Osteoarthritis of the knee joint treatment

Than to treat arthrosis of knee joint

Than to treat arthrosis of knee joint

Today it is more often possible to hear complaints of people on pains in the area of ​​knees. And talk about it all, and athletes, and people who are overweight, elderly patients, and, just those who daily have excessive loads. Pain in the knee joint may indicate the onset of various diseases.

The most common disease affecting the predominantly knee joints is arthrosis. In people, this disease is simply called the deposition of salts, and doctors - gonarthrosis. If the disease is not treated, it threatens the patient with complete destruction of cartilage and exposure of the underlying bone, the appearance of osteophytes and complete deformation of the joint.

The appearance of osteophytes and the complete deformation of the joint.

How to recognize arthrosis of the knee joint

The most common symptom of the onset of gonarthrosis is pain in the knee joint region. At the same time, the disease does not occur sharply, the pain will increase over many months and even years. First they will disturb the patient only with increased stress on the legs, and then even at rest. Arthrosis can be distinguished from other diseases by the fact that the pain syndrome has an increasing character, therefore, if acute and sharp pain occurs, another disease should be suspected.

Gonarthrosis can occur in three stages, each stage will have its own distinctive features. The first stage is accompanied by such symptoms as: insignificant limitation of joint mobility and light crunch;slight fatigue;moderate pain in the affected area. The pains will not be strong at all, more aching and stupid, arise periodically.

Usually, a person feels them after a morning awakening at the first steps and while walking the stairs. In a calm state the limbs of pain are absent. At this stage, the bones have their original shape and do not deform. Only on the radiographic image can you see a small narrowing of the joint space.

Clinic of the disease

During the second stage without complex treatment is no longer enough. The patient will suffer pain even with the slightest movement, and even more intensify even with minor loads and while walking. Pain syndrome can only be released after a very long rest. This stage is characterized by a more distinct crunch in the knee joint.

Radiography will show: the narrowing of the joint gap is two or even three times higher than normal;osteophytes are clearly visible and in most cases there is fluid accumulation in the joint.

The third stage of gonarthrosis is characterized by severe pain, which is present even at rest. At this stage, it is very difficult for the patient to find a comfortable position, to attach the leg in such a way that at least slightly reduce the not leaving feeling of pain. The X-ray picture shows the absence of an articulation gap, deformation of the joint surface, tofu are very pronounced.

Types of gonarthrosis

There is a primary and secondary arthrosis of the knee joint.

Primary type often appears later disturbances of metabolic processes in the tissue area of ​​the joint. This type is usually sick elderly people, women with excess weight, and often those who have a disturbed exchange of venous bleeding in the extremities and endocrine disorders.

Secondary gonarthrosis

Secondary gonarthrosis occurs as a result of a previous illness or knee injury.

Treatment of arthrosis in the knee

Of course, the most important and basic issue of patients is the question: "How to treat arthrosis of the knee joint?".First of all, when treating this disease, doctors direct all their actions to eliminate pain and inflammation. And only after the patient feels relief, they proceed directly to the effect on the causes of unbearable pain, that is, arthrosis.

The volume of complex treatment will depend on the severity of the lesion and the stage of arthrosis. Due to the fact that the disease is chronic, the maximum that doctors can achieve is prolonged remission. But if the patient asked for help at the earliest stage and together with the attending physician it is possible to eliminate the cause of gonarthrosis( for example, weight loss), then it is completely possible for the patient to recover completely.

Treatment of arthrosis of the knee joint has a wide range of therapeutic techniques

The main ways that doctors resort to in the treatment of arthrosis in the knee are:

  • use of medicines;
  • surgery;
  • massage;
  • manual therapy;
  • reconstitution therapy.

Do not self-medicate, diagnose the disease correctly, and only a doctor can prescribe a rational treatment, based on the survey.

Therapeutic treatment includes the administration of NSAIDs and chondroprotectors. NSAIDs are indispensable in the treatment of knee arthrosis, but due to the fact that they negatively affect the stomach and intestines, they are used in short courses. This group includes such drugs: indomethacin;Voltaren;butadione;nimesulide;meloxicam and others.

No less important and very effective in the treatment of knee arthrosis are chondroprotectors, such as: arkoxia;teraflex;chondrosamine;structum and others. Chondroprotectors play a very important role in the treatment, since they not only help to reduce the pain syndrome, but also restore cartilaginous tissue and normalize the production of joint fluid. This group of drugs is very effective at the 1 st and 2 nd stages, when the remains of the cartilage tissue are still present in the joint. In the third stage, it is already meaningless to take them, because there is nothing to restore, the cartilage is completely destroyed.


Great value in the treatment of gonarthrosis is given to local treatment with the use of ointments, gels, creams. The most widely distributed are: voltarene-gel;nicoflexin;menovazine;espol;gevkamen;fasts and many others. Often a positive effect is given by compressive agents based on dimexide, bischofite, bile medical.

Physiotherapy treatment is carried out at the stage of abating the pain syndrome and only after the acute period of the disease has passed. Usually patients are prescribed:

  • electrophoresis;
  • laser therapy;
  • ozokeritotherapy;
  • massage, manual therapy;
  • medical gymnastics;
  • reflexotherapy.

Surgical treatment of knee arthrosis

Operative intervention is used in case of ineffective therapeutic treatment, or when the disease has reached the third stage and the knee joint has undergone irreversible changes.

There are several options for surgical treatment: artodesis and prosthetics. The arthrodesis consists in a kind of immobilization of the joint, which helps to eliminate the pain syndrome. Prosthetics is a more modern method, with the help of special prostheses complete and partial replacement of the damaged joint is carried out.


Treatment of gonarthrosis with folk remedies

The greatest effect from the treatment of arthrosis in the knee joint can be achieved by combining traditional methods of treatment with folk remedies. One can cite an example of several very effective compresses based on natural products and herbs.

Very well promotes the removal of the pain syndrome tincture of the lice. To make it, you will need: fill a 3-liter bottle of lycopene and pour 0.5 liters of vodka. Then pour the grass with boiled cold water until it is completely covered and covered with a lid, put it for ten days in a dark place. Take three teaspoons a day.

Another very effective tincture on the leaves of a golden mustache. It is necessary fifteen leaves of a golden mustache( without stems) to fill half a liter of boiling water, cover with a lid and cover with a coverlet. Wait until the infusion cools, then drain and take after eating 25 milliliters three times a day.


