Orthovoltage X-Ray Therapy Significantly Reduces Disability Risk In Knee Osteoarthritis Patients: A Decade-Long Cohort Study

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL
Maria V. Makarova, Mikhail Yu. Valkov, Andrey M. Grjibovski
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引用次数: 0

Abstract

Introduction — Osteoarthritis (OA) of the knee and hip joints affects 13% of the adult population in the Russian Federation. While medications can provide some relief from the pain associated with OA, they are often not enough. An alternative treatment option is orthovoltage radiation therapy (OVRT), which not only relieves pain, but can also help prevent disability. However, there is little evidence for the long-term effectiveness of OVRT. Objective — We compared the incidence of disability among patients with OA who received standard treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) in combination with the symptomatic slow-acting drugs for osteoarthritis (SYSADOA), or in combination with OVRT for knee OA in the setting of an open randomized controlled trial with long-term follow-up. Material and Methods — The sampling frame included patients with confirmed OA of the knee sensu Altman (1991), with radiographic grades of OA from 0 to 2 sensu Kellgren-Lawrence. A total of 292 patients were randomly distributed among two groups of equal sizes. The control group received combination therapy with NSAIDs and SYSADOA. In the experimental group, OVRT was additionally performed at a total dose of 4.5 Gy. Relationships between treatment regimen and time to disability were studied using actuarial analysis, Kaplan-Meier plots. Crude and adjusted hazard ratios (HR) with 95% confidence intervals (CI), as well as attributable fraction (AF) and population attributable fraction (PAF) were calculated. Results — The cumulative time at risk for disability was 2,304.9 person-years. In total, 9.5% of patients in the experimental group became disabled during the observation period vs. 17.8% in the control group. In the experimental group, the level of disability was lower (HR=0.49, 95% CI: 0.26-0.95). Differences became more pronounced after adjusting for sex, age, radiographic grade of OA, pain intensity, and duration of OA before treatment (HR=0.24, 95% CI: 0.11-0.48). AF and PAF were 49.9% and 25.8%, respectively. Conclusion — It has been shown that the introduction of OVRT in the treatment regimen can reduce the disability of patients with knee OA by almost 50%. One in four disability cases could be prevented if OVRT were used universally in the treatment of knee OA. Our results indicate that combining OVRT with standard care is a more effective approach to preventing disability in patients with knee OA than standard treatment alone.
正电压x线治疗可显著降低膝骨关节炎患者致残风险:一项长达十年的队列研究
引言-膝关节和髋关节骨关节炎(OA)影响了俄罗斯联邦13%的成年人。虽然药物可以在一定程度上缓解与OA相关的疼痛,但它们往往是不够的。另一种治疗选择是正电压放射治疗(OVRT),它不仅可以减轻疼痛,还可以帮助预防残疾。然而,很少有证据表明OVRT的长期有效性。目的:在一项长期随访的开放随机对照试验中,我们比较了接受非甾体抗炎药(NSAIDs)联合症状性慢效药物治疗骨关节炎(SYSADOA)或联合OVRT治疗膝关节OA的OA患者的残疾发生率。材料和方法:样本组包括确诊为膝关节骨性关节炎的患者(Altman, 1991),骨性关节炎的影像学分级为0 - 2级(kelgren - lawrence, 1991)。292例患者被随机分为两组。对照组给予非甾体抗炎药和SYSADOA联合治疗。在实验组中,在总剂量为4.5 Gy的基础上进行OVRT。采用精算分析、Kaplan-Meier图研究治疗方案与致残时间之间的关系。计算95%置信区间(CI)的粗风险比(HR)和校正风险比(HR),以及归因分数(AF)和总体归因分数(PAF)。结果-残疾风险累积时间为2,304.9人年。实验组患者在观察期内致残率为9.5%,对照组为17.8%。实验组残疾程度较低(HR=0.49, 95% CI: 0.26-0.95)。在调整性别、年龄、骨性关节炎的影像学分级、疼痛强度和治疗前骨性关节炎持续时间后,差异变得更加明显(HR=0.24, 95% CI: 0.11-0.48)。AF和PAF分别为49.9%和25.8%。结论-研究表明,在治疗方案中引入OVRT可使膝关节OA患者的致残性降低近50%。如果OVRT在膝关节OA的治疗中得到普遍应用,四分之一的残疾病例是可以预防的。我们的研究结果表明,与单独的标准治疗相比,将OVRT与标准治疗相结合是预防膝OA患者残疾的更有效方法。
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来源期刊
Russian Open Medical Journal
Russian Open Medical Journal MEDICINE, GENERAL & INTERNAL-
CiteScore
0.90
自引率
0.00%
发文量
39
期刊介绍: Russian Open Medical Journal (RusOMJ) (ISSN 2304-3415) is an international peer reviewed open access e-journal. The website is updated quarterly with the RusOMJ’s latest original research, clinical studies, case reports, reviews, news, and comment articles. This Journal devoted to all field of medicine. All the RusOMJ’s articles are published in full on www.romj.org with open access and no limits on word counts. Our mission is to lead the debate on health and to engage, inform, and stimulate doctors, researchers, and other health professionals in ways that will improve outcomes for patients. The RusOMJ team is based mainly in Saratov (Russia), although we also have editors elsewhere in Russian and in other countries.
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