Modern effective medications for arthrosis of the knee joint
Osteoarthritis of the knee joint( gonarthrosis) does not affect life expectancy, but can seriously impair the quality of life due to severe joint pain and mobility restriction. The medicamental treatment of arthrosis of the knee joint helps to cope with the pain and stop the progression of the disease. Read in this article: a detailed description of the most effective means to date, which are guaranteed to help in treatment.
Pain relief ointments for gonarthrosis
If pain is mild, ointments based on drugs from the group of non-steroidal anti-inflammatory drugs( NSAIDs) can help get rid of it. Popular local remedies for arthrosis of the knee joint are ointments and gels with diclofenac and indomethacin.
Despite the fact that ointments are applied superficially to the skin, they penetrate deep into the tissues, including the knee itself and even the cartilage. NSAIDs have a pronounced anti-inflammatory and analgesic effect, so relief comes quickly.
The advantage of ointments and gels for external use is their safety: they do not damage the mucous membrane of the stomach and intestines, they do not adversely affect the body.
Drugs for knee pain for ingestion
Four effective medicines:
Highly effective and inexpensive means of those taken internally is paracetamol. It is much safer for the gastrointestinal tract than all other medications for arthrosis, even the most modern, does not have negative effects on the cardiovascular system, does not affect the level of blood pressure. But in patients who abuse alcohol, paracetamol can lead to serious health problems.
Most of the drugs used to treat arthrosis belong to the group of so-called non-steroidal anti-inflammatory drugs of indiscriminate effect. This is well known to patients diclofenac, indomethacin, and other effective means.
The effectiveness of all NSAIDs is approximately the same. The main differences are the safety of drugs in this group. Ibuprofen, indomethacin and diclofenac do not act selectively: they not only suppress inflammation in the joints, but also provoke the formation of ulcers in the stomach and intestines, cause dangerous fluctuations in blood pressure, can increase the risk of heart attack and stroke. Indomethacin, so popular with outpatient physicians and patients themselves, disrupts metabolic processes in the cartilaginous tissue, which causes the cartilage to collapse more quickly.
To date, the best ratio of efficacy and safety have an NSAID selective effect. They have a powerful anti-inflammatory effect in the tissues of the affected joint and practically do not affect the stomach, intestine, metabolic processes in the cartilage, cardiovascular and coagulation systems. A disadvantage of NSAIDs of selective action is their high cost. In some situations, they are chosen unequivocally, for example, when it comes to patients older than 65 who have serious concomitant illnesses or who take drugs from the anticoagulant group( heparin, fractiparin and others) and glucocorticoids( prednisolone, dexamethasone, metipred).
To selective action NSAIDs include celecoxib, rofecoxib, etorikoksib and other coxibes. They are inferior to them in safety, but nevertheless they are safer than indiscriminate NSAIDs such drugs as nimesulide, meloxicam.
With very severe pain caused by exacerbation of arthrosis of the knee joint, the doctor can prescribe a prescription for tramadol. In fact, he is an opiate drug( heroin, morphine also apply to opiates).He perfectly copes with pain, but very quickly causes addiction, has multiple side effects on health, so it is used in exceptional cases.
Click on the picture to enlarge
Drugs that repair damaged cartilage
Earlier it was thought that articular cartilage does not have the ability to self renewal. Recent research has proved otherwise. This was the impetus for creating preparations based on glucosamine, hyaluronic acid and chondroitin sulfate. Glucosamine and chondroitin sulfate gradually restore the cartilage structure with prolonged admission, so the progression of the disease stops, the pain decreases or passes at all, and the volume of movements in the knee joints increases.
Hyaluronic acid is not taken internally, but is injected into the cavity of the knee joint. Her injections are carried out 2-3 times a year, as a result of which there is a tangible improvement in the function of the affected knee.
In severe osteoarthritis, drug treatment is ineffective. In this situation, surgery is required.
For the treatment to give the best effect and was safe for health, it must be prescribed by a doctor. Only he will be able to take into account all the data on concomitant diseases, taken medications and to choose the right treatment regimen. Be healthy!
Medication for arthrosis: what drugs help stop the disease
Arthrosis is the destruction of articular cartilage - a special "interlayer" tissue that covers each of the rubbing surfaces of bones in the joint. This disease can occur due to frequent inflammatory phenomena in the joint( arthritis), after injuries, hormonal changes and as a result of a constant load of excess weight of a person. Osteoarthritis can be complicated by arthritis, that is inflammation, but these two diseases - arthrosis and arthritis - are completely different in essence and approaches to treatment for them should not be the same.
How does the process start with arthrosis?
cartilage destruction structure
Articular cartilage itself does not have blood vessels in it, it gets the substances necessary for itself from the fluid produced by the capsule of the joint. Arthrosis occurs when a process disrupts the production of this fluid. As a result, the usual load on the joint becomes stress for the articular cartilage. From its cells, enzymes are released that begin to destructively act first on their surface layers, then on deeper. Such destruction changes the intra-articular pH, and a vicious circle turns on: a violation of the acid-base balance prevents the cartilage from recovering, the normal relationship between its two main components, chondroitin and glucosamine, changes. And this same pH shift to the acid side further activates the destructive enzymes.
arthrosis affects the hands
The joint tries to restore itself in ways that are accessible to it: osteophytes arise( bone growths, replacing areas with "spoiled" cartilage ").What does it need to know? To understand what is the correct approach in the treatment, in what sequence of medication for arthrosis you need to take in order to achieve a good effect.
