Smolina: Early Knee Osteoarthritis: Assessment of the Severity in Age-Sex Groups of Patients at Stages of Clinical Monitoring. Stage I: Characteristics of Differentiation Therapy Groups



Problem statement and analysis of the recent research

Knee osteoarthritis (OA) is a common disease. Its pathogenetic basis is a violation of connective tissue metabolism with primary clinical manifestation of a process manifested in articular cartilage degradation [1, 6, 8]. The process is characterized by a prolonged period of multifactor impact of a number of endogenous and exogenous factors including factors of dysembryonal influence forming a special clinical picture at the time of clinical manifestation: joints stiffness and pain during the locomotor exertion and at rest, violation of joint motion activity scope, and others [2]. A number of current researches cover the issues of prevention, diagnosis and pathogenetically substantiation therapy and clinical monitoring (CM) of patients at different levels of medical care [2]. The assessment of algo-functional activity and quality of life are also studied in modern researches [4, 11]. Modern ideas about aetiopathogenesis, clinical picture, prognosis and risk assessment of gonarthrosis are based on the studied dataon clinical and instrumental manifestations of the disease which can develop even in adolescents with changes in connective tissue metabolism, immune disorders depending on the sex [5].

The choice of differentiation therapy means taking into account age and sex and clinical features of OA in case of different its severity remains an unsolved issue.

The objective of the research involved the clinical assessment of the knee OA severity in patients depending on the age and sex as a prerequisite for further differentiation and evaluation of treatment effectiveness.

Materials and methods

146 patients (n = 146) with knee osteoarthritis (OA) at the early (I-II) stages of the disease including 88 - female (nf) and 58 (nm) male individuals were engaged into the stages of clinical monitoring (CM). Treatment of patients involved the use of two therapeutic programs (TP). Namely, standard therapeutic program (TPst) was based on the remedial measures in accordance with the clinical protocol [3] and was applied among 46 women (0nf) and 32 men (0nm). Advanced therapeutic program (TPa) was different from TPst in the application of differential treatment using autologous platelet rich plasma (APRP) at CM stages [9, 10]. TPa was applied in 42 female (anf) and 26 male (anm). Dynamic evaluation of clinical examination technics (including standardized questionnaire “WOMAC”) was performed at CM stages every 6 months. Before the treatment, verification of OA stage and severity of the inflammatory process was performed according to the data of radiological methods (CT, radiography) and paraclinical methods (C-reactive protein).

Results and Discussion

The patients of CM groups included 88 females of different age and 58 males. Taking into account possible age and sex and clinical differences in patients, their stratification was performed considering substantiation therapy groups.

Thus, the most significant component reducing algo-functional activity (AFA) among 22 women under 35 years was the severity of pain syndrome constituting 52.9 ± 2.9 points. Manifestations of stiffness in the knee joints were ranked the second by the influence on the reduction of daily activity and constituted 42.5±1.5 points. Personal and social performance restriction was ranked the third constituting 36.8±0.9 points. It should be noted that forming the groups of differentiation therapy (DT) of OA, the first component, namely the pain syndrome was expressed more significantly (p<0.001) among 13 women who were prescribed TPa. Disease manifestations restricted personal and social performance in these patients (34.3±1.0 points and 38.6±0.9 points, respectively, р<0.05) to a greater extent (Table 1). In general, generalized index (W) of the disease impact on the patients’ functioning depending on their distribution according to TP was significantly higher among patients who underwent advance therapeutic approach.

The most significant component reducing AFA among 14 men at the age up to 35 was also pain syndrome constituting 46.8±3.7 points. Manifestations of stiffness in the knee joints were ranked the second by the influence on the reduction of daily activity and constituted 42.8±2.2 points. Personal and social performance restriction was ranked the third constituting 37.7±1.0 points. It should be noted that forming the groups of OA DT, the first component, namely the pain syndrome was expressed more significantly (p<0.001) among 14 men who were prescribed TPa (67.5±3.6 points and 42.5±2.5 points respectively, р<0.001), while disease manifestations limited personal and social functioning of patients to a lesser extent in comparison with women of the same age (Table 1). In general, generalized index (W) of the disease impact on the functioning of the male patients under 35 depending on their distribution according to TP did not significantly differ from the according group of patients who underwent advance therapeutic approach.

