The scientific novelty of the treatment program for patients with psoriatic arthritis with naftalan de-tarred purified.

The relevance of the problem. The development of new, highly effective physiotherapeutic technologies suitable for use at all stages of the treatment and prevention of diseases, including rheumatic, is one of the promising directions for the development of restorative medicine and balneology. 
Treatment and rehabilitation of patients with psoriatic arthritis, which occupies a significant place in the structure of chronic inflammatory joint diseases, has important medical and socio-economic significance. The progressive course of more than 50% of patients leads to severe destructive processes in the joints, the development of systemic manifestations, disability and a noticeable deterioration in quality The use of modern medications in the treatment of PA, despite the obvious effectiveness, often becomes unacceptable for the patient due to the nature of the development of serious complications. Therefore, the search for effective and safe treatment methods, including methods of rehabilitation therapy, the development and improvement of rehabilitation programs for patients with PA remains relevant. Particular attention is paid to tools that can influence the course of the main clinical syndromes - skin and articular, based on the relationship and interdependence of these processes. 
Tarred naphthalan is a unique balneological factor obtained from naphthalan oil and is characterized by a systemic multifunctional nature of the action. Despite the effectiveness of naphthalan and its preparations in the treatment of rheumatic diseases of the joints, chronic dermatoses, including psoriasis [53, 32], technologies for its use in patients with PA have not been developed. Unresolved issues regarding the mechanisms of the biological effects of naphthalan oil, in particular the impact on the immune-mediated inflammatory process that underlies the development PA The reaction of the skin is of paramount importance, since in PA, the skin is both a target organ affected by the disease, and an organ of influence and transformation of the energy of the physical factor. Therefore, an in-depth study of the responses of the skin of patients with PA to the action of tarred naphthalan could expand the understanding of the mechanisms of its therapeutic effect and reveal the patterns of sanogenetic processes that arise as a result of such an action. skin and joint tissues could help identify the features of the formation of the pathological process in this disease. sume evident that the problem of reducing chronic systemic disease with progressive, which include the PA can not be sufficiently solved by using one physical factor. Given the complexity of the etiology and pathogenesis of the disease, physiotherapeutic effects should be directed both at the determinant of the pathological system and at stimulating existing or emerging mechanisms of compensation, regeneration, and restitution [20, 75]. This can be achieved by the combined action of physical factors. From this point of view, in our opinion, in the rehabilitation of patients with PA, the complex application of tarred naphthalan with DMV, IR LILI, and DUV radiation seems promising. The theoretical prerequisites for the use of these factors in PA were modern ideas about the mechanisms of their therapeutic and biological effects. Thus, the foregoing indicates that the creation of new pathogenetically substantiated technologies for the rehabilitation treatment of patients with PA taking into account the clinical course of the disease, the development of therapeutic meyudic and assessment of their therapeutic effectiveness is an urgent problem of modern restorative medicine and rheumatology. 
Objective: to substantiate the scientific and methodological principles of medical rehabilitation of patients with PA based on new pathogenetically justified physiotherapeutic technologies, including tarred naphthalan, its combination with other physical factors, the study of the mechanisms of their therapeutic effect. 
Research Objectives: 
1. To determine the rehabilitation possibilities of using tarred naphthalan in patients with PA, to develop methods for its use taking into account the clinical course of the disease. 
2. To study the effect of rehabilitation complexes, including tarred naphthalan, DMV, LNIL and DUV on the condition of articular and skin syndromes, according to immediate and long-term results. 
3. In patients with PA to identify the effects of tarred naphthalan, its combination and combination with other physical factors on indicators of local and general inflammatory activity, cellular and humoral immunity.
4. Using immunohistochemical research methods to study the nature of the immune response in the skin of patients with PA before and after exposure to the tarred naphthalan, to determine the phenotypic features of immunocompetent cells in the skin and synovial fluid. 
5. To evaluate in comparative aspect the effectiveness of the studied methods of physiotherapy and based on them to develop rehabilitation complexes for patients with PA.