What you need to know for effective treatment of
pathology. As already mentioned, the usual load on the joints affected by osteoarthritis becomes stress for the cartilage. Therefore, before you start treatment, be concerned about reducing this burden. For example, if you have osteoarthritis of the knee, you can use a walking stick when walking, and also wear special fixing devices on the foot - calipers, which will minimize this load.
Completely remove the load, too, can not. For example, fix it with a bandage and do not move your fingers at all, if the destruction of cartilage occurs in these joints. Why? Articular cartilage can be fed only when moving in this articulation of bones: it works like a sponge, sucking in nutrients from the joint fluid, when the bones converge, and then diverge. Therefore, avoiding movements is wrong, they just need to be dosed, with the support of various devices.
support for the knee
Also reduce the load on the joint, especially when it comes to the disease of the ankle joint( it has one of the greatest loads in ordinary walking), it is necessary by getting rid of excess weight and further adherence to proper nutrition.
- Anti-inflammatory therapy( it is also anesthetic).These are not just drugs that relieve pain, as many people think. These are medicines that are designed to stop the process described above, when enzymes actively destroy the joint. The earlier you apply this therapy, the more chances your cartilage has to "stay alive".
With anti-inflammatory and analgesic, tablets and ointments are used with preparations similar to analgin: they block the main enzyme responsible for the development of inflammation and pain. AD) Ointments( gels).This Diklak-gel, Voltaren-Emulgel, Ibuprofen-gel. They can be used in the initial stages of arthrosis, when they effectively relieve pain, while not giving those side effects that are characteristic for systemic( in tablets and injections) anti-inflammatory drugs. Such effects include damage to the walls of the stomach and intestines with the development of ulcers. B) Paracetamol. It has fewer side effects than other drugs of similar action, in addition, it well helps to relieve pain. You can not only exceed its maximum dosage, it is also necessary to take into account its contraindications.
c) Non-steroidal anti-inflammatory non-selective agents. These are Ibuprofen, Diclofenac, Indomethacin and others. Good relief of pain and inflammation, but they have quite a few side effects.
d) A subgroup of anti-inflammatory non-steroidal agents - coxibs, which are designed specifically to relieve pain and inflammation in arthrosis( Celecoxib, Lumiracoxib, Rofica).But they have other side effects: they can not be used for severe heart, liver, kidney problems, you must carefully consider the compatibility with those drugs that a person usually takes.
e) Medicines for arthrosis, which relieve inflammation when other drugs are ineffective. These hormones are glucocorticoids, which are injected into the joint( Kenalog, Diprospan, Hydrocortisone).They are used only with inflammation, effectively relieve pain. But often( more often than once a week) they can not be used, as they contribute to the destruction of cartilage. If one drug for three injections did not show its effectiveness, you need to change it to another, rather than continue to methodically destroy the cartilage.
- Tablets, whose action is aimed at restoring the cartilage of the joint. These are those that contain glucosamine and chondroitin. They are produced quite a lot both by the domestic and foreign pharmaceutical industry. These drugs require a long reception( at least three months).Apply them ineffectively when there is no cartilage left.
For the present effect, it is necessary to take chondroitin at least 1000 mg per day, and glucosamine - at least 1200 mg. It is possible to take both combined preparations( in which there are both components, for example, Artra), and monopreparations( for example, Don, which contains only glucosamine and is very effective, especially in injections).
Also there are bioadditives( Susanorm, Stoartite, Chondro), containing these two components. They are not a remedy, since their clinical effectiveness has not been proven. Preparations containing chondroitin and glucosamine, positioned as an ointment from arthrosis( Teraflex-ointment), have rather low efficiency.
- A preparation based on soy and avocado - Piascladin. It effectively slows down the process of cartilage destruction by blocking the production of an enzyme that breaks down collagen. These pills for arthrosis are quite expensive, they should be taken 1 capsule per day for 6 months.
- Hyaluronic acid, which is called "liquid lubrication" of the hip joint, and other joints is also very effective. The only nuance: sodium hyaluronate( Synvisc, Fermatron, Ostenil) must be administered after the inflammation in the joint has subsided, otherwise the drug will not act.
- In the treatment also used drugs, which are called proteolysis inhibitors( Counter, Gordoks): they are used for inflammation. Their action is aimed at suppressing the production of enzymes that provoke the "dissolution" of the articular cartilage.
- Heating compresses and ointments can also be used as a cure for arthrosis of joints: their action is aimed at increasing blood flow to the joint, alleviating pain and increasing filtration of intraarticular fluid. These are such drugs as Bischofite, bile medical, Dimexid( it needs to be diluted 1: 3 or 1: 4 with water, otherwise you can get a burn).
- Also improve microcirculation in the joints such drugs as Actovegin, nicotinic acid, Troxevasin, vitamins of group B.
Also a great help in the treatment are joint massage and manual therapy: since more blood flows into the "sick" capsule, it begins to update itself more quickly and to update the liquid produced by it. As a result, the cartilage gets better nutrition. One "but": these types of manual exposure( like other thermal procedures) are not applicable in the presence of an acute inflammatory process. Therefore, first those drugs are used for arthrosis, which will reduce inflammation, and then massage is applied.
Medical treatment of arthrosis
All medicines used for the treatment of arthrosis are divided into several groups depending on the purpose of the exposure:
is one of the effective means of
. The introduction of medication into the joint
The use of drugs in the complex has a positive effect and makes it possible to forget about arthrosis for a long time.