It is also possible to quickly remove inflammation in the knee joint by applying to the diseased knee the leaves of cabbage, pre-lubricated with honey. Wrap and leave for the night. You can use the usual burdock leaf, attach it to the affected area, wrap it with cellophane and top with a warm scarf, leave it overnight.


In order to avoid such a disease as knee arthrosis, several very important rules should be followed. First, it is right and balanced to eat. Secondly, to lead a healthy lifestyle and monitor weight. Third, to conduct adequate physical activity.

Video - How to treat arthrosis of the knee joint


Osteoarthritis of the knee joint: treatment at home. Treatment of arthrosis of the knee joint folk remedies

Everyone knows the complaints of elderly people for pain in the knees, a crunch, the inability to move freely. In medicine, this condition is referred to simply as arthrosis of the knee joint. It is necessary to know what kind of disease it is, how to treat it at home, what folk remedies to use, what auxiliary methods and exercises will be needed to improve the quality of life.

Clinical picture of

Osteoarthritis is a series of pathological changes in the body of the joint. It is thinned, deformed, the structure of the cartilaginous tissue changes. Osteoarthritis does not occur suddenly, the disease develops over the years.

There are 4 stages of arthrosis:

  • 1 stage - pathological process at the cellular level, thinning of the joint. Asymptomatic.
  • 2nd stage - the beginning of joint destruction. There is a crunch, pain, swelling of the knee.
  • Stage 3 - progresses knee arthrosis, its symptoms become pronounced, the patient experiences severe discomfort.
  • Stage 4 - destruction of the knee joint, disability, the need to replace the joint.

As a rule, the first symptoms appear in people after forty years( women are 2 times more likely than men).However, today, arthrosis has grown younger, its signs are observed even in 20-year-olds.

Who should think about?

In the risk group are:

  • people with excess weight;
  • leading a sedentary and stressful lifestyle;
  • professional sportsmen and amateurs, keen on sports with a heavy load on the knee joints( runners, football players, weightlifters);
  • people who have had knee injuries;
  • are people whose professional activities are associated with a heavy load on their knees;
  • fans of restrictive diets;
  • people with hormonal and autoimmune diseases, the consequence of which is the pathology of bone and cartilaginous tissue;
  • patients with infectious lesions;
  • people suffering from long-term parasitic diseases.

All these reasons contribute to the development of arthrosis at an earlier age and severe course of the disease.


The main insidiousness of the disease lies in the fact that in the first stage it does not manifest itself at all, and the patient simply does not know about the problem. The second is characterized by discomfort, to which the future patient does not pay attention. Athletes write off the arising pains and crunch for a big load, office workers - for sedentary work. As a rule, most people seek medical care at the third stage of the course of the disease, when severe pain and limited mobility occur.

Osteoarthritis is diagnosed by:

  • X-ray examination;
  • clinical blood test( arthrosis of the knee joint of the third degree can be diagnosed exactly so);
  • visual inspection;
  • puncture knee fluid.

As a rule, a competent doctor can diagnose arthrosis according to a specific clinical pattern characteristic of the disease.

General treatment

There is an opinion that arthrosis can not be cured. This is not quite true. In the list of diseases that can be completely cured, the knee arthrosis has recently been listed. Treatment of it is long and requires a systematic approach. In addition, a complete cure is possible in the diagnosis of the disease at its 1-2 stages.

For arthrosis of the knee joint, the following treatment methods are used:

  • drug therapy;
  • physiotherapy with the use of low-frequency and high-frequency currents, magnets, laser;
  • hydrotherapy( water treatment);
  • medical gymnastics;
  • massage;
  • diet;
  • therapeutic ointments;
  • aids( bandages and knee pads);
  • folk methods;
  • surgical intervention( used for 4 stages of the disease, joint replacement).

With regard to medical and physiotherapy treatment, it is used in courses supervised by a doctor. The operation is indicated if the destructive processes in the joint threaten the patient with a disability. Other methods of the patient can be used independently for a long time.

Medical treatment

Let us briefly consider what preparations can eliminate arthrosis of the knee joint. Treatment at home implies the use of:

  • corticosteroids( "Hydrocortisone");
  • chondroprotectors( "Glucosamine");
  • analgesics;
  • vitamin complexes.

We will not consider therapy in the hospital. It is indicated for severe lesions and is prescribed individually by a doctor. It is important to understand how to treat arthrosis at home effectively and safely.

Home treatment

Therapy is long-lasting and systemic. In any case, you should apply for a doctor appointment and be patient - rehabilitation can take years. Elderly, the treatment of arthrosis is often shown at home, age-related destructive changes in joints, medicine can not stop.

For a complete cure there is a chance for people up to 40-50 years. The exception is the elderly, who completely changed their thinking and way of life and got rid of arthrosis( and other age-related diseases) in 70, 80, 90 years. So everyone has a chance to eliminate arthrosis of the knee joint. Treatment at home implies:

  • use of folk remedies, therapeutic ointments;
  • diet;
  • performing gymnastic exercises;
  • wearing knee pads and other auxiliaries( elastic bandage, for example).

Naturally, a noticeable effect is provided by a combination of all the methods of treatment and rehabilitation. They need to be considered in more detail.

Folk remedies

Even medicine recognizes that folk remedies have an excellent effect. Osteoarthritis of the knee joint and treated with such proven methods:

  • In equal parts, prepare the sheep oil, the leaves of the nettle are burning and the juniper berries are green. Rastolkite the leaves and berries, combine with the oil. Stir thoroughly. Ointment should be stored in the refrigerator in a bowl of dark glass. Rub daily in the knee in the mornings and evenings.
  • Warm the knee with a warm compress with sea salt for half an hour. Fry the fir oil in the affected joint. Do the procedure with the courses, once a day.
  • Take clean sand, heat it, lay it on a natural linen or cotton cloth, warm the joint for about an hour. Do the procedure once every 2-3 days.
  • Wash the joint with a glove, scarf, dog fur belt.
  • Mix 200 grams of fat-free cottage cheese with 200 grams of kefir. Fold the cheesecloth into 4 layers and put the composition on it, wrap it. Attach to the knee, cover with parchment and warm it with a warm kerchief or scarf. The inflamed joint will absorb all the liquid. Repeat ten times.
  • Apply to the knee the leaves of burdock, oiled with honey.
  • Rub olive oil with essential oil of lemon( 200 grams of butter and 5 drops of lemon oil).

