Diz Osteoartritinde Sürekli ve Kesikli Ultrason Tedavilerinin Değerlendirilmesi: Randomize ve Plasebo Kontrollü Bir Klinik Çalışma

Öz

Bu çalışma, diz osteoartritinde, terapotik sürekli, kesikli ve plasebo ultrason uygulamasının, klinik ve biyokimyasal etkinliğini karşılatırmak amacıyla yapılmıştır. Diz osteoartriti tanısı alan 30 hasta üç gruba ayrıldı. 1. gruba sürekli ultrason (1 MHz, 2 W / cm2); 2. gruba kesikli ultrason (1MHz,2W/cm2,1:4); 3. gruba ise plasebo ultrason tedavisi uygulandı. Tüm gruplar 10 gün (5 dakika/seans) tedavi aldı. Hastalar tedavi öncesi ve tedavi sonrası 1. ayda WOMAC, serum hs - CRP, COMP, MMP - 1, MMP - 3 ve idrar CTX - II düzeyleri ile değerlendirildi. Demografik özellikler karşılaştırıldığında, üç grup arasında yaş, vücut kitle indeksi ve radyolojik evreleme açısından istatistiksel olarak anlamlı bir fark bulunmadı ( p > 0.05 ). Klinik parametreler açısından, tedaviden sonraki ilk ayda, plasebo grubunda WOMAC sertlik dışında, her üç grupta iyileşme saptandı, ancak gruplar arasında istatistiksel olarak anlamlı bir fark gözlenmedi ( p > 0.05 ). Biyokimyasal parametrelerin 1. ay değerlendirilmesinde tedavi öncesi ve tedavi sonrası gruplar arasında anlamlı fark bulunmazken, grup 1 ve grup 3 arasında grup 3 lehine istatistiksel olarak anlamlı bir fark vardı ( p = 0.019 ). Diz OA’de tek başına ve kısa süreli uygulanan terapötik ultrasonun (sürekli/kesikli) klinik ve biyokimyasal belirteçler üzerine etkinliği gösterilememiştir.

Anahtar Kelimeler

• diz osteoartriti,terapotik ultrason,biyokimyasal belirteç

Evaluation of Continuous and Pulsed Ultrasound Treatments on Knee Osteoarthritis: A Randomized and Placebo-Controlled Study

Öz

This study evaluates effects of therapeutic ultrasound (continue, pulsed, placebo) treatment on the clinical and biochemical parameters in knee osteoarthritis. 30 patients (30-70 aged) diagnosed with knee osteoarthritis were randomly separated into three groups. The 1st group includes 10 patients given continue ultrasound treatment (1 MHz, 2W/cm2), the 2nd group consists of 10 patients given pulsed ultrasound treatment (1MHz, 2 W/cm2, 1:4) and 3th group includes 10 patients given placebo ultrasound treatment (switch off). The patients were assessed before and one month after the treatment with WOMAC, COMP, Hs CRP, MMP-1, MMP-3 levels in serum and CTX-II levels in urine. When the demographic characteristics were compared, no statistically significant difference was found between the three groups in terms of age, body mass index and radiological staging ( p > 0.05). In terms of clinical parameters, there was an improvement in all three groups in the first month after treatment except WOMAC stiffness in pulsed and placebo groups, although no statistically significant difference was observed between the groups ( p > 0.05). In the evaluation of biochemical parameters, there was no significant difference between the groups in terms of pre-treatment and post-treatment 1 month, whereas there was a statistically significant difference between the group 1 and group 3 in favor of group 3 ( p = 0.019). The efficacy of therapeutic US (continuous / pulsed) which was applied short term and alone, on clinical and biochemical markers in knee osteoartrithis, has not been demonstrated.

Anahtar Kelimeler

• knee osteoarthritis,therapeutic ultrasound,biochemical marker

Kaynakça

1. 1. Cesare Paul E., Steven B. Abramson. Osteoartrit Patogenezi; İç: Dinçer F, editör. Kelley Romatoloji. Ankara: Güneş Kitapevi 2006: 1493-1513.
2. 2. Evcik D. Babaoğlu Ü. S.Osteoartrit Etyopatojenezi. İç:Sarıdoğan M.editör. Osteoartrit.İstanbul:Nobel Tıp Kitapevleri.2007.S.51-
3. 3. Taşkıran D. Kıkırdak yaralanması ve onarımında biyokimyasal belirteçler. Acta Orthop Traumatol Turc 2007;41-Suppl 2:6-12.
4. 4. Jordan K M, Syddall H E, Garnero P, Gineyts E, Dennison E M, Sayer A A, Delmas P D.Urinary CTX-II and glucosyl-galactosyl-pyridinoline are associated with the presenceand severity of radiographic knee osteoarthritis in men. Ann Rheum Dis 2006;65:871-877.
5. 5. Taşkıran E, Taşkıran D, Kutay FZ, Lök V. Sinoviyal sıvıdaki kıkırdak matriks yıkım ürünlerinin osteoartrlt olgularının erken tanı ve izlenimindeki önemi. Acta Orthop Traumatol Turc 1995;29:455-8.
6. 6. Punzi L, Oliviero F, Plebani M. New biochemical insights into the pathogenesis of osteoarthritis and the role of laboratory investigations in clinical assessment. Crit Rev Clin Lab Sci 2005;42(4):279–309.
7. 7. Tune N: Romatizmal hastalıklar. Hacettepe Taş Yayıncılık, 3.Baskı, Ankara 1994.
8. 8. Dennisson E.Copper C: Osteoarthritis: Espidemiology and classification, in Rheumatology, Mosby, 2003.