Knee joint arthrosis tablets
Knee joint injuries are difficult to tolerate due to high soreness and limited mobility, and also difficult to treat. This disease, like arthrosis, requires an integrated approach to therapy, which includes oral administration of drugs and topical treatment in the form of applications, compresses and ointment application.
Tablets from arthrosis of the knee joint are divided into several groups and affect various manifestations of the disease:
All of them are particularly effective at the initial stages of the disease, require admission courses and strict compliance with the prescription of a specialist.
Anti-inflammatory tableted medicines
Currently, non-steroidal anti-inflammatory drugs, such as Indomethacin, Ibuprofen, Diclofenac, Piroxicam and many others are most often used. Their main advantage is that, unlike hormonal drugs, non-steroidal preparations have far fewer contraindications and side effects.
All these drugs are divided into two large groups: first-line and second-type cyclooxygenase inhibitors. Preparations of the second group have fewer side effects and are better tolerated by the gastrointestinal tract, nevertheless they can have a serious negative effect on the cardiovascular system, kidneys and liver, as well as on the digestive tract in people with increased sensitivity to these substances. Allergic reactions are possible, these drugs are contraindicated for pregnant and lactating mothers.
The second type of cyclooxygenase inhibitors( for example, the drug Movalis) are better perceived by patients and have a pronounced anti-inflammatory and analgesic effect. With the correct admission of courses with compliance with dosage and under the supervision of a doctor, swelling, inflammation, pain and sensation of a swollen hot knee go away. Much better mobility of the joint and a person gets the opportunity to move independently, giving up the cane or even crutches.
Anesthetics for arthrosis of the knee joint
Pain relief in case of arthrosis can significantly improve the patient's condition, because in most cases it is the increased sensitivity and soreness of the knee that interferes with the full life, reduces efficiency and mobility. Most of the non-steroid drugs along with anti-inflammatory drugs have a pronounced analgesic effect, which allows reducing the number of medications used. The usual analgesics in tablets are not always able to reduce pain in the bones and joints, which makes their intake irrational. Most often, the doctor prescribes various ointments, compresses and applications with drugs like Dimexide to remove the edema and reduce pain. Recently, injections directly into the knee joint have been widely used. The course of such injections helps to improve health, restore mobility of the joint. Such drugs are prescribed solely by the attending physician depending on the severity of the illness.
Vessel Maintenance Vessels
In cases of joint damage, their nutrition is disturbed, therefore, the use of vasodilator drugs helps to improve the blood supply to the affected area. Such measures contribute to the improvement of tissues and the restoration of their functions. In the vast majority of cases, vasodilators are used in conjunction with substances called chondroprotectors. They help to restore the affected cartilage of the knee joint, and the means that expand the vessels, contribute to increased blood supply.
Among the often prescribed medications are Trental and Xantinol Nicotinat, which relieve spastic manifestations and help the work of blood vessels and capillaries.
Chondroprotectors - effective remedy for cartilage regeneration with arthrosis
If the cartilage is not completely worn out, there is hope to affect its condition and try to restore its density and functionality. For this purpose, substances called hodoprotectors are used.
There are two main drugs - chondroitin sulfate and glucosamine. Both are effective in the defeat of cartilaginous tissue, so they are most often used together or even as part of a single drug. Recently, the composition of such tablets began to add hyaluronic acid, which helps to restore the natural "lubrication" of the knee joint. In addition to the addition of chondroprotective agents, hyaluronic acid is used in the form of injections directly into the joint.
Preparations Chondroitin and Glucosamine are well tolerated and have no side effects, moreover, they help improve the condition of hair, skin and nails. To obtain a pronounced effect, it is necessary to take them for a long time in courses, under the supervision of the attending physician. Interruption of admission or short irregular courses, as well as reception with very damaged articular cartilage, will not give the desired result. Chondroprotectors act slowly, but have a pronounced therapeutic effect in the initial stages of arthrosis of the knee, especially when using complex therapy in combination with other effective drugs, compresses and injections.
Self-medication even with "harmless" chondroprotectors can lead to serious consequences, so consult a doctor and follow only his instructions. The sooner the treatment is started, the better the result and the more chances to keep strong, healthy and mobile joints.
Treatment of arthrosis of the knee joint( gonarthrosis)
Before you start your hard struggle, be sure to find a good doctor, check with him and together with him make a treatment plan. Do not try to diagnose yourself! The fact is that joint damage resembling arthrosis occurs in many other diseases, and low-scoring people very often make mistakes in determining the disease. Assess the possibility of treatment with the use of KSL Koltsov plates.
It is better not to save time and money on medical advice, because a mistake can cost you much more in all respects. But this does not mean that you must blindly believe any doctor and should not delve into the essence of his recommendations, comprehending the mechanism of action of those drugs that are assigned to you. The patient should understand the meaning of the medical appointments and represent what the various treatment procedures are for.
So, in the therapeutic treatment of gonarthrosis, it is important to combine a number of medical measures in such a way as to solve several problems at once:
- - to remove pain;
- - to improve nutrition of articular cartilage and accelerate its recovery;
- - to activate blood circulation in the area of the affected joint;
- - reduce pressure on the damaged articular areas of bones and increase the distance between them;
- - strengthen the surrounding aching joint of the muscle;
- -increase the mobility of the joint.
Below we will look at how a particular treatment method helps achieve the stated goals:
1. Non-steroidal anti-inflammatory drugs( NSAIDs): diclofenac, piroxicam, ketoprofen, indomethacin, butadione, meloxicam, tselebrex, nimulide and their derivatives.