Change the money alternately. Use their courses.

The use of medicinal ointments

Ointments can be purchased both in the pharmacy and prepared independently. Apply them regularly, apply by massage or rub.

Ointments for joint treatment and rehabilitation are divided into:

  • pain relievers;
  • chondroprotectors;
  • is an anti-inflammatory;
  • regenerating.

Ointment for arthrosis of the knee joint is applied depending on the course of the disease. Anesthetics and anti-inflammatory drugs must be used in acute stages. Chondroprotectors and regenerating - courses, to restore cartilaginous tissue.

In any case, the use of funds must be agreed with the attending physician. Chondroprotectors for arthrosis of the knee joint are also used in the form of ointments. They directly affect cartilage tissue and have a restoring effect. Ointment for arthrosis of the knee joint of this kind is not contraindicated, but it is dangerous to engage in self-medication.


Special therapeutic nutrition is very important. Wrong diet is one of the factors that cause arthrosis of the knee joint. Treatment at home implies the daily use of such products:

  • fruits, vegetables, berries;
  • dairy products;
  • freshly squeezed juices from carrots, beets, parsley, celery, apples( you can make drinks from any combination of fruits and vegetables);
  • whole grains;
  • gelatin-containing products( jelly, jelly, jelly).

Therapeutic diet should begin with the cleansing of the body for a period of 3 days. You can eat rice, raw fruits and vegetables. The purpose of this purification is to remove the dead tissue, cleanse the body, start the restoration program.

In days of medical cleansing hormonal preparations( for example, "Diprospan") and chondroprotectors for arthrosis of the knee joint should not be used.

Such three-day cleaning stations should be held once a month. In the rest of the time, profess the principles of proper nutrition and remember that arthrosis is best friends - alcohol, cigarettes, fast food.

Gymnastic exercises

Most patients think that a fat cross on physical activity puts arthrosis of the knee joint. Treatment at home implies regular and competent physical activity.

It is desirable that the medical complex is picked up by the doctor individually, proceeding from the course of the disease. Gymnastics with arthrosis of the knee joint is not just important, but it is obligatory. In any case, you see such types of loads:

  • swimming;
  • medical gymnastics;
  • yoga;
  • minimal aerobic load in the stage of joint repair.

Some physicians recommend lightweight dance gymnastics to their patients with arthrosis of 2-3 degrees, however, in the 3-4 stages with explicit destructive processes, loads of this kind are prohibited.

Gymnastics for arthrosis of the knee joint should be combined with massage and applications. Your task is to preserve mobility and restore tissue. According to the experience of patients, regular gymnastic exercises give a wonderful recovery effect.

Knee pads

Osteoarthritis is characterized by destructive processes in the joint tissue. Therefore, knee joints are used for arthrosis. How to choose them?

  • Materials should let in air, do not cause discomfort, allergies.
  • Choose products from reputable companies.
  • Dimensions of the knee should correspond to the individual shape of the knee and the nature of the deformation of the joint.

For proper selection of the knee joints, consult a physician. But only wearing them will not solve the problem. Combine use with other therapies.

The disease that many people have to face is arthrosis of the knee joint. Treatment at home will help not only to stop the course of the disease, but also contribute to the almost complete restoration of the articular tissue. However, remember that the effectiveness of the methods used depends only on you.


Effective treatment of knee joint gonarthrosis

The structure of the knee joint of a person

Problems with joints are familiar to almost every second person on Earth. Modern methods of treating the disease help the body to mobilize its own resources, open new resources and be healed of such a disease as gonarthrosis of the knee joint. There are indications and contraindications for any kind of medication, as well as nuances, non-observance of which causes harm to health.

How to treat gonarthrosis of the knee joint and what effect does this or that medical preparation give? The pain can be successfully eliminated if the doctor has sufficient knowledge and can make a specific plan of treatment for the patient. Self-medication of joint ailments is unacceptable and entails dangerous consequences for the diseased organ.

Knee joint gonarthrosis is accompanied by numerous symptoms, characteristic of other diseases, so the specialist should always monitor the progress of treatment and the performance of prescribed procedures. The doctor who is treating the gonarthrosis of the knee joint 1 degree, assigns a complex of medical procedures to the patient, which contribute to the following important tasks:

  • improvement of the cartilage nutrition process;
  • elimination of pain symptoms;
  • adjustment of pressure on the joint area;
  • preservation of mobility of the cartilaginous joint.

Ointments and creams for the treatment of gonarthrosis

Having set a specific goal, a person seeks to cure the ailment with the help of ointments and anesthetic gels or creams. It is important to remember that anesthesia with ointments is a symptomatic treatment that is not capable of eliminating the cause of the ailment, but which brings relief in an uncomplicated process.

Cartilage gradually deteriorates, leading to destruction of the joint bones

Knee joint gonarthrosis is treated with warming ointments that improve blood circulation in the affected organ. When they are applied, the mechanism for reconstructing the blood filling of the cartilage tissues is triggered. For treatment use such preparations:

  • "Espol";
  • "Nikofleks";
  • "Menovazine";
  • "Fast Relief".

Therapeutic ointments have a therapeutic effect, penetrating through the skin. They pleasantly warm, soothe the skin. When using local anesthetics, the overall psychological mood of the patient is important. With the development of clinical manifestations of synovitis, the physician recommends that gonarthrosis of the knee joint be treated with ointments containing non-steroidal components.

  1. Indomethacin and turpentine ointments.
  2. "Fastum-gel".
  3. "Apizartron".

Treatment of gonarthrosis of the knee with non-steroid ointments is less effective due to the insignificant penetration of the active substance to the diseased organ.

Application of chondroprotectors

Chondroprotector is a drug that is injected directly into the joint

Quite often the doctor recommends that patients begin treatment with chondroprotectors that repair the cartilage base and supply it with the necessary nutrients. The state of cartilage is well influenced by glucosamine and chondroitin sulfate. When the diagnosis of "knee joint gonarthrosis" is required not only to eliminate the symptoms of arthrosis, but also to work on the cause of the disease.

Glucosamine heals the cartilage surface, and also promotes:

  • to improve the formation of synovial fluid;
  • change and normalization of its qualitative composition.

Gonarthrosis 1 degree is treated very quickly and successfully if the doctor uses chondroitin sulfate and glucosamine. In more advanced cases, treatment with chondroprotectors is less effective due to the complete destruction of the cartilaginous tissue. In the second and third stages of knee joint gonarthrosis, chondroprotectors stop the development of the disease very slowly.

