Rehabilitation of patients with chlamydial spondyloarthritis at the health resortv

Abstract

Background. Rehabilitation of patients with chlamy­dial spondyloarthritis (CSA) under the conditions of the health resort remains undeveloped, there are not enough data to elucidate the mechanism of natural and preformed physical factors in such category of patients, the criteria for the effectiveness of rehabilitation measures not yet defined. The objective of the study: to evaluate the results of treatment in patients with CSA in a Slaviansk balneological health resort. Materials and methods. The research included 117 patients, who were treated at the rheumatological clinic, and then underwent rehabilitation in health resort, which has continental sulfide lake muds and brines with highly minerali­zed chloride-sodium composition. Among the patients under the study, there were 61 % of males and 39 % of females with an average age of 35 years. Both genders did not differ in the duration of illness (median of 7 years) and the degree of activity of the pathological process. Seropositivity for rheumatoid factor is detected in 2 % of patients, and by the presence of antibodies to cyclic citrulline peptide — in 70 %. During the resort stage, in 91 % of cases of СSA, Chlamydia trachomatis was found in prostatic secretions, scrapings from the urethra, cervix, vaginal walls, 83 % reported positive serological tests for chlamydial infection. Results. Analysis of the results showed that in 3 % of cases the effect was absent, in 14 % there was a slight improvement, in 50 % — an improvement and in 33 % — a significant improvement. The effectiveness of sanatorium stage of rehabilitation for women was higher, and due to increasing degree of disease activity, the positive results were getting worse. A significant adverse effect on the efficiency of sanatorium and health resort treatment activity has the presence of sacroiliitis and cardiac pathology in patients. Differences in the effectiveness of rehabilitation of patients depends on the types of the autonomic (vegetative) neural system (“vegetative passport”), in particular, in comparing eutonics and sympathotonics, sympathotonics and vagotonics. Prior drug treatment did not affect the results of the health resort rehabilitation of patients, a correlation between the effectiveness of treatment of patients in the hospital and nursing home was not revealed. The results of rehabilitation of patients with CSA were affected by the use of the sulfosalicylate in sanatorium. There was noted the influence of drugs on the effect of baths and laser beams, but a correlation with the concurrent use of drugs for peloids effects or electric and magnetic fields was not found. Mud baths caused an increased efficiency due to electroprocedures and peloids, besides, were further intensifying magnetic field’s effect. Health resort mud treatment exceeded the efficiency of balneoprocedures. Thus, in 7 % of patients treated with the bath, there was no effect, 25 % has a slight improvement, 32 % — an improvement and 36 % — a significant improvement. In turn, peloidotherapy gave positive results in all cases, and in 8 % a slight improvement was established, in 55 % — an improvement and in 37 % — a significant improvement. Meanwhile, in patients, who received baths, there was a higher degree of the pathological process activity. We emphasize that in terms of such indicators, as joint index, the severity of tendovaginitis, enthesopathies, spondylopathies, sacroiliitis, urogenital, eye, skin and heart lesions, patients, who received peloids and bath treatment, are not much different among themselves. Any specific contraindications for CSA patients’ staying in balneological health resort have not been established. Conclusions. In CSA, the positive results of rehabilitation of patients is higher for women, and the effectiveness of sanatorium and health resort treatment depends on the presence of sacroiliitis and cardiomyopathy and is reduced in patients with left ventricular hypertrophy and its systolic dysfunction, but can be enhanced by the concomitant administration of sulfasalazine. There is the connection between the effect of rehabilitation and the use of natural and preformed physical factors, which are potentiating their interaction, and besides, electroprocedures are advisable to use in parallel peloids or baths, but in case of magnetic field — only with mud therapy.

Keywords

• Chlamydia
• joints
• rehabilitation
• health resort