Análise comparativa de técnicas de aplicação da terapia conjugada de laser e ultrassom, como recurso antiálgico, nas pequenas articulações das mãos na artrite reumatóide

Abstract

Rheumatoid arthritis is an autoimmune, chronic, systemic inflammatory disease that mainly affects the synovial tissue of the proximal interphalangeal joints and may affect the distal interphalangeal joints in both hands. Joint pain is the most common clinical symptom that causes impairments in the practice of daily and work activities, leading to psychological distress, negatively impacting quality of life. Drugs are administered to control joint synovitis, but the partial effectiveness and side effects lead to the suspension of their use. Therefore, non-pharmacological therapies can contribute to the control or remission of joint inflammation, reducing pain without side effects. The objective of the research was to analyze different and comparative methods, using the combined therapy of ultrasound and laser, aiming to minimize the pain caused by rheumatoid arthritis in the hands. Forty female volunteers who were diagnosed with rheumatoid arthritis and had pain in the proximal and distal interphalangeal joints were selected for the study. Pre- and post-intervention pain was assessed by using the McGill Pain Questionnaire and digital algometer. For the treatment, an equipment commercially called RECOVER® and RECUPERO® which combines Ultrasound and Laser was used and a metallic vat. The volunteers were divided into four treatment groups: Laser Group, Ultrasound Group, Combined Ultrasound and Laser Group without and with the use of the vat. In the four groups, the following ultrasound parameters were used: Frequency 1 MHz, Intensity 0.5 W/cm², pulsed mode 100Hz (50%,) Power 1.30 W and Time of 3 minutes per point and the following Laser parameters: continuous laser with Energy density of 33.3 J/cm², power 100 mW, Wavelength 808 nm and 660nm and Time 3 minutes per point. There were 8 applications, twice a week. At the end of 4 weeks, the combined treatment with a vat showed, through the pain index, a percentage higher (49.7%) than the Laser treatments (36.8%), Ultrasound (5.09%) and the combined treatment without a vat. (36.2%) for the reduction of joint pain in rheumatoid arthritis. The mean evolution of the pain threshold before and after treatment with the ultrasound, laser, conjugated and conjugated vat resources were significant, varying within the normal range p<0.05 for all resources in the proximal and distal interphalangeal joints of both hands. However, in percentage terms, the combined resource with a bowl showed superior results (53.35%) compared to ultrasound (11.86%), laser (26.19%) and combined (44.43%) in the proximal interphalangeal joints of the right hand. , the same occurred in the distal interphalangeal joints of the same hand, whose combined resource with a bowl showed a higher percentage improvement (54.70%) than ultrasound (7.36%), laser (26.75%) and conjugated (47.10%). In relation to the left hand, in percentage terms, the resource combined with a bowl showed superior results (44.39%) in relation to ultrasound (6.82%), laser (24.64%) and combined (45.52%) in the joints interphalangeal joints, the same was verified in the distal interphalangeal joints of the same hand, whose combined resource with a bowl showed a higher percentage improvement (49.67%) than ultrasound (0.50%), laser (25.20%) and conjugated (53.33%). The conjugated therapy applied with the vat for the treatment of small joints of the hands, provides a new non-pharmacological and non-invasive treatment approach that contributes to a better quality of life for patients with this chronic inflammatory joint disease .