Миофасциальный болевой синдром (МФБС) -одна из наиболее частых причин обращения к врачам первично-го звена и специалистам клиник боли. Большинство людей на протяжении жизни испытывают боль в мышцах после травмы, чрезмерной нагрузки или растяжения. Такая боль обычно хорошо купируется в течение нескольких дней или недель независимо от применяемого лечения. В некоторых случаях мышечная боль сохраняется длительное время пос-ле разрешения травмы и распространяется на другие облас-ти. Этому способствует сенсибилизация, которая возникает на фоне хронического болевого расстройства, при этом боль сама по себе становится заболеванием и требует специ-ального медицинского вмешательства [1].П а т о г е н е з В середине прошлого века сразу несколько исследова-телей -Гетстейн в Германии, Келли в Австралии, Келлгрен в Великобритании -независимо друг от друга выдвинули гипотезу о важности мышечного компонента в развитии бо-левых синдромов различной локализации. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, neuropsychiatry, psychosomatics. 2017;9 (2):95-101.
Surgical treatment as accelerated functional recovery for discogenic radiculopathy has been proven to have advantages over medical treatment, the efficiency of which remains debatable. Objective: to investigate the efficiency of combination conservative treatment in patients with discogenic lumbosacral radiculopathy. Patients and methods. Thirty patients (12 men and 18 women; mean age, 39.5±2.2 years) with discogenic lumbosacral radiculopathy confirmed by magnetic resonance imaging were followed up. All the patients underwent combination conservative treatment (epidural glucocorticoid administration, analgesic therapy, and motor mode correction). They were surveyed using questionnaires (numeric pain rating scale (NPRS), Oswestry disability index, Hospital Anxiety and Depression Scale, the 12-Item Short Form (SF-12) of Quality of Life (QoL) Questionnaire on admission to the clinic, at 7-14 days after treatment (pain intensity and functional status), and in the long-term period (at 3, 6 and 12 months) after discharge. At baseline, the patients were severely disabled due to pain syndrome. The average Oswestry index was 57.9±3.7%, the back and leg pain intensity scores were 6.5±0.6 and 6.9±0.5, respectively, as evidenced by NPRC. The majority of patients were found to have the combined musculoskeletal sources of pain, such as a myofascial component in 56.7% and sacroiliac joint dysfunction in 43.3%. In these cases, nonsteroidal antiinflammatory drugs and muscle relaxants were additionally used. Results. The conservative treatment resulted in a statistically significant clinical improvement with a preserved positive effect in the long term: at 1 year, the average Oswestry index was equal to 16.6±3.9%, the back and leg pain intensity scores were 1.7±0.5 and 1.6±0.5, respectively, as shown by NPRC (p<0.001 vs baseline). Within a year, only one female patient required surgical treatment; regression of large extrusions and sequesters, the average initial size of which reached 11.1 mm, was observed in 9 cases. Conclusion. The findings reflect the efficiency of conservative treatment and the expediency of detecting mixed musculoskeletal disorders and their correction in discogenic radiculopathy.
Background Disregulated apoptosis of T lymphocytes was postulated as one of the potential patomechanisms of rheumatoid arthritis. In peripheral blood of RA patients atypical clones of T cells were identified, overexpressing Bcl-2 protein and apoptosis resistant. Experimental treatment inducing apoptosis of joint infiltrating T cells and synovial fibroblasts resulted in disease remission in animal models. Objectives The objective of the study was to examine the expression of apoptosis regulatory proteins (p53, Bcl-2, Bax and Fas) in peripheral blood and synovial fluid lymphocytes as well as sFas concentrations in patients with RA and to compare it with expression in other arthritides. We analized the correlation with disease clinical characteristics and treatment. The other aim was to determine the relation of those markers expression in blood and synovial fluid lymphocytes from the same patients. Methods Study covered 77 RA patients, 18 OA patients 10 patients with other arthritides and healthy control group. Immunocytochemical analysis was performed with indirect immunoperoxidase test. sFas concentration was measured with ELISA test.Results In RA patients with advanced joint destruction and active disease high overexpression of Bcl-2 was found (over 80%of cells) which correlated to ESR (r = 0.63, p = 0.027). Bcl-2 expression was significantly higher in RA patients with limited disease than in pts with extra articular disease (p = 0.02) No significant difference in other apoptosis markers expression among examined groups was found. We did not observe its relation to disease duration, RF seropositivity, clinical stage or treatment. Serum sFas concentration was significantly higher in extra articular RA (p = 0.009). Conclusion The above results may indirectly suggest the role of lymphocyte apoptosis defect in RA pathogenesis, which demands further investigation.
Неспецифическая люмбалгия часто вызвана дисфункцией крестцово-подвздошного сочленения (КПС), при ее лечении обсуждается эффективность лечебных блокад с анестетиками и глюкокортикоидами (ГК), радиочастотной денервации (РЧД) КПС. Цель исследования-изучение эффективности и безопасности лечебных блокад с анестетиками и ГК, РЧД КПС в комплексной терапии хронической люмбалгии вследствие поражения КПС.
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