The course of therapy lasts 3 months, during which glucosamine or chondroitin sulfate is taken. To achieve a stable result, you need to undergo 2-3 courses of treatment. The funds prescribed by the doctor after the examination and diagnosis, help the patient to effectively combat the disease, especially with the disease of the knee joint 1 degree.

For therapy use monopreparations and combined agents:

  • "Artra";
  • "Chondroitin AKOS";
  • "Dona";
  • "Hondrolon".

Popular Medication for Arthras

Chondroprotectors do not have contraindications and only in case of individual intolerance cause side effects. Among them, most often there is an allergic reaction. There are also such symptoms:

  • insomnia;
  • headache;
  • diarrhea;
  • constipation.

Caution should be given to biologically active additives containing glucosamine and chondroitin sulfate. They are not medical devices and can harm a person's health.

Treatment of joint damage of 1 degree

If signs of gonarthrosis show up, treatment of joint fatigue and restriction of movements should be started as early as possible to obtain a quick effect. Medicinal products should fulfill the main therapeutic task - reducing the burden on the affected joint. Treatment of gonarthrosis of the knee joint involves diet food, exercise therapy.

To achieve maximum effect, the doctor suggests the patient:

  • exercise therapy;
  • sanatorium treatment;
  • massage.

The medicamentous effect consists in the use of anti-inflammatory drugs, hormonal and anesthetic drugs, chondroprotectors. Anti-inflammatory drugs eliminate pain in the joint, reduce inflammation and promote faster recovery. The result of treatment depends on how the disease proceeds. Before prescribing NSAIDs, the doctor examines the patient's state of health, since these drugs are contraindicated for people with liver, kidney, stomach ulcer.

It should be remembered that anti-inflammatory drugs do not treat gonarthrosis, but only eliminate pain in the joint. Long-term therapy with drugs leads to a disruption in the supply of cartilage to water, exacerbation of the inflammatory process and destruction of the cartilage of the diseased joint.

Doctors recommend the use of drugs that have a selective effect, for example, "Movalis."This medicine has no dangerous side effects and does not destroy articular cartilage. It can be taken for a long time, but only under medical supervision, until the patient feels better.

Folk treatment for joints sufferers

Phytotherapy of articular ailments can effectively remove inflammation of the hip and knee joints, eliminate pain attacks. Treatment of sawdust from pine, fir, spruce has a calming effect. These substances are used as an integral part of compresses that do not cause any harm, if there are no abrasions on the skin.

Nature is a universal healer, and preparations from laurel leaf relieve inflammation and treat sick joints no worse than medications. Collected herbs, carefully selected, used for articular ailments, using as infusions and broths. Treatment with folk remedies involves the use of sunflower. From his baskets, a medicinal ointment is made for rubbing into the patient's skin several times a day. Tincture of dried chestnut flowers on turpentine eliminates pain and deformity in the joint. She warms up the affected tissues well, relieves pain. During treatment, drafts must be avoided.

An effective remedy is the Caucasian hellebore and a drug based on it. After its use in patients, pain disappears, inflammation passes, joints are freed from salt deposits. Oil based on a resin, with the addition of ginger, juniper, propolis, relieves inflammation, removes puffiness and pain.

In case of joint diseases, it is useful to take medicinal sage preparations or to make triturate from turpentine turpentine, pork fat, iodine and aloe juice. Turpentine baths are used at 1 degree of arthrosis. They greatly facilitate the patient's condition. Before their application it is necessary to consult a doctor, as they are contraindicated in case of increased blood pressure, heart disease, after a stroke. In the period of exacerbations of the disease, the patient is also helped by coniferous baths, which relieve pain and muscle spasms. The fees for gonarthrosis include:

  • birch leaf;
  • flowers of violets;
  • nettle leaf.

Treatment of phytopreparations facilitates the patient's condition in 1,5 months after the start of treatment. Metabolic processes improve the collection of clover, linen and grass sabelnik. Patients should not wait for the full stiffness of the joint. They need to include a day of exercise for the joints, which are gentle. Do not exercise when exacerbated. The result is Nordic walking, which has a healthy character. Use a pedometer for lessons, gradually increasing the path to 10,000 steps per day.

For many years, the condition of patients helps to ease the saber. It suppresses the formation of salts in the joints, cleans the cells of accumulated toxins. From the grass, the plants are made to infuse, for 10 days, an ointment is used from the rhizomes and stems of the saber. Ointment is rubbed into sore spots and covered with a warm cloth. When the disease worsens, the treatment continues: a more vivid manifestation of the symptoms testifies to the effective action of the plant on the diseased joint.

Treatment of gonarthrosis is long, symptomatic. To date, there are no highly effective drugs that affect the mechanism of the disease. Physiotherapy and medicines are the basis of complex treatment of joint diseases.


Arthrosis of the knee joint: treatment and prevention

Arthrosis of the knee joint( gonarthrosis) is a disease that over time causes irreversible changes in the cartilage, leading to its gradual destruction due to circulatory disorders and the occurrence of degenerative processes in the joint. Timely medical treatment, physiotherapy, massage and gymnastics can slow the development of gonarthrosis.

How the knee joint works and its function

To understand how and what to treat gonarthrosis, it is necessary to remember a few basic features of knee functioning. This joint is formed by articular surfaces of the femoral and tibia, which are covered with hyaline cartilage. To ensure the congruence of the surfaces in the joint, the medial and lateral menisci are provided. In addition, the knee is strengthened by ligaments( some of them pass into the joint cavity) and the periarthric bag.

Inside the knee is a synovial fluid that provides lubrication of the joint, feeding the cartilage surface and preventing friction of the joint surfaces from each other. The peculiarities of the structure of the joint are such that only 2 kinds of movements are performed in it: extension and bending of the knee, and also, if the leg is bent in the knee, rotation around the axis. The knee joint is one of the largest joints of the body, and it is on it that the main load is when the person is standing. It increases significantly when lifting weights, excessive body weight, jumping and running.

Causes of arthrosis

There is a primary and secondary gonarthrosis. The primary form of this disease develops due to anomalies of the femoral or tibia, ligaments or surfaces of the joint. In this case, the knee experiences strong overloads, which provoke the destruction of the cartilage.

