Sakarya University, Turkey
Gülay Trak works as a doctor in a University hospital in Turkey. After graduating from the Faculty of Medicine, she has been working as a family physician for 5 years, as an assistant doctor in the field of Microbiology for 4 years and as a Microbiology specialist for the last 7 years. She has been dealing with Hirudotherapy from the field of traditional and complementary medicine for the last 5 years. She has presented his work at various conferences and continues to work in the field of hirudotherapy.
Title: Efficacy of Hirudotherapy for Ankilosing Spondylitis: Case Report and Literatur Review
Gülay TRAK 1, Ä°brahim TEKEOÄžLU 2
1. Sakarya University Training and Research Hospital, Department of Medical Microbiology, Sakarya, TURKEY
2. Sakarya University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Department of Rheumatology, Sakarya, TURKEY
Treatment with leeches has been studied by researchers for centuries for rheumatic diseases, inflammatory diseases or post-surgical complications. There are over 100 bioactive substances with different properties in the salivary gland secretions of leeches. These secretions have been shown to be effective in vasodilation, analgesia, suppression of inflammation, increase of anticoagulation in blood, inhibition of bacterial proliferation, resolution of edema, acceleration of microcirculation, increase of permeability and vitality in damaged vascular structures of organs and tissues, correction of hypoxia, reduction of blood pressure, reduction of pain and regulation of immunity (1).
Food and Drug Administration of USA permitted the sale of leeches and their use in general purpose and plastic surgery and microsurgery in 2004.
Ankylosing spondylitis (AS) is an inflammatory, chronic, progressive disease of unknown etiology. It often presents with insidious onset inflammatory low back pain. It is a disease that progresses with sacroiliac joint inflammation in the early stages and axial and peripheral joint inflammation in the late stages, and can also involve the eye, lung and intestine. The HLA-B27 gene has a great effect on the etiology (2).
The “European League Against Rheumatism (EULAR)” has developed evidence-based recommendations for the treatment and care of patients with AS. Nonsteroidal anti-inflammatory drugs (NSAIDs), local corticosteroid administration, disease-modifying antirheumatic drug therapy such as sulfasalazine (SLZ), methotrexate, and tumor necrosis factor inhibitors from biological treatments are among the treatment options as pharmacological treatments (3). All 3 of our patients have chronic low back pain and are being treated with the diagnosis of AS with axial involvement, which is an etiologically inflammatory disease. Patients regularly use NSAIDs and SLZ 2 gr/day.
Patients received additional leech therapy while continuing standard medical therapy. The difficulty in doing activities at home and at work improved by 40% in the first patient, 25% in the second patient, and 37.5% in the third patient. One month after the leech application, morning stiffness, which lasted for 1 hour, disappeared completely in two of our patients, while it decreased to 10 minutes in the other patient. Fatigue scores of the patients decreased by 50%, 54% and 37.5%. All three of our patients stopped using NSAIDs and stated that they could tolerate their current pain with exercise. According to the VAS pain scale, three patients reported their pain before hirudotherapy as 7, after treatment as 4 in one patient and as 3 in the other two patients. It was observed that CRP values decreased to normal after 1 month in all three patients.
Fatigue, morning stiffness and acute phase reactants decreased in all three patients. There were no side effects.
In conclusion, although there are many studies with hirudotherapy in various diseases in the medical literature, research on inflammatory low back pain is limited. The results obtained from three patients show us that promising results can be obtained with hirudotherapy for AS patients.