For non-steroidal arthrosis, that is non-hormonal, anti-inflammatory drugs are traditionally used to eliminate pain and inflammation of the joint, as against a background of severe pain it is impossible to begin normal treatment. Only by eliminating acute pain with anti-inflammatory drugs, you can later go, for example, to massage, gymnastics and those physiotherapeutic procedures, which because of the pain would be intolerable.
However, it is undesirable to use drugs of this group for a long time, as they are able to "mask" manifestations of the disease. After all, when the pain decreases, a deceptive impression is created that a cure has begun. Arthrosis, meanwhile, continues to progress: NSAIDs only eliminate individual symptoms of the disease, but do not treat it.
Moreover, in recent years, data have been obtained, indicating the harmful effect of prolonged use of nonsteroidal anti-inflammatory drugs on the synthesis of proteoglycans. Molecules of proteoglycans are responsible for the entry into the cartilage of water, and a violation of their function leads to dehydration of the cartilaginous tissue. As a result, the cartilage already affected by arthrosis begins to break even faster. Thus, the tablets that the patient takes to reduce pain in the joint can accelerate the destruction of this joint.
In addition, using non-steroidal anti-inflammatory drugs, it must be remembered that they all have serious contraindications and, if used for a long time, can have significant side effects( described in detail in the book "Pain in the legs").
Therefore, if you need a long-term use of anti-inflammatory drugs in arthrosis therapy, it is better to use selective anti-inflammatory drugs( drug Movalis).Selective agents are much less likely to give unpleasant side effects, almost do not cause complications and do not adversely affect the structure of the articular cartilage. They can be drunk for a long time, even by courses from several weeks to several years( naturally, only under the supervision of a doctor).
2. Chondroprotectors - glucosamine and chondroitin sulfate.
Glucosamine and chondroitin sulfate belong to the group of chondroprotectors - substances that feed cartilage tissue and restore the structure of damaged cartilage of joints.
Chondroprotectors( glucosamine and chondroitin sulfate) - the most useful group of drugs for the treatment of arthrosis.
Unlike non-steroidal anti-inflammatory drugs( NSAIDs), chondroprotectors not only eliminate the symptoms of arthrosis, but affect the "basis" of the disease: the use of glucosamine and chondroitin sulfate promotes the restoration of the cartilaginous surfaces of the hip joint, the improvement of articular fluid production and the normalization of its "lubricating" properties.
Such a complex effect of chondroprotectors on the joint makes them irreplaceable in the treatment of the initial stage of arthrosis. However, there is no need to exaggerate the possibilities of these drugs.
Chondroprotectors are not effective at the third stage of arthrosis, when the cartilage is almost completely destroyed. After all, it is impossible to grow a new cartilaginous tissue or restore the old form to the deformed bones of the knee with the help of glucosamine and chondroitin sulfate. And in the first and second stages of gonarthrosis, chondroprotectors act very slowly and improve the patient's condition far from immediately. To get a real result, you need to undergo at least 2-3 courses of treatment with these drugs, which usually goes from six months to one and a half years, although advertising glucosamine and chondroitin sulfate usually promises recovery in a shorter time.
I regret to note that there is some cunning in these promises. With all the usefulness of chondroprotectors of miraculous medicinal healing, arthrosis can not be expected. Recovery usually requires much more effort than taking two or three dozen tablets.
Probably, the fact that the chondroprotektors' capabilities are often overestimated in advertising caused the attacks on these drugs in one of the "popular" TV shows. TV host of the program "Health" from someone's filing said that chondroprotectors are useless for the treatment of arthrosis.
Thus, she cast a huge shadow on these very useful medicines, questioned the work of a number of serious medical institutions and clinics that tested these drugs and proved that chondroprotectors uniquely contribute to the restoration of articular cartilage and inhibit the development of arthrosis.After the clinical approbation of chondroprotectors, the Ministry of Health of Russia has allowed their sale in pharmacies as medications( of course, this does not refer to those medicines that have not been registered as medicines and sold as bioadditives).Another thing is that, as I said, chondroprotectors are not "all-powerful".Treatment with these medicines requires proper and long-term administration in combination with other treatments.
Nevertheless, of all the drugs used in the treatment of arthrosis, it is the chondroprotectors that bring the greatest benefit. In addition, they have virtually no contraindications and rarely give unpleasant side effects.
It's important to know! To achieve maximum therapeutic effect, chondroprotectors should be used by courses, regularly, for a long time. It is practically meaningless to take glucosamine and chondroitin sulfate once or occasionally.
In addition, in order to obtain the maximum effect from the use of chondroprotectors, it is necessary to ensure the daily intake in the body of adequate, that is, sufficient doses of drugs throughout the course of treatment. A sufficient dose of glucosamine is 1000-1500 mg( milligram), and chondroitin sulfate - 1000 mg per day.
Note by Dr. Evdokimenko. Scientists are now arguing about how to better take glucosamine and chondroitin sulfate - simultaneously or separately. Opinions were divided. Some scientists argue reasonably that glucosamine and chondroitin sulfate must be taken together, simultaneously.
Others argue in the same way that glucosamine and chondroitin sulfate with simultaneous reception interfere with each other, and they should be taken separately.
Perhaps there is a clash of interests of those manufacturers that manufacture monopreparations containing only glucosamine or only chondroitin sulfate, with those manufacturers that produce "two in one" preparations containing a combination of glucosamine with chondroitin sulfate. Therefore, the issue of joint or separate use of glucosamine and chondroitin sulfate remains open, and I will leave it at your discretion.
