The dynamics of morphological changes by MRI at orthovoltage x-ray therapy in patients with gonarthritis stage 0-2: long-term results of a randomized trial

Abstract

The aim of the study was the comparative analysis of morphological changes dynamics for gonarthritis 0-2 stages by symptomatic therapy (Symptomatic slow acting drugs for osteoarthritis — SYSADOA) in combination with orthovoltage x-ray therapy (OVRT) using magnetic resonance imaging (MRI) on WORMS criteria. Material and methods . The study included the patients with clinically confirmed gonarthritis. All the patients were randomly divided into 2 groups, each received a combined SYSADOA glucosamine (500 mg) and chondroitin (400 mg) sulfate, OVRT was performed for patients of the group 2 performed on Xstrahl-200 equipment, a single dose of 0,45 Gy, in 10 sessions to a total dose of 4,5 Gy. Evaluation of morphological MR-changes was carried out by WORMS in 15 conditional areas calculating of the average value for each anatomical zone before, after 12 and 36 months. Results. There were selected 300 patients, 150 in each group, eight people were lost. The difference in meniscus status was statistically significant before treatment. After 12-36 months a statistically significant advantage of OVRT in cartilage thickness (8,6 vs 1,9; p=0,009), the degree of prevalence of bone marrow edema (5,7 vs 0,6; p=0,024), thinning of articular surfaces (1,6 vs 0,3; p=0,042; t=2,11, df=34), the presence of marginal osteophytes (4,4 vs 1,8; p=0,042) and synovitis (1,1 vs 0,5; p=0,022). Conclusion. Complex MR-evaluation of the results of treatment of gonarthritis according to the WORMS criteria showed a significantly lower rate of progression of pathological changes in patients who received SYSADOA in combination with OVRT compared with patients who were prescribed monotherapy with SYSADOA, the effect remains for at least three years.