“To develop a technology of preventing of osteoarthrosis formation and progression against the background of inflammatory and dysplastic articular lesions in adolescents”
(research supervisor – Doctor of Medical Sciences, professor I.S. Lebets, 2008−2010 yrs)
Some notions about the significance of heredity in at formation were broadened in consequence of the research work fulfilment. The data which testify to the genetic apparatus instability were obtained as for patients with OA.
Object of study: osteoarthrosis (OA) in children, aged 11–18, which developed against the background of hypermobility syndrome or after getting reactive arthritis.
Objective: improvement of OA prophylaxis in children on the basis of working out programs of treatment-and-prophylactic measures considering development of the disease and its complications.
Methods: clinical, X-ray, ultrasonic investigation of joints, immunological, biochemical, radioimmune, retrospective analysis of case histories, and statistical.
Theoretical and practical results: there were determined some risk criteria in OA formation against the background of articular inflammatory diseases, and prognostically significant signs of its development. There were expanded some notions on hereditary factors in formation of the disease, and instability of genetic apparatus was established as well. With consideration of the above factors there were worked out differentiated treatment-and-prophylactic complexes for OA which included integrated employment of chondroprotectors, anti-inflammatory medicines, nonmedicamentous measures, aiming at correction of metabolism disorders in the cartilage connective tissue structures, inhibiting inflammatory process, and improving microcirculation status. Positive dynamics was registered for 3 years in clinical and paraclinical findings which depended on duration of the treatment and inclination of the pathological process to development. It was revealed that during the first year of treatment there decreased mainly clinical and echosonographic manifestations of the disease, and only moderately some deviations in the metabolism of connective tissue structures, immune homeostasis, and microcirculation. It was proved that a treatment course of three years contributed to a significant improvement of proteoglycane and collagen metabolism, decrease in the activity of collagen and elastin catabolism ferments against the background of certain increase in the activity of their inhibitors. There was also registered normalization of correlations of cells in T-link of immunity, and in IL-1β, IL-6 content.
Total effectiveness of treating adolescents with OA was determined according to the complex estimation of findings in their dynamics. A positive result (absence of acute attacks or development of the process) was registered in 44.6% of the examined adolescents; conventionally satisfactory result (presence of acute attacks but absence of further development of the disease) – in 11.6 %; unsatisfactory result (development of the disease) – in 43.8%.
Novelty: for adolescent patients with OA there were first worked out treatment-and-prophylactic measures with consideration of risk factors of its development; there were defined therapeutic complexes for prevention of OA progress, including medicamentous and nonmedicamentous measures; there were determined certain criteria for estimating effectiveness of OA prophylaxis in adolescents in the presence of different risk factors of development of the disease; there was substantiated a systemic approach to prophylactic measures for preventing formation and development of secondary OA with consideration of prognostic criteria for diagnosis.
Fields of application: out-patient clinics for children and adults, cardiorheumatologic prophylactic centers, therapeutic and cardiorheumatologic departments of in-patient clinics.
