Kade E. A., Eliseeva L. N.
Kuban State Medical University, Department of Faculty Therapy, Krasnodar
The basis of the pathological process in rheumatoid arthritis (RA) is a generalized, immunologically determined inflammation. TES-therapy in the mode of analgesia causes an anti-inflammatory effect, reduces vasospasm and improves the state of microcirculation. It is used in the complex therapy of inflammatory diseases in various body systems. This makes it possible to use TES-therapy in the complex treatment of patients with RA.
Materials and methods.
TES-therapy (7 sessions daily) was used to treat 146 patients with RA with II-III degree of activity, II-III X-ray stage (diagnostic criteria for ARA), the duration of the disease on average about 7 years, with severe pain syndrome, who received metatrexate and non-steroidal anti-inflammatory drugs. facilities. A group of 48 patients with RA with a disease duration of 9 years on average, who received only drug treatment, and a group of 40 relatively healthy individuals of the same age served as controls.
Clinical and laboratory studies were carried out before and after the course of TES-therapy. The levels of IL-1, IL-6, IL-10, α-endorphin, C-reactive protein (C-RP), seromucoid, ESR, the state of the microcirculation system (MC), the severity of pain syndrome, and the level of anxiety were determined.
The study of types of microcirculation showed that the normocirculatory type of MC in healthy people occurs in 72.5% of cases; in RA patients with a disease duration of up to 7 years (Group 1), this type of MC was detected in 38.6%, and over 7 years – in 8% of cases (Group 2, 3). After TES-therapy in patients with RA, a decrease in peripheral spasm at the level of pre- and post-capillaries and an increase in arterial blood flow into the MC channel due to a decrease in peripheral resistance were noted.
The frequency of occurrence of the normocirculatory type of MC increased by almost 4 times (especially in group 2). The normocirculatory type of MC in patients approached that in healthy people, due to the restoration of the main hemodynamic parameters and even their slight increase, which did not go beyond the norm, and a decrease in indicators in the system of compensatory reactions.
In patients of the control group, whose main treatment was drug therapy, after 10 days of standard treatment, there were no significant changes in MC parameters. In patients of the main groups, the severity of pain syndrome and the level of anxiety on the Spielberger scale decreased.
The indicators of ESR, the level of C-RP and seromucoid also decreased by 28%, 36.7% and 29.3%, respectively. The use of TES-therapy made it possible to normalize the initially reduced level of α-endorphins in the blood serum, regardless of the type of microcirculation, gender, and the duration of the course of RA. In the study of the cytokine system of RA patients, an increase in the level of IL-10, IL-6, IL-1β was noted (in comparison with healthy ones).
Under the influence of TES therapy, the level of IL-10 normalized and the level of IL-6 decreased by 52%. There were no significant changes in patients in the control group.
Thus, TES-therapy is most rationally used at any time of RA course in combination with drug treatment for the purpose of analgesia, normalization of MC, indicators of inflammation and correction of the cytokine system.