Currently, in our pharmacological market, chondroprotectors are most widely represented by the following drugs:
Arthra, manufactured in the USA.Form release: tablets containing 500 mg of chondroitin sulfate and 500 mg of glucosamine. To achieve a full-fledged therapeutic effect, you must take at least 2 tablets a day.
Arthroflex, produced in Romania. Form release: tablets containing 265 mg of chondroitin sulfate and 375 mg of glucosamine. To achieve a full-fledged therapeutic effect, you need to take at least 3-4 tablets a day.
DONA, produced in Italy. Monopreparation containing only glucosamine. Form release: powder, packaging of 1500 mg of glucosamine in 1 sachet;a day it is necessary to take 1 packet of the drug;or capsules containing 250 mg of glucosamine;a day, take 4-6 capsules of the drug;
Condro( Condro Nova), manufactured in India. Form release: capsules containing 200 mg of chondroitin sulfate and 250 mg of glucosamine. To achieve a full-fledged therapeutic effect, it is necessary to take at least 4 tablets a day.
Structum produced in France. Monopreparation containing only chondroitin sulfate. Form release: capsules containing 250 or 500 mg of chondroitin sulfate. On the day, you must take 4 tablets containing 250 mg of chondroitin sulfate, or 2 tablets containing 500 mg of chondroitin sulfate.
Teraflex, manufactured in the UK.Form release: capsules containing 400 mg of chondroitin sulfate and 500 mg of glucosamine. To achieve a full-fledged therapeutic effect, you must take at least 2 tablets a day.
Chondro, manufactured in India. Form release: capsules containing 200 mg of chondroitin sulfate and 250 mg of glucosamine. To achieve a full-fledged therapeutic effect, it is necessary to take at least 4 tablets a day.
Chondroitin AKOS, produced in Russia. Monopreparation containing only chondroitin sulfate. Form release: capsules containing 250 mg of chondroitin sulfate. To achieve a full-fledged therapeutic effect, you must take at least 4 capsules a day.
Chondrolon, produced in Russia. Monopreparation containing only chondroitin sulfate. Form release: ampoules containing 100 mg of chondroitin sulfate. To achieve a full therapeutic effect, it is necessary to conduct a course of 20-25 intramuscular injections.
Preparations containing glucosamine and chondroitin sulfate almost do not have contraindications. They can not be used only by those who suffer from phenylketonuria, or have hypersensitivity directly to glucosamine or chondroitin sulfate.
There are also very few side effects. Chondroitin sulfate sometimes causes allergies. A glucosamine can occasionally provoke pain in the abdomen, its swelling, diarrhea, or constipation;and very rarely - dizziness, headache, pain in the legs or swelling of the legs, tachycardia, drowsiness or insomnia. But in general, I repeat, these drugs very rarely cause any unpleasant sensations.
The duration of treatment with glucosamine and chondroitin sulfate may be different, but more often than not, I suggest that patients take chondroproteins daily for 5-6 months. At least six months of treatment should be repeated. That is, one way or another, glucosamine and chondroitin sulfate is recommended to take approximately 150 days a year for 3-5 years.
3. Medicinal ointments and creams.
Therapeutic ointments and creams can in no way heal arthrosis of the knee joints( even if their advertising claims the opposite).But nevertheless, they can alleviate the condition of the patient and reduce pain in the diseased knee. And in this sense, ointments are sometimes very useful.
So, with arthrosis of the knee joint, which proceeds without the symptoms of synovitis, I recommend warming ointments to my patients in order to improve blood circulation in the joint.
For this use Menovazine, Gevecamen, Espol, Nikoflex-cream, etc. The above ointments usually cause the patient a feeling of pleasant warmth and comfort. They rarely give any side effects.
Ointments based on non-steroidal anti-inflammatory substances( Indomethacin, Butadion, Dolgit, Voltaren-gel, Fastum) are used in cases where the course of gonarthrosis is aggravated by synovitis. Unfortunately, they do not work as effectively as we would like - after all, the skin misses no more than 5-7% of the active substance, and this is clearly not enough to develop a full-fledged anti-inflammatory effect.
4. Means for compresses
Compressors have a somewhat greater healing effect compared to ointments.
Of the locally used topical agents, in my opinion, three drugs deserve: dimexide, bischofite and medical bile.
Dimexide is a chemical substance, a liquid with colorless crystals, has a good anti-inflammatory and analgesic effect. In this case, unlike many other substances of external application, dimexide is really capable of penetrating through skin barriers. That is, the dimexide applied to the skin is really absorbed by the body and works inside it, reducing inflammation in the source of the disease. In addition, dimexide has a resolving power and improves metabolism in the field of application, which makes it most useful in the treatment of arthrosis occurring with the presence of synovitis.
Bishofit is an oil derivative, a brine produced in the drilling of oil wells. Got his fame thanks to the drillers, who first drew attention to its therapeutic effect for arthrosis. While working on oil wells from permanent contact with the brine of oil, the drillers underwent resorption of arthritic nodules in their hands. Later it turned out that Bischofite has a moderate anti-inflammatory and analgesic effect, and also acts warming, causing a feeling of pleasant warmth.
Bile is a natural bile extracted from the gall bladder of cows or pigs. Bile has a resolving and warming effect and is used in the same cases as bischofite, but it has some contraindications: it can not be used for pustular skin diseases, inflammatory diseases of lymph nodes and ducts, febrile conditions with fever.
5. Intra-articular injections( injections into the joint)
Intra-articular injections are often used to provide emergency relief for arthrosis of the knee joint. In many cases, intra-articular injection can really alleviate the condition of the patient. But at the same time, injections in the joint with arthrosis are done much more often than is necessary in reality. It is about this wrong, in my opinion, the trend I want to talk more.
