Principles of pharmacological therapy of comorbid diseases in patients with orthopedic pathology

Authors

  • Nataliya Prytula Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
  • Inga Fedotova Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine https://orcid.org/0000-0003-2069-7020
  • Iryna Korzh Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine

DOI:

https://doi.org/10.15674/0030-59872020464-71.

Keywords:

Comorbidity, recommendations, conservative therapy

Abstract

Comorbidity is one of the leading problems in clinical practice. Interaction of diseases, involutive processes of natural aging and pathomorphosis of drugs significantly change clinical picture and course of the disease, the nature and severity of complications, limit or complicate the treatment and diagnostic process. Objective. To analyze current information on available recommendations for the treatment of comorbid diseases in patients with orthopedic pathology. Materials. An overview of the recommendations of the European Society of Cardiology, European Society of Hypertension, European Society for Vascular Surgery, Ukrainian Gastroenterological Association and American Diabetes Association for the period 2017–2019 is presented. Results. The first stage in the treatment of arterial hypertension is the lifestyle optimization, and the initial therapy of most patients with hypertension should be a combination of two drugs. Management of patients with lower extremity artery disease is associated with an increased risk of any cardiovascular events. Therefore, preventive measures are of particular importance. Gastropathies induced by non-steroidal anti-inflammatory drugs are widespread in orthopedic practice. In the prevention of their occurrence, a well-chosen gastroprotective therapy is important. Once the diagnosis of diabetes is made, lifestyle modification should be started immediately along with the start of pharmacotherapy. Metformin remains the first-line drug for treatment, drugs of other groups can be prescribed when there are contraindications to metformin. In the treatment of neuropathic pain in diabetes or pre-diabetes, only pharmacological treatment strategies are effective. Conclusions. In most cases, a number of comorbidities with timely diagnosis and compliance with the algorithms of medical care can be corrected and treated. Properly selected conservative therapy can reduce the risk of peri- and postoperative complications.

Author Biographies

Inga Fedotova, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

Doctor in Medical Sci.

