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20DETERMINATION OF OSTEOARTHROSIS
IN PATIENTS WITH OBESITY Mirzaeva D.A.1, Musaeva A.F.2, Sadullaev A.F.3, Kurvandurdieva N.K.4
1Mirzaeva Dilnoza Abdialimovna - Head Teacher, DEPARTMENT FACULTY AND HOSPITAL THERAPY;
Musaeva Amina Faizullaevna - Student; Sadullaev Abdulla Fayzullaevich - Student;
4Kurvandurdiyeva Nazokat Kakhramon qizi - Student, MEDICAL FACULTY, URGENCH BRANCH TASHKENT MEDICAL ACADEMY, URGENCH, REPUBLIC OF UZBEKISTAN
Abstract: currently, obesity is considered as one of the most important predictors of the progression of osteoarthritis (OA) of the knee joints. S. Grazioetal. It is noted that the need for knee arthroplasty may be associated with obesity and a weight loss may lead to a decrease in functional impairment. Keywords: osteoarthritis, obesity, knee joints, the Leken index, the body mass index.
Currently, obesity is considered as one of the most important predictors of the progression of osteoarthritis (OA) of the knee joints [3,5,8]. S. Grazioetal. It is noted that in 69% of cases the need for knee arthroplasty may be associated with obesity and a weight loss of more than 5.1% may lead to a decrease in functional impairment [2; 6].
In rheumatology practice, a number of standard tests have been developed to characterize OA. In assessing the general condition of patients, joint pain and morning stiffness, a visual analogue scale (VAS) is used, the characteristics of gonarthrosis and coxarthrosis are the Leken index, the WOMAC test (Western Ontario and McMaster Universitiesteoarthritis Index). The severity of lower extremity dysfunction is determined by the integral index, which is calculated as the arithmetic average of the value of 6 expert signs in% [4; 9].
However, in many studies, surveyed methods were used only for articular syndrome, where OA is considered as a local pathology, there are very few observations in the literature on the use of standard tests in assessing the functional status of patients with obesity of various degrees [7].
Purpose of the study. To study the results of WOMAC, Laken indices and indicators of expert signs in patients with gonarthrosis and obesity and to determine their diagnostic value in determining the functional state of patients.
Materials and methods of the study. 80 patients (23 men, 28.8%, 57 women, 71.2%) aged 48 to 75 years (mean age 58.5 ± 0.8 years) were examined for OA of the knee joints examined in the department of rheumatology clinic № I SamMI. The OA diagnosis met the AKP criteria [10; 12].
Generalized OA (polyarthricular form) with damage to the knee, hip joints and hand joints was observed in 21.2%, monoarthrosis (left or right) of the knee joint - in 48.8%, oligosteoarthrosis - in 30.0% of patients. Reactive synovi diagnostics in 37.5% of patients. X-ray of the knee joints revealed all IV stages of gonarthrosis (according to Kellgren): Stage I was observed in 13 (16.3%) patients, Stage IV - in 11 (13.8%), Stage II and Stage III were detected in the vast majority of patients - 56 (70.1%). In 18.8% of patients, the functional state of the joints had no limitations, in 81.2%, dysfunction of the joints was ascertained: in 33.8% - I degree, in 32.5% - II degree and in 15.0% - III degree.
The study of articular syndrome was carried out according to accepted standards. The number of affected joints was assessed, the degree of pain, stiffness, limitations of functional ability and the general condition of patients were determined on a visual analogue scale (VAS), where the result is from 70 to 100 mm (7-10 cm) -correspond to pronounced changes, from 40 to 70 mm (4-7 cm) -moderate changes, from 10 to 40 mm (1-4 cm) - weak changes. The functional state of the joints was determined by the total algo-functional Leken index, WOMAC index and 6 expert features.
The quality of life of patients was determined using the international questionnaire EQ-5D consisting of 5 components:
movement in space (1), self-care (2), daily activity (3), pain and discomfort (4), anxiety and depression (5).
