Chronic benign polyarthritis, treatment
The disease is characterized by a lack of pronounced inflammatory changes and proceeds more with functional disorders than with anatomical changes in the joints. The process develops gradually. In the initial stages, fatigue of the joints, awkward movements, convulsive twitching of the muscles( especially at night), numbness of the limb are noted. Characteristic is the appearance of a mildly expressed morning stiffness, which is removed by a warm-up, then pains appear that are initially temporary, and only in later stages of the process - permanent, aching, bursting in the most affected joints and muscles. Appears stiffness of the joints, a rough crunch in them. Patients often react with painful sensations to weather change, changes in barometric pressure and humidity of the environment. As a rule, the process is not accompanied by an increase in body temperature, acceleration of the ROE and biochemical shifts in the blood. Deterioration of the general condition is usually due to prolonged pain. Sometimes there are secondary inflammatory changes in the joints with small effusions in them.
Since the etiology of dystrophic joint diseases is not clear, their treatment remains pathogenetic, aimed at restoring the impaired functions of a number of systems and locally on the affected joints. When starting treatment, it is always necessary to find out the moments that contribute to the disease, and, if possible, to eliminate them;it is necessary to reduce the static and physical stress on the affected joint, eliminate the adverse effects of the external environment( cooling, high humidity, etc.).
Since the emergence of dystrophic processes is associated with the disorder of the nervous system, its trophic function, with the violation of metabolic processes and endocrine regulation, it is advisable to take actions aimed at restoring these functions, and also aimed at improving blood and lymph circulation, trophic tissue of the affected joints. For this purpose, physical factors are widely used, with deformed osteoarthritis predominantly preformed, with chronic benign professional polyarthritis - mainly balneotherapy.
In severe pain, aspirin, pyramidone, rheopyrin, butadione is used, and if the pain is very severe( mainly with arthrosis), cortisone and its derivatives or intra-articular hydrocortisone( 75-100 mg several times depending on the effect);necessarily appoint at the same time and vitamins( C, B6, B12).In combination with medicines, irradiation of the area of the joints with ultraviolet or x-ray rays is used in order to improve blood circulation and analgesic effect.
X-ray irradiation is carried out at a source-skin distance of 30 cm, a field value of 10x15 cm, a voltage of 160-180 kV, a filter of 0.5 mm of copper + 1 mm of aluminum, a dose of 100-150 r, with intervals of 4-5 days before the totaldoses of 300-450 p. X-ray therapy is indicated by a patient with arthrosis with a pronounced pain syndrome, and also with calcified bursitis and heel spurs.
In the early stage of the disease( stage I of arthrosis) and in later stages with chronic benign polyarthritis, electrophoresis of calcium, iodine, sulfur is effective. In dystrophic lesions of joints, Novocain electrophoresis is shown that favorably influences the trophic processes, and also acts analgesically and normalizes the basic nervous processes in the cerebral cortex.
Electrophoresis of various drugs is especially indicated for elderly patients with the presence of concomitant diseases( atherosclerosis, hypertension, etc.), which are more contraindicated in more active methods of physical therapy.
When 1-2 joints are affected, electrophoresis is performed locally on the area of the affected joints, and for chronic benign professional polyarthritis( with multiple joint damage), it is carried out according to the general procedure for Vermel.
For electrophoresis of sulfur, use a 2-5% solution of hyposulfite, which is moistened with a pad of a negative electrode.
In dystrophic polyarthritis and deforming arthrosis of stages I and II, as well as in combination of these diseases with calcified bursitis, deforming spondylosis and heel spurs, microwave therapy is shown in a low thermal dosage.
The method of ultrasound therapy is one of the effective methods of conservative therapy of dystrophic joint diseases and, first of all, deforming osteoarthritis. Justification for the application of ultrasound to this group of patients is its positive effect on the trophic function of the nervous system, the activation of metabolic processes, increased circulation and lymph flow, stimulation and reactivation of the connective tissue system, analgesic, antispastic action.
The best effect of ultrasound therapy was noted in patients with primary deforming osteoarthritis, especially knee and ankle joints, as well as in patients with posttraumatic osteoarthritis. These patients under the influence of ultrasound therapy improved general condition, sleep, appetite, pain completely disappeared, stiffness decreased, mobility increased in affected joints. Significantly less effective is ultrasound therapy in patients with secondary deforming osteoarthritis arising from the Perthes disease, or in those suffering from a chronic form of infectious nonspecific polyarthritis;in these patients, ultrasound can be used only in complex therapy. There are indications of a resolving effect of ultrasound with calcified bursitis. Ultrasonic therapy is effective even with heel spurs.
Ultrasound is applied topically to the area of the affected joint, as well as paravertebrally to the region of the corresponding segments by a labile technique;intensity when exposed to the area of the joints 0.2-0.6 W / cm2, paravertebrally - 0.2-0.4 W / cm2;the duration of exposure to the affected joint is 3-6 minutes, paravertebral 2-3 minutes. The procedures are carried out every other day;on the course of treatment 10-15 procedures. When the small joints of the hands and feet are damaged, ultrasound treatment is carried out through the water in a faience bath.
With initial forms of deforming osteoarthritis I and I-II stage for improving local blood and lymph circulation, trophic tissues use inductothermy on the area affected by joints with an electrode-cable or a disk electrode.
Improves blood circulation and tissue trophism and acts as an analgesic electric field for UHF, and therefore it is used for deforming osteoarthritis of stages I-II.In the treatment of degenerative joint diseases, the pulsed electric field of UHF has spread.