Secondary form is caused by injuries and knee diseases. Its main causes are:

  • injuries of the knee of a traumatic nature - ruptures of ligaments, sprains, fractures of bones, etc.;
  • removal of the meniscus - increased wear of the hyaline cartilage;
  • excessive load on the joint in athletes and people engaged in certain types of professional activities or are overweight.
  • inflammatory diseases of the knee joint - arthritis. Long-term arthritis also leads to a disruption of cartilage nutrition and may eventually be complicated by arthrosis;
  • metabolic diseases that lead to the deposition of salt in the joint;
  • disease of the nervous system or blood vessels, resulting in impaired innervation and nutrition of the knee joint.

Depending on the cause, arthrosis can develop on one or both knees. One-sided process most often occurs due to injuries, operations, and bilateral - with excessive body weight.

What happens in the joint with gonarthrosis?

Violation of the blood circulation of the joint due to spasm of blood vessels or other causes leads to disruption of microcirculation and hypoxia of the cartilaginous tissue, which is accompanied by the gradual death of cartilage elements and its destruction. If the degenerative process affects the synovial membrane, then it begins to produce only a small amount of intra-articular fluid, there is "dryness of the knee".The particles of the destroyed cartilage in the joint cause reactive inflammation of other cartilage elements and promote the release of liposomal enzymes, which further dissolve and destroy the intraarticular surfaces.

Symptoms of gonarthrosis

  1. Initial stage. From time to time a person is worried about knee pain, especially if you need to climb or go down the stairs, get up after sleeping off the bed. It has been observed for several years.
  2. The second stage. Pain sensations and crunching occur when any movement is made. On the roentgenogram, signs of beginning degeneration of articular surfaces are revealed. The volume of movements in the joint is somewhat reduced.
  3. Third stage. The pain does not pass even at rest, the joints can no longer bend or unbend until the end, resulting in a change in the gait: it becomes "in the garbage".O- or X-shaped deformation of the knee joints is observed.

Which doctor treats gonarthrosis?

This depends on the stage of the disease and the intensity of the pain syndrome. For example, a patient can be referred to an orthopedic traumatologist, a rheumatologist, and in more mild cases of arthrosis - even to a therapist or family doctor. In any situation, the treatment of arthrosis of the knee joint at all stages of the disease should be complex and selected individually.

How to treat arthrosis of the knee?

The exact amount of treatment depends on the stage and severity of gonarthrosis. In any case, its goal is to achieve a stable and long-term remission, and in the early stages and completely cure it, eliminating the effects of the causes that caused it( for example, normalizing body weight).

The main goals of treating knee arthrosis:

  1. eliminate pain;
  2. provide cartilage nutrients by slowing or completely stopping its destruction;
  3. increase the amount of motion in the joint.

Drug treatment

In order to reduce a painful attack, to eliminate reactive inflammation and relieve exacerbation, hormonal and non-steroidal anti-inflammatory drugs( injections, tablets, ointments) - diclofenac, indometacin, ibuprofen or NSAIDs of the new generation( movalis, xsefokam) are used.

Chondroprotectors( chondrotic, dona, mucosate) help normalize cartilage nutrition and prevent its further destruction. However, they do not relieve the pain, so patients are not always sure that they help. In fact, these drugs are included in the basic therapy of joint diseases, because they create a fertile soil for the restoration of cartilage and its protection against new injuries. In addition, substitutes for intra-articular fluid and stabilizers for lysosomal membranes are used. If necessary, blockade of the joint can be performed. To improve blood circulation with arthrosis, tablets are prescribed or injections of no-shpy and other antispasmodics.

Physiotherapy and therapeutic gymnastics

On the effectiveness of physical therapy and exercise therapy without exacerbation - this is the best medicine for arthrosis. Physiotherapeutic procedures usually use:

  • laser therapy;
  • electrophoresis of medicinal solutions;
  • magnetotherapy;
  • inductotherapy;
  • impulsive currents;
  • ultrasound;
  • paraffin and mud treatment.

At home, it can be warming compresses, knee self-massage or contrasting baths, which also improve blood circulation. LFK provides for the performance of exercises that are performed with a minimum load on the joint. For example, swimming, aqua aerobics, an exercise bike, and also isometric exercises, performed mainly in a lying or sitting position.

X-ray therapy and surgical treatment

X-ray therapy is prescribed for advanced cases of gonarthrosis, severe pain syndrome and ineffectiveness of other treatment methods. If the joint is completely destroyed and can not perform its functions, replace it with an endoprosthesis.


In order to prevent exacerbation and further destruction of cartilage, the following is necessary: ​​

  1. diet, which helps to normalize body weight and contains all the microelements necessary for cartilage, vitamins and nutrients;
  2. physical activity. When gonarthrosis can not overload the knee, so running, jumping, long standing on your knees should be replaced by an exercise bike or riding a bicycle, swimming or aqua aerobics. You should also perform a set of exercise exercises on a daily basis, which the doctor will recommend;
  3. comfortable shoes. In this case, the studs or simply high unstable heels will also contribute to the progression of gonarthrosis, therefore it is desirable to refuse this type of footwear.


Osteoarthritis of the knee joint treatment at home

Osteoarthritis of the knee joint is most often found among other types of arthrosis. Is it possible to cope with this disease on your own? If arthrosis of the knee joint is detected, treatment at home involves the use of many available means.


General rules for feeding

At home, treatment of arthrosis must begin with a correction of nutrition. You should increase the intake of calcium( for example, in almonds, dairy products), vitamin E( in sprouted wheat), B vitamins( in pasta and whole grain bread).Limit the use of salt. Enlarge the vegetarian food in the form of salads and vegetables after a quick heat treatment.

Harmful and healthy products

When treating arthrosis from the menu, it is better to remove acidic fruits like lemons, grapefruits, oranges. Alcohol and coffee are undesirable. Meat consumed in the minimum amount. Flakes and dried fruits are not recommended.

Very useful cold prepared on bone broth. It contains collagen, necessary for building bone and cartilaginous tissue. Another useful product is food gelatin, which contains chondroprotektory - restorers of cartilaginous tissue.

Medical gymnastics

A set of three exercises can be performed even in a very neglected case of knee arthrosis.

