Ozone therapy for the treatment of a patient with rheumatoid arthritis and Hashimoto’s thyroiditis who had insufficient respond to multidrug therapy. 4 years follow up.

Yıl 2020, Cilt: 2 Sayı: 2, 31 - 35, 29.12.2020

Saltuk Aytaçoğlu Barlas Naim Aytaçoğlu

Öz

Introduction: Rheumatoid Arthritis (RA) with insufficient respond to multidrug-therapy combinations constitutes a challange in therapeutic planning. Ozone therapy (OT) may bring new dimensions in the management.

Case Presentation: A 53-year-old woman had different multidrug-therapy combinations (non steroid anti inflammatory drugs (NSAID), Hydroxychloroquine, Sulphasalazine, Metothrexate (MTX), Cortico steroids (CS) and Leflunomide) in 22 years but still had swollen and painful joints with multipl deformities due to moderate activity of RA. Disease Activity Score (DAS 28 - CRP) was found to be 4.48. She also had pangastritis, low vitamin B12 levels and euthyroid Hashimoto’s thyroiditis. She was unwilling to carry on with her medicines. She received medical intravenous ozone application starting as 2/week, 2000 gamma/session for 8 weeks, then lowered gradually to 1/month for a year. She stopped taking CS and Leflunomid after the 1st and 5th months of OT. She also stopped taking her pangastritis medications. After 4 years of initial OT, the last 3.5 years were free from medication and complaints. DAS 28 - CRP value difference was 2.26 (decrease > 1.2) wich denotes to a "major improvement". X-ray control of hands showed minimal increase in deformities. Decrease in Anti-Tiroglobulin levels has been found to be worth investigating.

Result: Appropriate ozone therapy may bring new horizons for patients with insufficient respond to multidrug-therapy combinations in Rheumatoid arthritis.

Anahtar Kelimeler

ozone therpy, Rheumatoid arthiritis, corticosteroids, csDMARD, Hashimoto's thyroiditis

Destekleyen Kurum

NONE

Proje Numarası

NONE

Teşekkür

NONE

Çoklu ilaç tedavisine yetersiz cevabı olan romatoid artrit ve Hasimoto tiroiditli bir hastada ozon tedavisi. 4 yıllık takip.

Öz

Giriş: Çoklu ilaç kombinasyonlarına yetersiz yanıt gösteren Romatoid artrit (RA), tedavinin planlanmasında zorluk oluşturmaktadır. Ozon tedavisi (OT) mücadelede ümit verici olabilir.

Olgu Sunumu: 53 yaşında kadın hasta. 22 yıl içerisinde farklı, çoklu-ilaç kombinasyonları kullanmasına rağmen (non steroid antiinflamatuar ilaçlar - (NSAID), hidroksiklorokin, Sulfasalazin, Metotreksat (MTX), Kortiko steroid (KS) ve Leflunomid) orta düzey RA aktivitesine bağlı eklemlerde şişlik, ağrı ve deformasyon şikayetleri ile müracaat etti. Hastalık Aktivite Skoru (DAS 28 – CRP) 4.48 bulundu. İlave olarak pangastrit, düşük B12 seviyesi ve Hashimoto tiroiditi mevcuttu. İlaçlarını kullanmakta isteksizdi.

Intravenöz tıbbi OT uygulanmasına 2/hafta, 2000 gamma/seans, 8 hafta süre ile başlandı. Daha sonra 1/ay olacak şekilde uygulama kademeli azaltılarak 1 yıla tamamlandı. OT başlangıcından 1 ay sonra KS, 5 ay sonra Leflunomid alımı durduruldu. Daha sonra hasta ihtiyacı kalmadığını belirterek pangastrit ilaçlarını durdurdu. OT başlangıcından 4 yıl sonra yapılan değerlendirmede son 3.5 yılın komplikasyon olmadan ve ilaç kullanılmadan gerçirildiği görüldü. DAS 28 – CRP değer farkı 2.66 (düşüş > 1.2) bulundu ki bu “majör düzelmeyi” göstermektedir. Ellerin X-Ray kontrollerinde, deformitelerde minimal artış görülmüştür. Anti-Tiroglobulin seviyesindeki azalma incelenmeye değer bulunmuştur.

