The effectiveness of combined use gastroprotektors and local periarticular therapy with simultaneous reduction of NSAIDs dosage to prevent drug-induced gastroduodenal lesions in patients with osteoarthritis

Резюме. Метою дослідження було встановити ефективність схеми лікування остеоартроза з включенням локальної навколосуглобової терапії та препарату з гастропротективними властивостями (пантопразол) на фоні застосування нестероїдних протизапальних препаратів (НПЗП). Наведені дані власних досліджень по ураженню гастродуоденальної зони НПЗП у хворих на остеоартроз. Запропонована та доведена ефективність схеми лікування з застосуванням пантопразолу та навколосуглобової терапії з одночасним зменшенням дози НПЗП.; Резюме. Целью исследования было установить эффективность схемы лечения остеоартроза с включением локальной околосуставной терапии и препарата с гастропротективними свойствами (пантопразол) на фоне применения нестероидных противовоспалительных препаратов (НПВП). Приведены данные собственных исследований по повреждению гастродуоденальной зоны НПВП у больных остеоартрозом. Предложена и доказана эффективность схемы лечения с применением пантопразола и околосуставной терапии с одновременным уменьшением дозы НПВП.; Summary. NSAIDs remain the main means for the treatment of pain in patients with OA. Appointment of NSAID is always threatens to damage the gastrointestinal tract, development of gastropathy. In our previous research of frequency and nature of the occurrence of gastroduodenal lesions under the influence of NSAIDs were examined 109 patients with OA. As evidence of risk lesions of the mucous membranes in the treatment of the underlying disease during EFGDS found 58 (53. 21 %) gastroduodenal defects. The aim of this study was to establish the effectiveness of treatment of osteoarthritis using the local periarticular therapy combined with the use of medicinal product with gastroprotective properties (pantoprozol) against the background of NSAIDs therapy. We observed 44 patients with osteoarthritis, age of the patients was 31-65 years, mostly it were women (72.2 %). Clinical and functional examination performed by interviewing, physical examination, assessment the quality of life of patients with OA using Stanford assessment Health Protection Profiles The Health Assessment Questionnaire (HAQ), severity of pain at rest and during movement by visual analogue scale (VAS, mm), counting the number of painful and deformed joints, Ritchie index, X-ray examination was performed. In order to study the state of gastroduodenal zone EFGDS performed in all patients before and after a course of treatment after three weeks. Patients were divided into 2 groups: the first (control) group consisted of 21 people, they received drug of choice NSAID – Nimesulide 100 mg 2 times per day. The second (experimental) group (23 patients), combined treatment with overlapping lotions with 50 % dimethyl sulfoxide (Dimexidum) on the affected joints, replacing evening reception NSAIDs. At 1 ml dimexide added 25 mg diclofenac sodium, 250 IU of heparin, 8 mg Nospanum, 0.5 g prodektynu (Patent of Ukraine № 41781 from 17.09.2001, the method of treating patients with osteoarthritis / Tkachenko T. I. Katerenchuk I. P. (Ukraine) № 2001042469). In order to protect the gastroduodenal zone used pantoprazole 20 mg in the morning. Results of these studies showed that both regimens provide a positive clinical effect. Dynamics of articular syndrome shows that after treatment was significantly reduced performance of Li test, Stanford Form (primary and secondary scales). Local periarticular therapy with simultaneous reduction of oral NSAIDs are an effective method which prevents the medicamentous damage of gastroduodenal mucosa. Combined application of pantoprazole as gastroprotector prevents negative effects of NSAIDs on gastroduodenal zone that proves high therapeutic effect in the experimental group