Purpose of work is to increase the effectiveness of the treatment of gonarthritis (GA) in women with hypertension (HTN) and body mass excess (BME) in the clinical practice of a general practitioner by determining the characteristics of clinical manifestations, the state of intracardiac hemodynamics and myocardial remodeling, indicators of proinflammatory and neurohumoral factors and optimizing the therapy scheme.
Clinical, instrumental, laboratory and statistical methods were used in the research. The study was carried out in two stages. During the first – inpatient stage – all women of the research contingent underwent a standard general clinical examination (which included a physical examination, collection of anamnestic data, their analysis), as well as research using the specified instrumental and laboratory methods. Based on the results of this stage, the program of therapy for women with GA with concomitant HTN and BME was optimized, and the obtained data served as a reference for further evaluation of the effectiveness of the proposed therapeutic interventions. The second – catamnetic stage – included the evaluation of the effectiveness of the application of the optimized therapy program after discharge from the hospital within the ambulatory department and was carried out by analyzing the dynamics of the clinical picture of GA, changes in the pro-oxidant and antioxidant systems, the level of C-RP, changes in the cytokine link and blood lipid spectrum.
The scientific novelty of the obtained results is that for the first time, the role of systemic inflammation in the pathogenesis of GA in patients with HTN and BME was determined, in particular, a direct correlation was established between BMI and the concentration of leptin in the serum of patients, which, in turn, affecting chondrocytes causes their degradation and, thus, causes an increase in the synthesis of IL-1β, IL-6, and TNF-α as mediators of inflammatory and destructive processes in the cartilage tissue of joints in GA. For the first time, the state of intracardiac hemodynamics and remodeling of the myocardium in the formed contingent of patients was determined, in particular, it was proven that HTN and BME are reliably associated with a decrease in the systolic function of the left ventricle, an increase in end-systolic and end-diastolic sizes and volumes, the formation of prognostic unfavorable types of left ventricle remodeling in patients with GA, which is of exceptional importance in the context of treatment and rehabilitation measures. Expanded understanding of the presence of correlational relationships between the clinical manifestations of GA, arthrosonographic data and BMI, in particular, the characteristics of pain syndrome associated with physical exertion, impaired mobility and functionality of the joints were reliably increased with increasing stage of GA, the addition of comorbid pathology and an increase in BMI. The practical significance of the obtained results lies in the fact that the cytokine profile of mononuclear cells in women with GA was determined, depending on the spectrum of accompanying pathology, in particular, it was established that the combination of inflammatory and destructive changes in the joints in HA with an increase in body weight and an increase in blood pressure creates conditions for the development of severe immunological disorders in the body, which allowed to formulate priority directions for pharmacological correction within the framework of an optimized therapy program; the GA therapy program was optimized, which is based on the principles of personalized medicine and includes the selection of a specific variant of pharmacological treatment depending on the spectrum of comorbid pathology, as well as the provision of recommendations for diet therapy and lifestyle modification, which allowed to significantly increase the effectiveness of the treatment of the specified contingent of patients.