  1. «Humpty Dumpty».Sit on a table or a high chair. The legs should hang freely. They need to be slightly rocked with an amplitude of not more than 10 cm. Perform relaxed and easy. The heaviest patients can perform every hour for five minutes. The rest - a few times a day for 510 minutes.
  2. Toptop. Sitting on a chair to put his feet on the floor. Lean on the toe and tear off the heel from the floor by 12 cm, then lower the heel freely. After three seconds, repeat the motion. If both legs are sick, you should alternately perform movements, pausing in a few seconds.
  3. "Schlepshlep".Sit like in exercise 2. Lean on the heel and slowly, relaxed slap on the floor with socks. Socks lift from the floor no higher than 12 cm between the movements to pause in 3 seconds.

The described exercises should not be accompanied by painful sensations, otherwise they should be stopped. In the case of serious diseases, the second and third exercises should be performed per day for many hours.

Also, see the complex of exercises:


Knee joint development

Knee joint lends itself to self-study at home. Main blows used: through the palm, through the fingers, slaps.

  • The impact of spanking on the skin activates the neural pathways and causes a rush of blood.
  • With the help of blows through the pressed fingers, the muscles, tendons, ligaments, and the joint bag are affected. With tightly pressed fingers, the impact energy is gently carried to the desired place, blood is squeezed out of the capillaries without damaging them.
  • By means of the pressed palm blows put not on a joint, and on a nearby site of a bone. This affects the working surfaces of the inner part of the joint.
  • The work begins with tapping with pressed fingers, especially painful places. On the patella, the blows are applied slightly to the side. Muscles should be in a relaxed state. Strikes against a very painful joint should be easy and cautious. As he is rehabilitated, they should be strengthened. The described procedure is accompanied by moderate pain.
  • Blows should not be applied to the popliteal cavity from behind. Tapping the affected tendons should be as cautious as possible. After tapping, they make strokes with the palm pressed to the left, right, front, under the knee, on the straightened leg, then on the bent leg. Everything ends in spanking.

Number of procedures:

  1. for moderate arthritis, repeat weekly;
  2. with mild degree - every 23 days;
  3. for severe arthrosis with edema and severe inflammation - every two weeks.

Other types of massage

  • Honey massage for the night. First, the patient's joints are warmed up with a warmer for about ten minutes. Next, knees spread with honey and massage for 15 minutes. Then put the leaves of burdock and fix it with a cloth. Duration of treatment is ten days.
  • If the state of health allows, every morning you should sit down and massage your knees in circular motions 100 times with the use of massage oil.
  • You can also do acupuncture at home, that is, acupressure.

For arthrosis, the knee should be massaged:

  1. point located in the center of the posterior surface of the calyx;
  2. the point below the kneecap on four transverse fingers;
  3. point in the deepening of the transition of the tibia to the knee.

Use of folk recipes


Arthrosis of the knee is well treated with a burdock.

  • Six, seven leaves to rinse and wipe. Then put them in a pile so that the bottom is a velvety side. Put a pan of hot water on this pile. Before the compress, the joint is lubricated with vegetable oil. After that, the joint is put on the prepared stack to the joint with the velvety side of the leaves. Over the stack, cellophane is applied and fixed with a woolen shawl.
  • According to another method, the burdock leaf is crushed until the juice appears, then moisten it with cologne and apply to the sick joint for the night. Put the cellophane on top and fix it with a woolen cloth. The same thing to do the next day, only the sheet is smeared with honey, and then moistened with cologne. On the third day, the sheet is smeared with garlic paste, on the fourth - with Vishnevsky ointment. Compresses alternate daily. The course lasts two months.
  • The burdock leaves can be successfully replaced with cabbage leaves.
  • With arthrosis, celandine juice is effective. The fabric impregnated with it is superimposed on the diseased joint. After 50 minutes. With vegetable oil, the joint is lubricated. Duration of treatment - a week. Break - 10 days, and repeat everything.


One or two tablespoons of preheated sunflower oil are rubbed overnight in a sore joint. The pain is removed after five procedures.

Rubbing the interior pig fat in the aching joint gives a tangible result. This should be done within a month.

It is useful to make a dandelion infusion in the summer. In a dark bottle place the yellow dandelion flower heads and pour triple cologne. Insist a month, then drain. This infusion rubbed the diseased knees.

Tinctures of

  • Insist 17 gold bracelets in a half liter of vodka. Take three times a day before meals for 15 minutes on a tablespoon.
  • A glass of water with apple cider vinegar( two teaspoons) is drunk three times a day.
  • If you are overweight, you should try to reduce it. To cleanse the intestine, juice from the nettle, juniper, birch leaves, horsetail must be prepared. Or buy chemist's fees.

With proper treatment of arthrosis of the knee at home, it is quite possible to significantly improve the condition. And with mild forms - cure the disease.


Osteoarthritis of the knee joint, its treatment, symptoms and diagnosis of the disease

When you sit down, you feel a crunch in the knee joint, and when you bend and unbend legs there is unbearable pain? You may have developed arthrosis of the knee joint, which should be treated immediately . After all, the earlier treatment is started, the more effective and favorable the outcome of the disease will be. In no case do not start the disease, with this disease prematurely wear out intraarticular cartilage.

Osteoarthritis of the knee joint or on its scientific name is also called gonarthrosis. This disease is more exact gonarthrosis from arthrosis lesions of the joints takes first place in the frequency of their occurrence. People with this disease constantly prevail in other patients visiting polyclinics. The treatment of the disease is a time-consuming task and an integrated approach is required, and not only the use of medications.

In the people this condition is also called "salt deposition". But in fact, with arthrosis there may be calcifications( deposition of calcium salts) in the knee ligament apparatus, in soft tissues, in the places where tendons are attached, etc. But these manifestations of calcium salts are limited and, as a rule, nothave independent clinical significance. In the foreground, arthrosis of the knee joint is degenerative-dystrophic processes in the hyaline cartilage that cover the condyles of the tibia and femur. The process of arthrosis begins with a violation of normal blood circulation in small bony vessels, because of which a change occurs in the cartilaginous tissue of the joint.

The first initial changes appear and develop at the molecular level in the cartilaginous tissues, as a result of which the hyaline cartilage changes gradually: the cartilaginous tissue becomes turbid in places, thinens, stratifies, and cracks develop in different directions. As a result, the pathological process can result in the complete disappearance of the cartilaginous tissue on a smaller or greater extent, and by exposing the underlying bone. Bone tissue responds to the death of the cartilaginous coating by sclerosis( condensation) of the subchondral zone, excessive bone overgrowth begins at the periphery( there are so called spines), joint deformations from here and the full name of the disease deforming arthrosis.