Statistical data processing was carried out using the EXCEL program. To determine the significance of differences, Student's t-test, Mann-Whitney, Spearman criteria were used. Differences were considered significant when the probability degree was p <0.05.
Results and Discussion functional ability of the joints - 75.5 ± 6.6 mm (pronounced limitation). The result of the general self-esteem on YOUR was 76.5 ± 6.3 cm, which corresponds to a serious condition.
The body mass index ranged from 19 to 39. In 22 (27.5%) patients, a BMI was normal (according to WHO recommendations
— 18.5-24.9), in 23 (28.8%) - excess mass (pre-fat 25-29.9), in 15 (25.0%) - obesity of the I (first) degree (30-34.9) and in 20 (12.2%)
- obesity of the II (second) degree (35-40).
The increase in body weight contributed to the development of reactive synovitis and secondary changes in the veins of the lower extremities. Among patients with a normal body mass index, reactive sinovitis was diagnosed in 13.7% of patients, with an increased BMI index in 26.6% of patients, in obesity grade I in 46.7%, grade II in 70.0% of patients (r = 0 ,eight). The frequency of varicose veins of the lower extremities in patients of the above groups was, respectively, 27.3; 43.5; 53.0 and 65.0% (r = 0.6).
When conducting a Lecken test, the minimum result can be 1 point, the maximum - 14 point. In the presence of 1-4 points, OA is considered easy, 5-7 points - moderate, 8-10 points - heavy, 1113 points - very heavy, and 14 points - extremely heavy. According to the results of the evaluation of the Leken index, 15.0% of patients with OA were mild, 41.3% moderate, 20% severe, 16.3% very severe, and 7.5% extremely severe. With normal body weight, light OA (1-4b) was diagnosed - in 18.2%, moderate (5-7b) - in 63.6%, severe (8-10b) - in 18.2% of patients. With normal body weight, it is very heavy (11-13 b) and extremely heavy (14 b) OA was not detected.
Increased body weight of patients contributed to increased severity of OA. Thus, among patients with increased body weight, mild, moderate, severe, and very severe OA were found,
respectively, in 17.4; 52.2; 13.0 and 17.4% of patients. Among patients with obesity I and II, compared with normal and overweight, there were more patients with severe OA (26.7 and 25.0% versus 18.2 and 13.0%). Also, when I and II degree of obesity in 13.0 and 20.0% of patients, extremely severe OA was diagnosed (14 points).
According to the results of the WOMAC index, the severity of the pain syndrome (5 questions) averaged 6.5 ± 0.5 cm, stiffness (2 questions) - 3.5 ± 0.3 cm, the degree of limitation of the functional ability (17 questions) - 7, 5 ± 0.6 cm. The intensity of pain in patients with normal body weight averaged 5.8 ± 0.4 cm, overweight - 6.3 ± 0.3 cm, I grade of obesity - 6.7 ± 0 , 2 cm, II degree of obesity - 7.2 ± 0.4 cm (pronounced correlation r = 0.8); severity of stiffness, respectively - 3.2 ± 0.2; 3.3 ± 0.3; 3.5 ± 0.2 and 3.6 ± 0.3 cm (weak correlation r = 0.2); the degree of limitation of functional ability - 6.9 ± 0.4; 7.2 ± 0.5; 7.8 ± 0.6 and 8.2 ± 0.5 cm (moderate correlation r = 0.6).
According to the results of evaluation of 6 expert signs-"Movement" (1), "Additional support" (2), "Performing everyday functions" (3), "Self-catering" (4), "Using public transport" (5) and "Performing professional duties "(6) from 17.5% to 36.3% of patients with OA were not significant restrictions. Among patients with obesity I and II, there are no signs of preservation of the functional ability of the joints (minor claudication, preservation of the ability to self-care, use of public transport, performance of professional duties) were not identified. Only from 5.0 to 13.0% of patients with obesity of I and II degrees did not need additional support, from 6.6 to 10.0% of patients did not have limitations in the performance of everyday functions. With normal body weight, there were no significant functional limitations — from 40.9 to 63.6%, with increased body weight — from 21.7 to 52.2% of patients.