6. To develop a scientifically-based differentiated approach to the use of rehabilitation complexes in patients with PA taking into account the severity of the pathological process and clinical options for arthritis. 
7. Determine the indications and contraindications for prescribing the application of tarred naphthalan, as well as the developed complexes of rehabilitation treatment for patients with PA, taking into account the peculiarities of the clinical course of articular and skin syndromes.Scientific novelty. A new scientific direction has been formed in the field of restorative medicine, physiotherapy and rheumatology, considering the tarred naphthalan and its combination with other physical factors (UHF, IC NILI, DUV) as an important component of an integrated systematic approach to the medical rehabilitation of patients with inflammatory joint diseases on the basis of the PA model. Based on the results of clinical, biochemical, radioisotope, immunological, immunomorphological studies, scientific substantiation of their use in PA is given, depending on the severity of the inflammatory process and the clinical variety of the disease.It has been established that tarred naphthalan is an effective, pathogenetically substantiated means of treating and rehabilitating patients with PA, capable of exerting influence on the main clinical syndromes of articular and skin diseases. The use of local applications of tarred naphthalan on the affected joints both as a monofactor and in combination with IR LILI or UHF, with differentiated and correct prescription in patients with PA, causes anti-inflammatory, analytical, anti-edematous, antispasmodic effects that lead to suppression of inflammation and pain relief in affected joints, restoration of range of motion in them. Tarred naphthalan has a regenerating and anti-inflammatory effect on skin manifestations of the disease, promotes regression and resorption of psoriatic elements, reducing the area of the affected surface, and reducing the intensity of clinical signs.According to the results of immunohistochemical analysis in patients with PA against the background of secondary immune deficiency, local disturbances of the immune response in the affected tissues were revealed, manifested in the synovial fluid by a predominant population of mature T-lymphocytes (CD3 +), CD4 + and CD8 + effector cells, cell adhesion molecules (CD29 +, CD50 +); in the skin with epidermotropism of mature T-lymphocytes and their predecessors, the dominance of intraepidermal CD7 + and CD8 + cells over CD3 + lymphocytes, as well as an imbalance of HLA DR + and CDla + dendritic cells in the epidermis, uneven distribution and a decrease in the number of Langerhans cells. It was noted that in patients with PA, epidermal keratinocytes can acquire the ability to synthesize a transplantation antigen of class 2 -HLA DR, which confirms their active participation in skin immune responses and this, possibly, is a predictor of the development of articular syndrome in patients with psoriasis.It was established that the therapeutic effect of naphthalan therapy on the skin is provided by the correction of deviations in the immune system, which is manifested by a decrease in the epidermis of the proportion of keratinocytes expressing the HLA DR antigen, cells, carriers of the vla-p adhesive molecule, the severity of dermal infiltration from mature and cytotoxic lymphocytes, as well as an increase in the number and restoring uniform distribution in the epidermis of Langerhans cells; most accurately, the degree of completeness of clinical remission of skin lesions in patients with PA reflects the dynamics of a decrease in the expression of HLA DR on keratinocytes.It has been proven that the action of tarred naphthalan in combination with IR LILI or DMV, as well as exercise therapy and massage is superior in effectiveness to monotherapy with the indicated physical factors, expands the possibilities of medical rehabilitation and allows it to be prescribed in a heavy group of patients with PA. It is shown that the most pronounced effectiveness in relation to The skin process has the combined use of tarred naphthalan and DUV rays. The use of new rehabilitation technologies improves the course of PA, promotes remission and reduces the frequency of exacerbations, and leads to an increase in the quality of life of patients with severe disabling disease. The data we obtained allowed us to expand our understanding of the ways of implementing the therapeutic effect of the physiotherapeutic methods used and to reveal the sanogenetic orientation of the new developed technologies. 
For the first time, new technologies have been developed and scientifically substantiated for the rehabilitation treatment of PA based on local naphthalanotherapy and its combination with other physical methods - the effects of IR LILI, DMV, DUV, exercise therapy and massage,