Sonuç: Çoklu-ilaç tedavisine yetersiz yanıt gösteren Romatoid artititli hastalarda uygun şekilde yapılan ozon terapi yeni ufuklar açabilir.

Anahtar Kelimeler

Ozon terapi, Romatoid Artrit, kortikosteroidler, csDMARD, Haşimoto tiroiditi

Proje Numarası

NONE

Kaynakça

• 1- Safiri S, Kolahi AA, Hoy D, et al. Global, regional and national burden of rheumatoid arthritis 1990–2017: a systematic analysis of the Global Burden of Disease study 2017 Annals of the Rheumatic Diseases 2019;78:1463-1471.
• 2- Pincus T, Callahan LF. The “side effects” of rheumatoid arthritis: Joint destruction, disability and early mortality. Br J Rheumatol [Internet]. 1993;32(SUPPL. 1):28–37.
• 3- World Health Organization. Topics in Chronic Diseases and Health Promotions. URL: http/www.who.int/chp/topics/rheumatic/en
• 4- Zion Market Research. 05 April 2019. Report Code: ZMR-3999. Available from URL: http/www.zionmarketresearch.com/report/rheumatoid-arthritis-drugs-market
• 5- Einarsson JT, Willim M, Ernestam S, et al. Prevalence of sustained remission in rheumatoid arthritis: impact of criteria sets and disease duration, a Nationwide Study in Sweden. Rheumatology, 2019;58(2); 227–236.
• 6- Pincus T, Marcum SB, Callahan LF. Longterm drug therapy for rheumatoid arthritis in seven rheumatology private practices: II. Second line drugs and prednisone. J Rheumatol 1992;19:1885–1894.
• 7- Wolfe F. Adverse drug reactions of DMARDs and DC-ARTs in rheumatoid arthritis. Clin Exp Rheumatol 1997;15(suppl 17):75–81
• 8- Strand V, Miller P. Discontinuation of Biologic Therapy in Rheumatoid Arthritis: Analysis from the Corrona RA Registry: Rheumatol Ther. 2017; 4(2): 489–502.
• 9- Anderson J, Caplan L. Rheumatoid Arthritis Disease Activity Measures: American College of Rheumatology Recommendations for Use in Clinical Practice Arthritis Care Res (Hoboken). 2012;64(5): 640–647.
• 10- van Gestel AM, Prevoo ML, van’tHof MA, van Rijswijk MH, van de Putte LB, van Riel PL. Development and validation of the European League Against Rheumatism response criteria for rheumatoid arthritis. Comparison with the preliminary American College of Rheumatology and the World Health Organization/International League Against Rheumatism Criteria. Arthritis Rheum. 1996;39(1):34–40.
• 11- Gabriel SE. Why do people with rheumatoid arthritis still die prematurely? Ann Rheum Dis 2008; 67(suppl 3): 30–34
• 12- Listing J, Kekow J, Manger B, et al. Mortality in rheumatoid arthritis: the impact of disease activity, treatment with 6 Journal of Comorbidity glucocorticoids, TNFalpha inhibitors and rituximab. Ann Rheum Dis 2015; 74(2): 415–421
• 13- Efthimiou P, Kukar M, MacKenzie CR. Complementary and Alternative Medicine in Rheumatoid Arthritis: No Longer the Last Resort! HSS Jrnl 2010;6(1):108–111
• 14- Bozbas GT, Sendur OF New Therapeutıc Aproach in Rheumatoıd Arthrıtıs: Ozone. Int J Physiatry 2016; 2:007
• 15 – Fernandez OSL, Renate VH. Medical ozone increases methotrexate clinical response and improves cellular redox balance in patients with rheumatoid arthritis. European Journal of Pharmacology 2016;789; 313-318.