The pathological type of movement and the impossibility of walking among medium-sized bodies with normal body weight were not detected, and in obesity of the first and second degree, respectively, 13.3; 30.0% and 6.7; 10.0% of patients. With increased body mass, the pathological type of movement was
recorded in just 1 patient (4.3%). Comparatively difficult expert signs - the need for additional funds when walking, the inability to perform household functions, self-service, use of public transport and professional duties were found - from 6.7 to 10.0% of patients with OA CI and II degree of obesity.
According to the results of the international questionnaire EQ-5D among patients with osteoarthritis, health problems were noted to one degree or another by all respondents. According to the first section of the questionnaire - "Movement in space", 15.0% of patients had no problems, some problems - 85.0% of patients with OA. Among patients with normal BMI, some of the problems with movement in space were 77.3% of respondents, which was less than in patients with an increase in BMI (82.6%) and obesity grade II and III (93.3 and 90.0%). In the section "Self-care", 27.5% of patients had no problems: with a normal body weight -27.3%, with an increase in BMI -34.8%, with obesity of I and II degrees, respectively - 20.0 and 25.0% of patients . The number of patients with some problems with self-care increased with increasing BMI: 72.7%; 65.2%, 73.3% and 65.0% in patients with normal, increased BMI index, obesity, I and II degrees, respectively. According to the questionnaire, 6.7% and 10.0% of patients with obesity grade II and II could not wash and dress.
In the "Daily activity" section, 21.3% of patients had no problems: 22.7% with normal BMI, 30.4% with an increase in BMI, 80.0% and 75.0% with obesity in grades I and II. Had some problems - 77.3%, 69.6%, 80.0% and 75.0% of patients. 6.7% and 10.0% of patients with obesity I and II degrees could not perform everyday tasks. On the "Pain and Discomfort" scale, there was no pain and discomfort in 16.3% of patients. 72.5% of patients had slight pain and discomfort, 11.3% had severe pain and discomfort (patients with I and II degrees of obesity).
In the section "Anxiety and Depression", 12.5% of patients did not have anxiety and depression, 78.8% of patients had minor anxiety and depression, 8.8% of patients had expressed anxiety and depression. Among those with obesity with grade I and II,
13.3 and 15.0% of the patients had, respectively, severe anxiety and depression, respectively.
Over the past year, 18.8% of patients reported an improvement in their health status. In 61.3% of the surveyed there were no significant changes in the state over the last year. In 20.0% of patients, the condition was worsened: 13.6% with normal BMI, 17.4% with elevated BMI, 20.0% with obesity of the first, 30.0% with obesity of the second degree.
Conclusion. Thus, obesity is one of the most serious risk factors for the progression of OA, the development of functional disorders of the knee joints, reactive synovitis and varicose veins of the lower extremities. An increase in the body weight of patients contributes to an increase in the severity of OA: in the first and second degrees of obesity, in contrast to patients with normal and increased body weight, severe and extremely severe OA are more often diagnosed.
In obesity, pathological type of walking is more often detected, the range of movements in the joint is sharply limited, cases of the need to use additional funds increase, difficulties arise when using public transport. OA and obesity contribute to a decrease in professional abilities, and even to the loss of the ability of patients to self-care.
In patients with OA, the quality of life is deteriorating in all respects to the EQ-5D (EuroQol) questionnaire. The indicators of "Emergency and Depression" (87.6%), "Movement in Space" (85.0%), "Pain and Discomfort" (83.8%), "Everyday Activity" (78.3 %), which reflects the typical clinical manifestations of osteoarthritis. Low indicators of the parameters of the questionnaire are especially characteristic with increasing BMI, obesity, I and II degrees.
Indicators of WOMAC, Leken and expert signs are highly informative for assessing the functional status of patients. It takes from 5 to 10 minutes to complete these forms.
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