Most often, the joints are injected with corticosteroid hormones: kenalog, diprospan, hydrocortisone, flosteron, celeston.
Corticosteroids are good because they quickly and effectively suppress pain and inflammation in synovitis( swelling and swelling of the joint).It is the speed with which the therapeutic effect is achieved - the reason that corticosteroid injections have gained special popularity among doctors. But this led to the fact that intra-articular hormone injections began to be carried out even without real necessity. For example, I repeatedly encountered the fact that hormones were injected into the joint of the patient with a preventive purpose in order to prevent the further development of arthrosis.
However, the problem is that just the arthrosis itself corticosteroids can not be treated and can not be treated. So, they can not prevent the development of arthrosis! Corticosteroids do not improve the condition of the articular cartilage, do not strengthen the bone tissue and does not restore normal blood circulation. All they can do is to reduce the reciprocal inflammatory response of the body to this or that damage in the joint cavity. Therefore, intra-articular injection of hormonal drugs as an independent treatment method is useless: they should be used only in complex therapy of arthrosis.
For example, the patient identified gonarthrosis of stage II with swelling of the joint due to the accumulation of fluid in it. The accumulation of fluid( synovitis) makes it difficult to conduct treatment procedures: manual therapy, gymnastics, physiotherapy. In this situation, the doctor carries out intra-articular injection of the hormonal drug to eliminate the synovitis, and in a week starts the rest of the active medical measures - this is the right approach.
Now let's imagine a different situation. The patient also has stage II gonarthrosis, but without accumulation of fluid and joint edema. Is it necessary to inject corticosteroids into the joint in this case? Of course, no. There is no inflammation - there is no "point of impact" for corticosteroid hormones.
But even if the intra-articular injection of corticosteroids is really necessary, a number of rules must be followed. First, it is undesirable to make such injections in the same joint more often than once every 2 weeks. The fact is that the medication administered will "work" in full force not immediately and the doctor will be able to finally evaluate the effect of the procedure just after 10 to 14 days.
One should also know that usually the first injection of corticosteroids brings more relief than the subsequent ones. And if the first intra-articular injection of the drug has not produced a result, it is unlikely that it will give the second or third injection of the same drug in the same place. If the first intraarticular injection is ineffective, you either need to change the drug, or, if the drug change does not help, or rather choose the site of the injection.
If, after this, the introduction of a corticosteroid into the joint did not give the desired result, it is better to abandon the very idea of treating this joint with hormonal drugs. Moreover, to inject hormones into the same joint more than four to five times in general is highly undesirable otherwise the likelihood of side effects will significantly increase.
Unfortunately, in practice one has to deal with the excessive "purposefulness" of doctors who repeatedly inject corticosteroids into the same joint without achieving at least a minimal effect with the first three injections. More than the others, I was struck by two such cases.
One patient was given "only" ten injections of the Kenalog, and the procedure was performed daily, even without the necessary 10-day break necessary to evaluate the results of the injection. And the second patient was injected with hormones into the knee joints, observing the interval( true, only 3 to 5 days), but at the same time for the treatment of the poor fellow received twenty to twenty-five injections of corticosteroids in one joint!
It would seem that the doctor has "overdone" a little - nothing terrible. Can there be any harm from such treatment? It turns out, can! First, with each nyxis of the joint, although slightly, but injured by a needle. Secondly, with intraarticular injection, there is always some risk of infection in the joint. Thirdly, frequent hormonal administration provokes a disruption in the structure of the ligaments of the joint and the surrounding muscles, causing a relative "looseness" of the joint.
And most importantly, frequent injections of corticosteroids worsen the condition of those patients whose joint damage is combined with diabetes mellitus, high blood pressure, obesity, kidney failure, gastric or intestinal ulcer, tuberculosis, purulent infections and mental illness. Even introduced exclusively into the joint cavity, corticosteroids have an effect on the entire body and can exacerbate the course of these diseases.
It is much more useful to administer hyaluronic acid preparations( called hyaluronic acid - sodium hyaluronate) to the knee joint affected by arthrosis. They appeared on sale about 10 years ago.
Preparations of hyaluronic acid( sodium hyaluronate) are also called "liquid prostheses" or "liquid implants", as they act on the joint as a healthy synovial fluid - that is, as a natural "joint lubricant".
Hyaluronic acid preparations are very useful and effective medicines: sodium hyaluronate forms a protective film on the damaged cartilage, which protects the cartilage tissue from further destruction and improves the sliding of the contacting cartilaginous surfaces.
In addition, hyaluronic acid preparations penetrate into the depth of the cartilage, improving its elasticity and elasticity. Thanks to hyaluronidase, the "dried up" and thinned cartilage with arthrosis restores its damping properties. As a result of the weakening of mechanical overload, pain in the diseased knee joint decreases and its mobility increases.
At the same time, injected correctly into the joint cavity, hyaluronic acid preparations practically do not give side effects.
Treatment with hyaluronic acid is carried out by courses: in total for the course of treatment it is required to conduct 3-4 injections in each diseased knee, the interval between injections is usually from 7 to 14 days. If necessary, repeat the course in six months or a year.
From my point of view, the main and only serious drawback of hyaluronic acid preparations is their high price. So, in 2010 hyaluronic acid is represented in our market mainly by import preparations Synivsk, Fermatron, Ostenil, Duralan. And each injection with these drugs costs the patient at least 3000 rubles.