Iryna Korzh, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

PhD

References

  1. Global Burden of Disease Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. GBD 2017 Risk Factor Collaborators. Lancet, 392 (10159), 1923-1994. https://doi.org/10.1016/S0140-6736(18)32225-6
  2. (2019). International Diabetes Federation. IDF Diabetes Atlas. 9th ed. Brussels, Belgium : International Diabetes Federation, Retrieved from: https://www.diabetesatlas.org/en.
  3. Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., … & Desormais, I. (2018). 2018 practice guidelines for the management of arterial hypertension of the European Society of Cardiology and the European society of hypertension. Journal of Hypertension, 36(12), 2284-2309. https://doi.org/10.1097/hjh.0000000000001961
  4. Bilchenko, A. V. (2018). New European guidelines for the treatment of arterial hypertension (ESH / ESC, 2018). Health of Ukraine, 3(58), 21-23. [in Russian]
  5. Beckett, N., Peters, R., Leonetti, G., Duggan, J., Fagard, R., Thijs, L., … & Bulpitt, C. (2014). Subgroup and per-protocol analyses from the hypertension in the very elderly trial. Journal of Hypertension, 32(7), 1478-1487. https://doi.org/10.1097/hjh.0000000000000195
  6. Gupta, P., Patel, P., Štrauch, B., Lai, F. Y., Akbarov, A., Gulsin, G. S., … & Tomaszewski, M. (2017). Biochemical screening for nonadherence is associated with blood pressure reduction and improvement in adherence. Hypertension, 70(5), 1042-1048. https://doi.org/10.1161/hypertensionaha.117.09631
  7. Zhuravleva, M. V., Kukes, V. G., Prokofiev, A. B., Serebrova, S. Yu., Gorodetskaya, G. I., & Berdnikova, N. G. (2016). Rational use of NSAIDs is a balance of efficacy and safety (literature review). International Journal of Applied and Basic Research, 6-4, 687–696. [in Russian]
  8. Westin, G. G., Armstrong, E. J., Bang, H., Yeo, K., Anderson, D., Dawson, D. L., … & Laird, J. R. (2014). Association between Statin medications and mortality, major adverse cardiovascular event, and amputation-free survival in patients with critical limb ischemia. Journal of the American College of Cardiology, 63(7), 682-690. https://doi.org/10.1016/j.jacc.2013.09.073
  9. Bagger, J. P., Helligsoe, P., Randsbaek, F., Kimose, H. H., & Jensen, B. S. (1997). Effect of Verapamil in intermittent claudication. Circulation, 95(2), 411-414. https://doi.org/10.1161/01.cir.95.2.411
  10. Paravastu, S. C., Mendonca, D. A., & Da Silva, A. (2013). Beta blockers for peripheral arterial disease. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd005508.pub3
  11. Anokhina, G. A., Bondarenko, O. O., & Dorofeev, A. E. (2017). Recommendations of the Ukrainian Gastroenterological Association for primary and secondary health care physicians for the prevention and treatment of NSAID-induced gastropathies. Kyiv. Retrieved from: https://ukrgastro.com.ua/wp-content/uploads/2017/10/%D0% A0%D0%B5%D0%BA%D0%BE%D0%BC%D0%B5%D0%BD%D0%B4%D0%B0%D1%86%D0%B8%D0% B8-% D0%A3%D0%93%D0%90.pdf. [in Ukrainian]
  12. Lanza, F. L., Chan, F. K., & Quigley, E. M. (2009). Guidelines for prevention of NSAID-related ulcer complications. American Journal of Gastroenterology, 104(3), 728-738. https://doi.org/10.14309/00000434-200903000-00035
  13. Yeomans, N. D., Tulassay, Z., Juhász, L., Rácz, I., Howard, J. M., Van Rensburg, C. J., Swannell, A. J., & Hawkey, C. J. (1998). A comparison of omeprazole with Ranitidine for ulcers associated with nonsteroidal antiinflammatory drugs. New England Journal of Medicine, 338(11), 719-726. https://doi.org/10.1056/nejm199803123381104
  14. Malfertheiner, P., Megraud, F., O'Morain, C. A., Atherton, J., Axon, A. T., Bazzoli, F., … & Kuipers, E. J. (2012). Management ofHelicobacter pyloriinfection—the Maastricht IV/ Florence consensus report. Gut, 61(5), 646-664. https://doi.org/10.1136/gutjnl-2012-302084
  15. Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2019. (2018). Diabetes Care, 42(Supplement 1), S90-S102. https://doi.org/10.2337/dc19-s009
  16. Waldfogel, J. M., Nesbit, S. A., Dy, S. M., Sharma, R., Zhang, A., Wilson, L. M., … & Robinson, K. A. (2017). Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life. Neurology, 88(20), 1958-1967. https://doi.org/10.1212/wnl.0000000000003882
  17. Raskin, P., Huffman, C., Toth, C., Asmus, M. J., Messig, M., Sanchez, R. J., & Pauer, L. (2013). Pregabalin in patients with inadequately treated painful diabetic peripheral neuropathy. The Clinical Journal of Pain, 1. https://doi.org/10.1097/ajp.0b013e31829ea1a1
  18. Finnerup, N. B., Attal, N., Haroutounian, S., McNicol, E., Baron, R., Dworkin, R. H. … & Wallace, M. (2015). Pharmacotherapy for neuropathic pain in adults: A systematic review and meta-analysis. The Lancet Neurology, 14(2), 162-173. https://doi.org/10.1016/s1474-4422(14)70251-0
  19. Pop-Busui, R., Boulton, A. J., Feldman, E. L., Bril, V., Freeman, R., Malik, R. A., Sosenko, J. M., & Ziegler, D. (2016). Diabetic neuropathy: A position statement by the American Diabetes Association. Diabetes Care, 40(1), 136-154. https://doi.org/10.2337/dc16-2042

How to Cite

Prytula, N., Fedotova, I., & Korzh, I. (2023). Principles of pharmacological therapy of comorbid diseases in patients with orthopedic pathology. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (4), 64–71. https://doi.org/10.15674/0030-59872020464-71.

Issue

Section

ORIGINAL ARTICLES