Symptoms of

Statistically, women suffer from arthrosis of the knee joint several times more often than men. Usually the disease develops after 40 years, as a manifestation of age-related changes, or earlier, and for other reasons. These can be traumas, post-traumatic inflammatory processes, constant stresses due to the costs of the profession( for example, an agricultural worker, a football player).

The course of the disease is severe, in women with excess weight and those who in parallel suffer from varicose veins. The symptoms of arthrosis develop gradually and begin with a slight sensation of pain in the knee while walking. The patients note that it is difficult for them to go down or climb the stairs. Also very painful are the first steps after the transition from a sitting position. In a calm state, lying and sitting, these pains subsided.

Most people suffering from arthrosis of the knee joint complain of difficulty walking in the morning, immediately after sleep or after prolonged sitting. People say, "You divorce, it gets easier."Further, over time, arthrosis progresses. The pain becomes stubborn, constant, intense, the pain is more often localized on the inner side of the knee.

At the initial stage of the disease, the knee bone is not particularly deformed, but the joint swells, which is explained by the presence of synovitis( accumulation of pathological fluid in the knee).

In the next stage of the disease, after a certain period from the onset of the disease, the pain becomes more pronounced. They appear even from a small load. After rest, this pain ceases, but with repeated exercise again occurs.

Approximately at the same time, the crunch in the knees during movement is added. Accordingly, with the progression of the disease, this crunch also becomes more and more pronounced. The second stage of gonarthrosis is characterized by a decrease in a person's ability to flex normally into the knee joint.

The transition to the third stage of gonarthrosis is indicated by the intensification of pain, which occurs even in a state of rest. It is difficult for a person to lie in bed comfortably, besides, there is often another symptom that is associated with a circulatory disturbance. In this case, the patient complains that he "twists" the joint. Naturally, at this stage the mobility of the joint is reduced to a minimum. A person goes all the time on several bent legs, knee joints are deformed, and the gait becomes sometimes unstable.

Treatment of

Treatment of arthrosis of the knee joint is a difficult task. Treatment can be both conservative and operative, the latter course it is better to conduct the last. The basis of conservative treatment is rest and unloading of the affected joint. If these conditions are not met, then any conservative treatment will be ineffective .

In the treatment of arthrosis of the knee joint, all possible negative factors( excess weight, physical exertion) should be eliminated, physiotherapeutic procedures( UHF, electrophoresis) will also be superfluous. With the aim of treating inflammatory processes and pain, non-steroidal anti-inflammatory drugs are prescribed. Also, injections of hormonal drugs, such as cortisol, into the joint itself are possible.

Hyaluronic acid injections are used to replace the joint fluid. This reduces the manifestation of symptoms and slows the progression of arthrosis. Appoint also chondroprotectors, which improve the processes of metabolism in the cartilage, preventing its destruction. In severe disease, resort to surgical intervention( osteotomy, total and partial endoprosthetics).

If you have tried all these therapies, and the effect is not enough for you, you can try alternative methods, such as acupuncture, acupressure, special phytopreparations( naturally prescribed by a doctor).In general, the treatment of arthrosis should be comprehensive and with an individual approach. In the complex treatment of the disease, therapeutic gymnastics positively influences. And also various folk compresses on the affected joint.

The medicamentous treatment of arthrosis of the knee joint, despite its wide application, has a very small role. The solution of the problem of arthrosis to a certain extent depends on the prevention of arthrosis. Reasonable combination of leisure and work, active lifestyle, allows you to maintain the tone of the muscular and vascular systems for many years, to follow the body weight, timely seeking medical help at the first suspicions of the disease - these are the factors to prevent the development of this disease.


When examining the knee joint in the initial stages of the disease, there are no external changes. Further during the disease, knee deformation can be seen - these are rough contours of the knee joint, contracture( incomplete flexion and extension) and curvature of the shank axis, usually inside the .If you put your palm on the front surface of the knee joint, then when you bend and unbend, the examiner can feel a crunch in the knee joint of varying intensity and duration.

Often, an effusion accumulates in the joint cavity - this means joining the synovitis. With synovitis, the smoothness of the contours of the knee joint affected by arthrosis is determined by swelling and protrusion of the tissues.

Synovitis testifies to the complication of arthrosis of the knee joint with aseptic inflammation and then one can speak of "arthrosis-arthritis".The temperature, as a rule, does not increase at the same time.

Patients with synovitis joining are subjectively defined as a new sensation of severity in the joint, which interferes with flexion of the knee joint. Diagnosis of arthrosis of the knee joint is apparently not very complicated and is quite accessible. But in any case it is necessary to conduct an x-ray study. Radiography specifies and confirms the diagnosis, establishes the degree of dystrophic changes and allows you to monitor the dynamics of the disease for a long time, as well as X-ray examination is necessary to exclude other diseases of the knee joints.

It should be noted that not all patients who have undergone examination have arthrosis symptoms of the knee joint. From this it is necessary to draw a conclusion that between age estates and arthrosis of the knee joint it is not necessary to put an equal sign. Only a combination of x-ray and clinical signs should determine the diagnosis of gonarthrosis, arthrosis of the knee joint.


Knee joint gonarthrosis: treatment of

To date, gonarthrosis is a fairly common pathology of the musculoskeletal system.

Most often this disease is registered among professional athletes and people who are subjected to frequent physical exertion. The risk group includes those with excessive body weight, metabolic disorders, gout, rheumatoid arthritis, diabetes mellitus, and elderly people.

The basis of gonarthrosis of the knee joint is the pathological changes of the hyaline cartilage, which is thinned and destroyed, so it can not provide sufficient amortization and protection of the joint surfaces from friction during movement.

In addition, with this disease in the soft tissues of the knee, calcium salts can be deposited. This is accompanied by pain, stiffness of movements, and in the future, if not treated - a complete blockade of the knee joint without the ability to move.

How to treat arthrosis of the knee joint?

Since this disorder can cause disability, therapy should be started at the first manifestations of the disease. Medical measures should be aimed at eliminating pain, improving the supply of cartilaginous tissue and restoring it. It is also necessary to improve blood circulation in the area of ​​the aching joint and strengthen the muscles that surround it.

Before the treatment it is necessary to clearly establish a diagnosis, so a doctor's consultation is mandatory. Only after the definition of the etiology of gonarthrosis and elucidation of the mechanisms of its development can an effective therapy be conducted.