9. 9. Karaaslan Y, Osteartrit, MD Yayıncılık, Ankara, 2000.
10. 10. Brandt KD: Management of ostearthritis Kelley’s Textbook of Rheumatology, sixth adition, volüme 2, Saunders Company 2001.
11. 11.Özge Ardıçoğlu, Salih Özgöçmen: Romatizmal Hastalıkların Reheabilitasyonu, içinde Tıbbi Rehebabilitasyon, Nobel Tıp Kitapevleri, 2004.
12. 12. Low J & Reed A: Electrotherapy Explained Principles and practise, Butterworth Heinemann, 3rd. Edition, 2000.
13. 13. Oosterveld FGJ, Rasker JJ: Effects of local heat and cold treatment on surface and articular temperature of arthritic knees. Arthritis Rheum 1994;37:1578-1582.
14. 14. Min, B.H., et al., Effects of low-intensity ultrasound (LIUS) stimulation on human cartilage explants. Scand J Rheumatol 2006;35(4):305-11.
15. 15. Naito, K., et al., Low-intensity pulsed ultrasound (LIPUS) increases the articular cartilage type II collagen in a rat osteoarthritis model. J Orthop Res 2010;28(3):361-9.
16. 16. Zhang, Z.J., et al., The effects of pulsed low-intensity ultrasound on chondrocyte viability, proliferation, gene expression and matrix production. Ultrasound Med Biol 2003;29(11): 1645-51.
17. 17. Tien, Y. C., Lin, S. D., Chen, C. H., Lu, C. C., Su, S. J., & Chih, T. T. Effects of pulsed low-intensity ultrasound on human child chondrocytes. Ultrasound in medicine & biology 2008;34(7), 1174-81.
18. 18. Lee, H.J., et al., Low-intensity ultrasound stimulation enhances chondrogenic differentiation in alginate culture of mesenchymal stem cells. Artif Organs 2006;30(9): 707-15.
19. 19.Tascioglu, F., Kuzgun, S., Armagan, O., & Ogutler, G. Short-term effectiveness of ultrasound therapy in knee osteoarthritis. Journal of International Medical Research 2010;38(4),1233-42.
20. 20.Kopakkala-Tani M, Leskinen JJ, Karjalainen HM, Karjalainen T, Hynynen K, Toyras J, Jurvelin JS, Lammi MJ. Ultrasound stimulates proteoglycan synthesis in bovine primary chondrocytes. Biorheology 2006;43:271–282.
21. 21.Tüzün EH, Eker L, Aytar A, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage 2005; 13: 28-33.
22. 22.Uddin, S. M., Richbourgh, B., Ding, Y., Hettinghouse, A., Komatsu, D. E., Qin, Y. X et al. Chondro-protective effects of low intensity pulsed ultrasound. Osteoarthritis and cartilage 2016;24(11),1989-98.
23. 23.Zeng, C., Li, H., Yang, T., Deng, Z. H., Yang, Y., Zhang, Y et al. Effectiveness of continuous and pulsed ultrasound for the management of knee osteoarthritis: a systematic review and network meta-analysis. Osteoarthritis and cartilage 2014;22(8), 1090-9.
24. 24.Jia, L., Wang, Y., Chen, J., & Chen, W. Efficacy of focused low-intensity pulsed ultrasound therapy for the management of knee osteoarthritis: a randomized, double blind, placebo-controlled trial. Scientific reports 2016;6,35453.
25. 25.Cakir, S., Hepguler, S., Ozturk, C., Korkmaz, M., Isleten, B., & Atamaz, F. C. Efficacy of therapeutic ultrasound for the management of knee osteoarthritis: a randomized, controlled, and double-blind study. American journal of physical medicine & rehabilitation 2014; 93(5), 405-12.
26. 26.Zhang, C., Xie, Y., Luo, X., Ji, Q., Lu, C., He, C., & Wang, P. Effects of therapeutic ultrasound on pain, physical functions and safety outcomes in patients with knee osteoarthritis: a systematic review and meta-analysis. Clinical rehabilitation 2016;30(10), 960-71.