Table 1

Component assessment of disease severity in patients with knee osteoarthritis depending on the age and sex (before the treatment)

Age-sex distribution of patients Results of WOMAC approach use
Clinical judgement components, Intensity in points W, points
pain stiffness activity
Women
nf=88
<35 years 52.9±2.9 42.5±1.5 36.8±0.9 40.9±0.9
0nf=9 42.8±3.3 44.4±2.3 34.3±1.0 36.9±0.9
anf=13 60.0±3.5 46.1±2.3 38.6±0.9 43.7±0.9
35-40 years 53.7±2.4 45.4±1.9 37.3±0.6 41.4±0.7
0nf=10 43.0±3.3 46.2±3.9 35.1±0.9 37.6±0.6
anf=17 60.0±2.4 44.8±2.2 38.7±0.7 43.7±0.5
> 40 years 57.3±1.9 45.5±1.7 37.8±0.6 42.5±0.6
0nf=27 57.2±2.6 а 45.8±2.2 37.2±0.7 42.1±0.8
anf=12 57.5±3.0 44.8±3.0 39.3±1.2 43.6±0.9
Men
nm=58
<35 years 46.8±3.7 42.8±2.2 37.7±1.0 39.9±0.7
0nm=12 42.5±2.5 42.7±2.5 38.7±0.8 39.8±0.8
anm=2 67.5±3.6 43.7±8.8 31.6±1.0 40.6±1.5
35-40 years 57.2±2.8 а 43.1±2.2 37.7±0.8 42.2±0.8 а
0nm =14 57.9±3.8 42.9±2.6 36.2±0.8 41.3±0.9
anm=6 55.0±2.4 43.8±4.7 41.2±1.2 44.3±1.1
> 40 years 57.5±2.2 а 48.4±3.1 38.91±0.9 43.6±0.8 а
0nm =6 50.8±4.1 43.7±4.7 34.7±0.8 38.4±0.9
anm =18 59.7±2.7 50.0±4.3 40.5±0.7 45.3±0.6
Total sex
n=146
women 55.1±1.4 45.5±1.0 36.3±0.4 40.9±0.4
men 54.8±1.5 45.3±1.5 38.2±0.4 42.3±0.5

Note.

a – significant difference of the index depending on the age, at р<0.05;

b – significant difference of the index depending on the sex, at р<0.05;

W – generalized index of osteoarthritis severity.

In a group of 27 women at the age of 35-40 the most significant component reducing algo-functional activity (AFA) was also the severity of pain syndrome constituting 53.7±2.4points. Manifestations of stiffness in the knee joints were ranked the second by the influence on the reduction of daily activity and constituted 45.4±1.9 points. Personal and social performance restriction was ranked the third constituting 37.3±0.6 points. Forming the groups of OA DT, the first component, namely the pain syndrome was expressed more significantly (p<0.001) among 17 women who were prescribed TPa (43.0±3.3 points and 60.0±2.4 points resepctively, р<0.001). Disease manifestations restricted personal and social performance to a greater extent (р<0.05) in these patients (Table 1). In general, generalized index (W) of the disease impact on the patients’ functioning depending on their distribution according to TP was significantly higher among patients who DT (37.6±0.6 points and 43.7±0.5 points, respectively).

The severity of pain syndrome constituting 57.2±2.8 points was traditionally the most significant component reducing AFA in a group of 20 male patients at the age of 35-40. Manifestations of stiffness in the knee joints were ranked the second by the influence on the reduction of daily activity and constituted 43.1±2.2 points. Personal and social performance restriction was ranked the third constituting 37.7±0.8 points. Forming the groups of the groups of OA DT, the pain syndrome and stiffness manifestations did not differ from the group of patients who were prescribed TPst while disease manifestations limited personal and social functioning of these patients to a greater extent (р<0.01) (Table 1). Generally, generalized index (W, Fig. 1) of the disease impact on the male patients’ functioning depending on their distribution according to TP was significantly higher in case of TPa application (41.3±0.9 points and 44.3±1.1 points).

Fig. 1.

Some components and generalized index of osteoarthritis severity in different age and sex groups of patients (before the treatment)

gmj-23-gmj.2016.3.31-g1.jpg

The most significant component reducing AFA in a group of 39 female patients at the age of 40 was the severity of pain syndrome constituting 57.3±1.9 points. Manifestations of stiffness in the knee joints were ranked the second by the influence on the reduction of daily activity and constituted 45.5±1.7 points. Personal and social performance restriction was ranked the third constituting 37.8±0.6 points. Significant differences in the manifestations of analyzed components between subgroups of female patients were not observed while generalized index (W) of the disease impact on the patients functioning depending on their distribution according to TP was not significantly different as well.

Pain component and symptoms of stiffness reducing AFA were equally significant in the group of 24 men at the age over 40. However, pain was significantly more severe among 18 patients who underwent TPa, generalized index (W) of the disease impact on the patients functioning depending on their distribution according to TP was higher in case of TPa use.

Conclusions

The level of algo-functional activity and quality of life of patients was determined to depend on the age and sex at OA early stages. The severity of pain component dominates in females and personal and social performance restriction is predominant in males. Referential indices (before the treatment) of algo-functional activity were determined in comparative perspective before the differentiation therapy. In such a case advanced therapy program was used in patients with more significant manifestations of algo-functional restrictions.

Prospects for further research

Prospects for further research involve the study of the correlation relationships of algo-functional activity and quality of life with connective tissue metabolism indices at the stages of the integrated management of patients.

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