Drug treatment

Among the drugs that are prescribed most often, the following groups should be distinguished:

  • NSAIDs are non-steroidal anti-inflammatory drugs( diclofenac, ketoprofen, indomethacin, nimulide, butadione).They are prescribed to reduce inflammation and severe pain, which is so intense that it is simply impossible to apply, for example, a massage or physiotherapy. But it should be remembered that anti-inflammatory drugs do not treat, but only mask unpleasant symptoms;
  • agents showing a chondroprotective effect( glucosamine, chondroitin sulfate).They restore the structure of the cartilage and help to reduce the symptoms of arthrosis. I must say that chondroprotectors have a positive effect only at the initial stages of pathological changes in the knee joint. They are completely useless in cases where the cartilage has completely collapsed. In addition, these drugs are slow and require systemic application in appropriate doses of two or three courses for 1-1.5 years. Among the most popular chondroprotectors, mention should be made of "Structum" and "Hondrolon";
  • ointments and creams for topical use that alleviate the condition of the patient and reduce pain. Often prescribe menopause, gevkamen or nicofleks-cream. These drugs rarely give side effects, improve blood circulation in the joint and give a pleasant sensation of warmth. In cases where gonarthrosis is complicated by synovitis, it is recommended to use ointments, which contain non-steroidal anti-inflammatory substances( butadione ointment, voltaren-gel, fastum).It is worth noting that local application of anti-inflammatory drugs is not always effective, as the skin only allows 7% of the active substance;
  • means for applying compresses. With gonarthrosis of the knee joint, dimexide, medical bile, and bischofite are used. A characteristic feature of dimexide is that when applied to the skin it penetrates well through the skin barrier and acts directly on the inflammation focus. It also improves metabolic processes and shows a resorptive effect, which makes this tool effective for arthrosis with concomitant synovitis. Bischofite gives a moderate anti-inflammatory effect, warms and anesthetizes. Bile medical has a resolving effect. It is important to know that local application of medicinal products can not be performed with pustular lesions of the skin;
  • is a corticosteroid hormone that is administered intra-articularly. Often appointed kenalog, diprospan or hydrocortisone. These drugs eliminate pain, swelling and swelling of the joint quite quickly, but they do not affect cartilage tissue and blood circulation. In addition, hormonal injections can worsen the condition of those patients who have comorbidities( eg, diabetes, hypertension, obesity, kidney failure, mental and infectious diseases, tuberculosis, peptic ulcer).This is due to the fact that corticosteroids show a systemic effect, so they affect the dynamics of other pathologies;
  • hyaluronic acid preparations - form on the diseased joint a film that prevents further destruction of the cartilage, as it reduces friction between the articular surfaces. Cartilage tissue becomes more elastic and elastic, its depreciation properties are restored. Treatment with hyaluronic acid should be conducted by courses.

Therapeutic physical training

There is an opinion that for any type of arthrosis any physical load is contraindicated, but this is not entirely true. For optimal functioning of the joints need strong muscles, so moderate exercise is only good. Positively affects gymnastics, consisting of simple and slow exercises, since the affected joints do not tolerate sudden movements and excessive strain. Good results are given by manual therapy, especially with simultaneous extension and administration of chondroprotectors.

Diet for arthrosis of the knee joint

Patient with gonarthrosis should adhere to a diet. You should change the diet and eat every 4 hours, taking the bulk of the food at lunch time. It is also necessary to limit the use of table salt and abandon semi-finished products, salted fish, chips and mayonnaise. During cooking, it is better to use unrefined oil.

Often in patients with gonarthrosis is overweight, so you should use a diet that would help lose weight, but at the same time provided the body with all the necessary substances. To maximize the correct menu, it is worth consulting with a nutritionist who will take into account the features of arthrosis and other associated pathologies.

To prevent excessive weight gain, it is recommended to eat a lot of fruits and vegetables, because they contain complex carbohydrates, which are slowly absorbed and not stored as fat. From sweet and good food is better to refuse.

To control body weight, it should be remembered:

  • any alcoholic beverages stimulate appetite;
  • should be eaten in small portions, thoroughly chewing food;
  • should be monitored for bowel movement - the stool should be daily.

For proper metabolism, the body should receive a sufficient amount of vitamins and minerals. When gonarthrosis is recommended to use a lot of protein, because it is proteins used to build new tissues and to repair cartilage. Especially useful are dairy products, low-fat varieties of fish and meat, buckwheat porridge and lentils. For better assimilation of proteins, it is recommended to eat boiled, stewed dishes or steamed foods.

Patients with joint damage are useful to include in their diet a cold based on bone broth. It contains a lot of collagen, which is necessary for building cartilage. In addition, food gelatin is useful. It promotes the restoration of cartilaginous tissue, since it contains substances with chondroprotective properties.

It should be noted that even a carefully formulated diet is not able to cure gonarthrosis of the knee joint, but with the observance of the main recommendations, it contributes to overall improvement and improvement of the joint condition.

Load reduction

When conservative treatment of gonarthrosis, patients with walking are advised to use a cane. This reduces the load on the affected joint by 40%.It is important to pick up the growth, it is also desirable that it has a rubber nozzle that provides cushioning and prevents slipping.


When the destruction of the cartilaginous tissue is expressed, an operation is performed in which the patient's joint is replaced with an endoprosthesis.

Treatment with folk remedies

In folk medicine, dandelion is often used. It is recommended in May to collect on a daily basis 5 leaves of this plant, pour them with boiled water and chew without swallowing.

For the treatment of joint diseases it is also useful to use infusion of leaves and stems of Jerusalem artichoke. To make it, you need to take 1.5 kilograms of the plant, chop and pour 8 liters of boiling water. When it cools down a little, lower the affected area into the prepared liquid for 30 minutes. Repeat the procedure for 10 days.

The following tool is effective.3 lemons, 120 g of garlic and 250 g of celery root should be twisted in a meat grinder, mix everything well, put in a three-liter jar and pour boiling water, then wrap and insist 12 hours. Take the drug first 70 ml in the morning, and then - three times a day.

With gonarthrosis, a positive effect is obtained by compressing honey( 1 tbsp) and apple cider vinegar( 3 tbsp).The ingredients are mixed, applied to the joint, a leaf of cabbage is applied from above, then cellophane, well wrapped and worn until completely dry.

Treatment with folk remedies should be long( several months) and carried out seasonally with exacerbations of the disease.


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