Introduction. Pain is an important problem in current medical practice and a fundamental issue of medical research. More than 75% of population suffers from chronic pain syndrome. One on seven patients who visit out-of-patient departments complains on painful feelings in joints or muscles. Moreover, in 30% of cases the symptoms of rheumatic diseases or the back pain syndrome are present that considerably impacts the quality of life. The aim of the study was to evaluate the effectiveness of the combined therapeutic strategy in the treatment of patients with osteoarthritis and comorbidities. The therapy included: glucosamine sulfatis in forms of solution for IV administration and powder for oral administration; patented form of undenaturated cartilaginous collagen (natural) type II (UC-ІІtm); non-steroidal anti-inflammatory drugs (meloxycam), angiotensin receptor type 2 blockers (valsartan), statins (rosuvastatin). Materials and methods. This prospective study was performed at the Department of Family Medicine and Therapy, Ukrainian Medical Stomatological Academy, and at Regional Rheumatology Centre of Poltava M. Sklifosovsliy Regional Clinical Hospital. 30 in- and out-patients aged 52-67 years having previously diagnosed primary gonarthrosis of X-ray stages ІІ–ІІІ by the Kellgren and Lawrence classification and any of the comorbid conditions (arterial hypertension, coronary arteries disease, chronic back pain syndrome, NSAIDS-induced gastropathy) were enrolled to the study, which lasted for 12 months. Results. Analyzing the effectiveness of the combined therapy for the patients with diagnosed osteoarthritis and concomitant conditions during the 12-month period of the study, we have found better results in the patients, who received chondroprotectors parenterally and orally. Significant clinical effect presumably caused by chondroprotectors in mixed forms among the patients with osteoarthritis and comorbid pathology was proved by the improvement in the following clinical parameters as the Leken index and WOMAC. In 6 months of the therapy, we achieved a significant decrease in the total functional Leken index (10.88 ± 2.07), p<0.0001 in the patients of the main group who received chondroprotectors in a mixed form compared to the control group (12.68 ± 2.08, p<0.0001). A significant decrease in the Leken index in the main group was also observed in 12 months since the theraoy started (p<0.0001), indicating the presence of long-term effects. We also observed the reducing in pain severity at rest and on movement, decline in the level of daily activities restrictions according to WOMAC questionnaire filled in 6 months since the therapy began. The findings supporting positive therapeutic effects fwere found in both groups, but in the main group they were more significant. The total WOMAC questionnaire score in 6 month treatment period was 676.08 ± 215.63 in the main group that was significantly lower compared to the control group (858.46 ± 167.64, p <0.0001). This clinical indicator was also significantly lower in the main group (564.82 ± 187.34) compared to the control group (797.12 ± 218.10, p <0.0001) in 12 month period.
Rheumatoid arthritis is a widespread disease in general population, which can progress to the permanent disability as in a short-time as in long-time periods. It was considered that estimated changes of the joints' morphology in patients suffering on rheumatoid arthritis may depend on the basic treatment received and, eventually, on the control over rheumatoid arthritis progression achieved. The aim of our work is to study the accuracy of using elastometry method in evaluating the severity of knee joints' synovitis in patients with rheumatoid arthritis and its dependence on received basic treatment and achieved control over rheumatoid arthritis progression. By using a correlation analysis, we found a close relationship between the stiffness of the synovial membrane of the knee joints and the level of C-reactive protein (r = 0.63, p = 0.022), as well as with the level of erythrocyte sedimentation rate (r = 0.66, p = 0.019) in all groups of patients at the time of inclusion to the study. This relationship was present even after 6 months of therapy (r = 0.61, p = 0.043) and (r = 0.59, p = 0.023), respectively. Performed correlation analysis also showed the dependence of the morning joints' stiffness severity with the synovial membrane stiffness indicators (r = 0.57, p = 0.018), with the severity of pain in the knee joints (calculated by using The Visual Analogue Scale) and with the severity of knee joint synovial membrane stiffness (r = 0.56, p = 0,024) at the time of inclusion. So, it was considered a presence of relationship between synovial stiffness and clinical manifestations of rheumatoid arthritis. This relationship was present even after 6 months of therapy (r = 0.57, p = 0.038) and (r = 0.63, p = 0.024), respectively. The obtained results clearly demonstrate the accuracy of evaluating the knee joints' synovial stiffness by using elastometric indicators in assessing the effectiveness of received basic treatment in patients with rheumatoid arthritis.
Rheumatoid arthritis is known as a highly prevalent disease worldwide, often resulting in stable loss of capacity for work or complete disability over short period from the onset. Detected changes in the joint morphology may depend on the basic treatment received as well as depend on the level of control over the disease progression. The aim of this work is to study the diagnostic potential of Doppler ultrasound technique and Dopplerography in assessing the severity of changes in the knee joints depending on the received basic treatment and the level of control over disease in patients with rheumatoid arthritis. Correlation analysis carried out to compare the severity of bone erosions' indicators and the level of C-reactive protein has revealed no significant correlations. At the same time, there has been found a strong correlation between the level of C-reactive protein values and the blood circulation rate in the arteries of the pannus in all studied groups at the beginning of treatment and in 6 months of the therapy (r≥0.65, p≤0.03). The obtained results clearly demonstrate the effectiveness of the ultrasound diagnostics, especially Doppler indicators, in assessing the effectiveness of the basic treatment for patients with rheumatoid arthritis.
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