An alternative to imported preparations of hyaluronic acid can serve as a new domestic preparation of Hyastat, produced by Tula pharmacologists. Not inferior to imported analogs, and for a number of indicators and superior to imported drugs, hyastat costs about 30% cheaper. And to date, hiastat may well be considered the drug of choice for intra-articular treatment of arthrosis of the knee joint.
Returning to the issue of saving, I want to note that despite the relatively high cost of hyaluronic acid preparations, their use allowed literally to "put on feet" many patients from those who, before the advent of these drugs, would have had to operate.
And given the cost of the operation on the joints, it turns out that the timely use of hyaluronic acid( even for several years) in any case and in all senses costs the patient much cheaper surgery for endoprosthetics of the knee joint. Of course, provided that the doctor who carries out such injections owns the technique of administration.
Note by Dr. Evdokimenko. It is important to know: hyaluronic acid preparations are instantly destroyed in that joint in which there are pronounced inflammatory processes. Therefore, it is practically useless to administer them to patients who have gonarthrosis on the background of the active stage of arthritis. But it is useful to use them for persistent remission of arthritis for treatment of the phenomena of secondary gonarthrosis.
At primary gonarthrosis too it is necessary to pay attention to similar moments. For example, if the patient's joint "bursts" from the accumulation of excess, pathological fluid, it makes sense first to "extinguish" the phenomenon of synovitis( inflammation) and remove excess pathological fluid by pre-intraarticular injection of hormones or the use of non-steroidal anti-inflammatory drugs. And only then to introduce hyaluronic acid into the joint, freed from inflammatory elements.
In addition to corticosteroid hormones and hyaluronic acid preparations, attempts are being made to insert into the joint various chondroprotectors, such as alflutope, chondrolon or homeopathic. Objective T.
But these drugs are inferior in effectiveness to hyaluronic acid preparations. They help from the strength of 50% of patients, and guess whether there will be an effect from their use or not, is impossible in advance. In addition, the course of treatment requires 5 to 20 injections per joint, which, as we have said, is fraught with possible injury to the joint and various complications.
6. Manual therapy and physiotherapy
Manual therapy for gonarthrosis I and II stages often gives an excellent result. Sometimes, several procedures are enough to make the patient feel a great deal of relief. Especially good manual therapy of knee joints helps, if you combine it with the extension of the joint, the use of chondroprotectors and intra-articular injections of ostenil.
This combination of treatment procedures, from my point of view, is much more effective than the numerous physiotherapeutic measures offered in any clinic. I will give one example from practice.
Case from the practice of Dr. Evdokimenko. At the reception came a woman of 47 years with arthrosis of the right knee joint of the II stage. By the time of our meeting, she had been sick for 5 years. Over the years, the woman has had time to experience all possible methods of physiotherapy, which can only be offered in our district clinics: laser, magnetotherapy, ultrasound, phonophoresis, etc. Despite all the efforts of physiotherapists, the patient's joint condition continued to deteriorate - and this is natural, since, say, chondroprotectors for all five years were assigned to a woman only once, in a short course.
Completely desperate, the woman decided to take extreme measures - she underwent a course of treatment with cauterization of sagebrush cigarettes according to the eastern method. As a result, the knee was covered with scars from burns, but did not move better. Yes, and I could hardly - in spite of all my respect for eastern medicine, I understand that wormwood cauterizations can not eliminate bone deformities and increase the distance between the bones knuckled in the knee.
After the woman was not helped by numerous physiotherapeutic procedures and even cauterization with wormwood cigarettes, she practically agreed to surgical treatment. But then all the same I changed my mind and decided to try the complex method I proposed.
The first treatment session was, as they say, "with a scratch" - we managed only to slightly "stir" the joint with the help of manual mobilization. Therefore, the next session we appointed after preliminary preparation: within 3 weeks the woman took chondroprotectors, did self-massage and compresses with dimexid. After 3 weeks, I again started with mobilization of the joint, and then repositioned( "correcting") the joint with the help of manual manipulation. There was a click and suddenly the joint began to move much easier and freer. The woman felt obvious relief.
In the following two sessions with the help of mobilization, we consolidated the achieved improvement, and then consolidated the success of two intra-articular injections of ostenil. And a month and a half later from the beginning of our not very intensive treatment( after all, we only needed six meetings), the woman was finally able to drop the boring wand and began to move quite freely.
Two years have passed since then. Twice a year the patient takes chondroprotectors short course, and occasionally comes to me at the control reception, where I am pleased to note that the condition of the knee is only getting better from year to year. And now even the first stage of arthrosis would be very difficult to assume - the knee joint of the patient was restored almost completely.
Thus, only six treatment sessions( manual therapy plus intraarticular injections ostenil) in combination with the course of chondroprotectors proved to be more effective than five years of physiotherapy.
From this story( and by no means unique in this way) it becomes clear why I consider physical therapy to be important, but only an additional part of the curative program for gonarthrosis. In this sense, more than other procedures I like laser therapy, thermal treatment( ozocerite, paraffin therapy, therapeutic mud) and especially cryotherapy( local cooling treatment).
For more information about each physiotherapy method, see the book "Pain in the legs".
8. Using the walking stick.
Drawing on a stick when walking, patients with arthrosis of the knee joints seriously help their treatment, since the stick takes on 30 to 40% of the load intended for the joint.
It's important to pick up a stick according to your height. In order to do this, stand up straight, lower your arms and measure the distance from your wrist( but not from your fingertips!) To the floor. It is this length and should be a cane. When buying a wand, pay attention to its end - it should be equipped with a rubber nozzle. Such a stick is amortized and does not slip when it is supported.
