The use of preparations based on bacterial lysates in the treatment of chronic tonsillitis in patients with rheumatoid arthritis

Анотація

In the therapy of decompensated form of chronic tonsillitis (CT) were used as immunomodulatory agents IRS and Ismigen. These bacterial lysates differ in the bacterial setting, the method of preparation (chemical, mechanical) and the method of application.Rheumatoid arthritis (RA) is one of the important factors that could significantly complicate the therapy of chronic tonsillitis. RA is a chronic immune inflammatory disease that progressively affects connective tissue mostly of the peripheral joints and it has a wide range of extra-articular manifestations. The aim of our study was to explore the dynamics of immunologic indicators during the active disease and treatments in patients with decompensate form of chronic tonsillitis, including tonsillitis complicated with RA. Materials and methods. 33 patients with decompensate form of chronic tonsillitis in active period of disease observed during the study. Patients were divided into the following groups: 24 persons with the decompensate form of CT, 9 persons with the rheumatoid arthritis and 9 persons with the decompensate form of CT complicated with RA in remission stage. The control group consisted of 15 apparently healthy persons. Concentrations of serum IgA, IgM, IgG were determined by the method of radial immune diffusion by Manchini. Levels of sIgA, IFN – γ and rheumatoid factor in the blood serum of patients were evaluated using ELISA test systems of "Vector-best". Patients of group CTD (with decompensate form of chronic tonsillitis) were divided into subgroups CTD1 and CTD2, depending on the applied treatment. Both subgroups treated with standard therapy for two weeks and received Derynat during 1 month by 2 drops in each nostril twice a day. After 30 days of the standard therapy beginning the subgroup CTD1 patients received IRS 19 during two weeks, one intranasal inhalation in each nostril 3 times a day. Patients subgroup CTD2 and CTD+RA instead IRS 19 received Ismigen  after 30 days of the beginning of the standard therapy, during 10 days, sublingually 1 per day.Patients with RA were at the stage of clinical remission and do not receive basic disease-modifying drugs for at least 6 months after the last course of therapy. The effectiveness of the treatment was assessed by the general state of the patients according to oropharyngoscopy, concentration of IgA, IgM, IgG and IFN-γ in serum and sIgA in pharynx secret after 45 days of observation.Antibodies to microbial antigens (antistreptolysin O-hemolytic streptococci) were determined before treatment and after 45 days using passive hemagglutination reaction.Statistical analysis of the results was performed using the Mann-Whitney U test. According to the accepted level of reliability index value between the groups (p), which constituted or were less than 0.05. Results and discussion. 1. In all groups before treatment was determined deficiency of humoral immunity. The level of sIgA was significantly reduced relative to controls as in patients with exacerbation of decompensate form of chronic tonsillitis with RA (CTD + RA group) and in the group with chronic tonsillitis without RA (CTD group). The level of IgG before treatment group CTD + RA was significantly elevated relative CTD group, the comparison group (patients with RA without tonsillitis) and the control group.2. Preparations Ismigen and IRS 19 demonstrated high efficacy as immune modulatory agents in the treatment of decompensate form of chronic tonsillitis in the acute stage. Combined with Derynat use of these drugs after standard therapy allowed to normalize humoral immunity. In the subgroup of patients which received Ismigen level of sIgA after 45 days was significantly higher with respect to the subgroup that received IRS 19. These differences may be related both to the various quantitative and qualitative antigenic composition of the drug, and the difference in the method and circuit their application and in accordance with the bioavailability of the components of bacterial lysates.3. Рatients at CTD + RA before treatment is characterized by elevated levels of ASO for the group CTD. ASO level was significantly higher than normal level in CTD and CTD + RA groups.4. Application of bacterial lysates containing antigens of hemolytic streptococci, such as Ismigen or IRS 19, does not cause increase level of ASO and rheumatoid factor in all groups of patients, indicating an insufficient level of immunogenicity of these drugs to influence the course of RA in the inactive phase of the disease.