For the treatment of patients with far-reaching deforming arthrosis, a complex treatment method has been developed that includes a pulsed electric field of UHF on the area of affected joints( 10-15 minutes per day, 12-14 procedures in total), curative gymnastics, massage, cuff traction and intraarticular injections of hydrocortisonein an amount up to 50 mg with an interval of 2-4 days( from 2 to 6 injections per course of treatment).
For deforming osteoarthritis and dystrophic benign polyarthritis, mineral waters are widely used both in resorts and artificially prepared in an out-of-court environment. The medical complex also includes sea bathing, aerogeliotherapy, climatotherapy. Mud treatment is used less widely;it is most effective when the process is localized in several small or single large joints and when inflammatory processes attach to degenerative processes, that is, with arthrosis-arthritis.
In the first stage of deforming osteoarthritis and initial manifestations of benign professional polyarthritis, all the aforementioned mineral waters have a pronounced therapeutic effect, but in the appointment it is necessary to take into account some specificity of their action;Thus, hydrogen sulfide waters are contraindicated in concomitant inflammatory processes in the liver and gall bladder, radon can enhance the spasm of the coronary vessels, high concentrations of bath salts slow the induction of lipolytic enzymes, which is especially important when used in people with impaired lipoid metabolism, particularly in patients with atherosclerosis.
In the second and third stages of deforming osteoarthritis and professional polyarthritis of a long time ago, accompanied by trophic disorders, muscle thinning, as well as in the presence of concomitant hypothyroidism in the thyroid gland, violations of fat metabolism, decreased ovarian-menstrual function, skin diseases( psoriasis, scaly lichen,eczema), obliterating atherosclerosis of the vessels of the extremities in the absence of ulcers and disorders of cerebral and coronary circulation, with occupational polyarthritis due to intoxicum(mercury, lead), hydrogen sulphide baths with a concentration of hydrogen sulphide of 50, 100, 150 mg / l of temperature of 36-37 ° are more effective.
MN Syroechkovsky developed a method of "stepwise" increase in the concentration of hydrogen sulfide - 50-75-100-150 mg / l during the course of treatment, depending on the tolerance( 14-15 baths per course).
In Sochi, I.T. Karaseva, V.P. Lysov, L. A. Petina also use baths according to this method, but at higher concentrations of hydrogen sulphide - from 100-150 to 400 mg / l. It is noted that such a technique for the use of hydrogen sulphide baths is more effective than the use of baths of one constant concentration of hydrogen sulphide.
In non-infectious polyarthritis accompanied by severe algic syndrome, common fibromyositis occurring in the background of hyperthyroidism, climacteric disorders( ovarian dysfunction), diseases of the cardiovascular and nervous systems, resorts with radon waters and artificially prepared radon baths with a radon concentration of 100-200units Mahe, temperature 36-37 °, duration of 10-12 minutes, for treatment course up to 15 baths.
For patients of advanced age, in which the process often takes place against a background of various diseases of the cardiovascular system( atherosclerosis, hypertension, etc.), in violation of metabolic processes and endocrine dysfunctions, treatment in resorts with iodine-bromine chloride sodium waters and artificialiodine-bromine baths of low salinity( 10-15 g / l).
With deforming osteoarthritis and professional benign polyarthritis occurring with secondary inflammatory processes of joints and periarticular tissues, mud therapy can be applied in balneo-mud resorts or in extra-resort conditions. Therapeutic mud is also used with concomitant lesions of the digestive system against the background of dietary nutrition and with simultaneous drinking of mineral waters, as well as with accompanying inflammatory processes. Mud applications are applied to the area of affected joints and the corresponding segments of the spinal cord( "collar", "panty" zones, etc.), temperatures 40-44 °, lasting 15-20 minutes, every other day;on the course of treatment 12-14 procedures. To apply the affected area of the joints, wax or ozocerite applications are also used.
For patients with dystrophic joint diseases, treatment in climatic health resorts using solar and air baths is effective. Sun baths are used in the warm period of the year in the morning hours, starting from 5 and up to 20 calories, air - at EET not lower than 19 ° with a gradual increase in their duration from 5 to 20 minutes. At seaside resorts, these procedures are combined with sea bathing, which is possible at a water temperature of at least 20-22 °, lasting from 2-3 to 10-12 minutes. People with a trained cardiovascular system can be allowed to swim along the shore with frequent rest.
The important components in the treatment of degenerative-dystrophic polyarthritis are therapeutic exercises and massage. It should only be noted that in dystrophic joint diseases, active forms of gymnastics are most acceptable, less passive, especially in the initial stages, when there is still no restriction of movements. Widespread use of exercises with projectiles at maximum amplitude of movements;Self-massage is shown to reduce soreness in the joints.
With progressive process and restriction of movements, active corrective exercises are used with the use of devices for mechanotherapy, sports games, muscle massage of the area of the affected joints. To increase the volume of movements consistently appoint thermal procedures, active exercises, massage.
Compulsory treatment of patients with dystrophic lesions of joints is compliance with the correct regime. During the intensification of pain( which are more frequent with arthrosis) for several days, appoint bed rest. Out of attacks of pain with arthrosis, it is necessary to protect the joint from excessive load. For arthrosis of the hip and knee joints, the patient should not walk too much, should avoid prolonged standing and should not wear weights. Patients with arthrosis of the hip joint are useful in cycling.
Static abnormalities( flat feet) should be corrected by wearing insteps or special shoes.
The patient's diet should be rich in vitamins;if the fat metabolism is disturbed, the calorie of food is limited and days of unloading are included.
Patients with dystrophic lesions of joints must strictly observe the mode of work and life.