Remember that if you have a left legache, then the stick should be held in the right hand, and vice versa. Making a step with the patient's leg, transfer some of the body weight onto the wand.
9. Medical gymnastics
The most important method of treatment of arthrosis of knee joints is special therapeutic gymnastics. Virtually no person who suffers from gonarthrosis will not be able to achieve a real improvement in the condition without therapeutic gymnastics.
After all, in no other way it is impossible to strengthen muscles, "pump" the blood vessels and activate blood flow as much as this can be achieved with the help of special exercises.
At the same time gymnastics is almost the only method of treatment that does not require financial expenses for the purchase of equipment or medicines. All that is necessary for the patient is two square meters of free space in the room and a rug or blanket thrown to the floor.
You do not need anything else, except for the advice of a specialist in gymnastics and the desire of the patient himself to do this gymnastics. True, it is precisely this desire that most sufferers do not burn. Practically every patient, whom I examine with arthrosis, literally has to be persuaded to practice physical therapy. And convince a person most often succeeds only when it comes to the inevitability of surgical intervention.
The second "gymnastic" problem is that even those patients who are inclined to practice physical therapy can often not find the necessary sets of exercises. Of course, brochures for patients with arthrosis are on sale, but the competence of a number of authors is questionable - in fact, some of them do not have medical education.
So, such "teachers" do not always understand the meaning of individual exercises and the mechanism of their action on the aching joints. Often, gymnastics complexes are simply thoughtlessly copied from one brochure to another. At the same time they meet such recommendations that it's just right to grab your head!
For example, many brochures prescribe a patient with knee arthrosis "to exercise at least 100 sit-ups a day and walk as much as possible."
Often, patients follow such advice, without consulting with a doctor in advance, and then genuinely wonder why they became worse. Well, I'll try to explain why the condition of the affected joints from such exercises, as a rule, only worsens.
Let's imagine the joint as a bearing. Damaged by arthrosis, the diseased joint has already lost its ideal shape. The surface of the "bearing"( or cartilage) has ceased to be smooth. Moreover, cracks, potholes and "burrs" appeared on it. Plus, the grease inside the sphere thickened and dried, it was clearly not enough.
Try to put into operation such a design and in addition give it a load in excess of the norm. Do you think that from excessive rotation such a deformed "bearing" can become smoother and smoother, and lubrication more liquid and "sliding"?Or, on the contrary, the whole construction will quickly erase, loosen up and collapse? In my opinion, the answer is obvious: from excessive load such a "bearing" will collapse before time. In the same way, any bearings are destroyed and erased while driving, if sand, for example, gets into the lubricant and excess friction occurs.
It is easy to understand that under the same scheme, already damaged, cracked and "dried" joints are being destroyed. Hence, from exercises, creating an excessive load on the aching joints, these joints will only get worse.
So maybe, with arthroses, you can not do gymnastics at all? Nothing of the kind is possible and even necessary. As already mentioned, gymnastics is an important method of treating arthrosis. However, of all exercises, you must choose only those that strengthen the muscles of the affected limb and ligament of the aching joint, but do not force it to bend and flex.
Probably, after such a recommendation, many of the readers will be surprised: how can you load muscles and ligaments of the limb without forcing it to bend and unbend its joints?
In fact, everything is very simple. Instead of the usual fast dynamic exercises, that is, active flexion-extension of the legs, we must do static exercises. For example, if, while lying on your back, you slightly lift up your straightened leg and keep it on weight, then in a minute or two you will feel tired in the muscles of the leg and abdomen, although the joints in this case did not work( did not move).This is an example of static exercise.
Another option. You can very slowly raise your straightened leg to a height of 15 - from the floor and slowly lower it. After 8 to 10 such slow exercises, you will also feel tired. This is an example of a sparing dynamic exercise.
Quite a different matter if the exercise is performed quickly and vigorously, with the maximum amplitude. Waving your legs or actively crouching, you put the joints under increased load, and their destruction accelerates. But the muscles, strangely enough, with such movements strengthen much worse. We conclude: to strengthen the muscles and ligaments with arthroses, the exercises must be done either statically, fixing the position for a certain time, or slowly dynamically.
By the way, it is slow dynamic and static exercises that most of my patients do not like to do, because it is especially difficult to perform them. But it should be: properly selected, these exercises strengthen those muscles and ligaments, which the person atrophied because of illness. Therefore, at first, be patient.
Doing gymnastics, do not rush. If you want to be cured, you will somehow have to train yourself to do the exercises slowly and smoothly, without jerking. The jerking effort is only able to "rip" the muscles and will not bring any benefit. And remember: if some exercise causes severe pain, then it is contraindicated to you or you are doing it wrong. In such a case, be sure to consult your doctor about the correct implementation of this exercise.
In conclusion of the section on the treatment of arthrosis of the knee joint, I want to touch upon one question that patients often ask me: is it necessary to develop a leg for long walking and is walking useful for gonarthrosis?
Answer: Of course, for a healthy person, long walking is useful in all senses - for the heart, for the respiratory system, for the vessels, for the legs, etc. But with arthrosis, especially neglected, knee joints can not cope even with minimal daily exercise, andhere you can download them even more! Such actions, most likely, will only lead to an aggravation and further destruction of the joints.
Before you load, or rather overload your knees, you must first relieve exacerbation, strengthen the muscles of the legs and how to properly treat sick joints. Only then you can move on to active daily activities, gradually increasing the load and in no case avoiding pain.