Why is it necessary to take a blood test for arthrosis?
Osteoarthritis is a chronic joint disease that is degenerative in nature. The disease is characterized by damage to the cartilaginous tissue, which can be complicated by reactive synovitis( inflammation of the synovitis of the joint).
Modern medicine divides arthrosis into primary or idiopathic, which has no apparent cause and secondary, in which the causes of the occurrence are established, for example, an incorrect load on the joint and microtraumas of the cartilage, as well as past inflammation.
This disease has accompanied a person throughout history. Preserved medieval medical records, from which it becomes clear that arthrosis was an unpleasant ailment of mankind since time immemorial. Dystrophic changes in joints in skeletons of people and animals, typical for arthrosis, are also found in excavations of ancient cities by archaeologists.
Arthrosis( or, as it is now called modern medicine, osteoarthrosis) is similar in its symptoms to another common joint disease - arthritis. To differentiate arthrosis from arthritis it is possible, having handed over the analysis of a blood which necessarily appoint or nominate at an arthrosis.
Reactive arthritis is accompanied by deformity of the joints and pains, which resemble pain in arthrosis. Unlike arthrosis, arthritis is an inflammatory disease caused by the penetration of microorganisms into the tissue or other( for example, autoimmune) factors.
The disease begins gradually. The first signs are smeared and determined by the patient as joint stiffness and a slight pain during exercise. In the future, the symptoms progress, there is a characteristic crunch. The pain syndrome with arthrosis is expressed in different degrees, depending on the cause of the appearance of pain. In general, the pain is mechanical and occurs when moving. Possible pain at the beginning of walking, the so-called starting pain, after a long stay at rest. It passes with active movement and load. Sometimes there are night pain associated with increased intraosseous pressure, passing after lifting from bed.
When the disease passes to the second stage, the cartilaginous tissue begins to disappear in some areas with the exposure of the bone. Bone tissue responds to this by the growth of bone sites along the periphery. In the third stage, severe deforming changes and pain at rest appear. The mobility of the joint is significantly reduced.
In arthrosis, inflammation of the synovial membrane - synovitis often occurs. This complication is characterized by the appearance of severity in the joint, difficulty in flexing and small inflammatory changes in the blood.
The most common arthrosis of the knee( gonarthrosis), femoral( coxarthrosis) and elbow joints. Because of the characteristic symptoms, the diagnosis is usually not difficult. The physical examination is supplemented with laboratory and instrumental tests in order to exclude arthrosis-related joint diseases, in particular rheumatoid and infectious arthritis. For this, the following studies are recommended:
- Clinical blood test
For pain in the joint this procedure is mandatory. In arthrosis, a clinical blood test does not usually show significant changes in the indications. Sometimes there is a slight increase in ESR( sedimentation rate of erythrocytes) to 25 mm, usually with complication of the disease with synovitis. In arthritis, on the contrary, the inflammatory picture of blood with a sharp increase in ESR up to 40-80 mm is clearly pronounced.
- Biochemical analysis of
The blood for this analysis is taken strictly on an empty stomach from the vein. With arthrosis, biochemical blood levels remain normal. Increased markers of inflammation( seromucoid, C-reactive protein and some immunoglobulins) helps to correctly diagnose and differentiate arthritis from arthrosis.
- Radiographic examination of
This method is the most common after laboratory diagnosis of arthrosis. With the help of it you can determine the degree of the disease due to the presence of bone deformation and the width of the joint slit. But this method has its drawbacks, since on the x-ray one can not see soft tissues, that is, cartilages, and establish the amount of their destruction.
- Ultrasound examination of
ultrasound allows you to see all the tissues, including cartilage, but the method is not very accurate. The picture of the study depends on the quality of the apparatus and on the subjective interpretation of what was seen by the ultrasound examiner.
- Agnemagnetic resonance imaging( MRI)
This is an expensive and accurate method for diagnosing joint diseases. At the heart of MRI is the use of magnetic waves. With this method, you can see the earliest and minor changes in cartilaginous tissue and make an accurate diagnosis in the initial stage.
- Computed Tomography( CT)
This method is recommended when there are some contraindications to MRI.Computed tomography is a modern X-ray, because it is based on X-rays. The method is more accurate than radiography, but inferior to magnetic resonance imaging for accurate diagnosis of diseases.
Treatment and prevention of
With a correctly diagnosed diagnosis, the treatment of arthrosis that is started in a timely manner slows down the degenerative changes in the joints of the patient and improves the quality of his life. The process of treating arthrosis is long-term and is complex. The treatment is performed by a rheumatologist and includes exercise therapy and physiotherapy, sanatorium and spa treatment, as well as taking medications. As drugs prescribe painkillers and non-steroidal anti-inflammatory drugs( with complication of synovitis), taking courses of chondroprotectors and hyaluronic acid preparations. Of modern techniques, laser therapy, electromyostimulation and endoprosthetics are used.
Prevention of arthrosis is a healthy lifestyle and good motor activity. It is necessary to treat inflammatory diseases and joint injuries in time, not allowing the appearance of excess weight. What is the difference between arthritis and arthrosis?
Arthritis and arthrosis are often confused because of the similarity of names. Yes, and affect both the ailments of the joints( for example, there is also arthritis, and arthrosis of the knee joint).Suffered from disease joints become inflamed, swollen and aching. In other respects, these are completely different diseases. Let's try to understand, what is the difference between arthritis and arthrosis?
Difference between arthritis and arthrosis
Arthritis is accompanied by inflammation of articular joints, which, in turn, leads to impaired motor functions. The patient experiences discomfort, he has acute or aching pain, both with physical activity and during rest, especially in the morning. The skin in the joint area swells up, turns red and becomes strained. Often the body temperature rises.
Arthrosis is a disease in which degenerative processes occur in articular cartilage. Changed cartilage ceases to cope with the load falling on them and are gradually destroyed. The pain that occurs with the load usually passes in a state of rest. The tissues near the joint swell and become inflamed. Progressing disease leads to destruction of cartilage and severe deformation of the joints.
The difference between arthrosis and arthritis lies in the causes of the disease. Arthrosis can be:
- primary, usually associated with the elderly;
- secondary, arising from other diseases or genetically determined.
Predisposing factors for the development of arthrosis are:
- excessive weight;
- excessive physical exertion( most often, in athletes) or very low physical activity;
- past injuries;
- endocrine diseases.
Arthritis is inflammatory. Allocate such causes of the disease, as:
- various infections;
- joint damage and recurring minor injuries;
- metabolic disturbances;
- deficiency of microelements and vitamins.
Analyzes for arthritis and arthrosis
For the prompt diagnosis of the diseases affecting the basic apparatus, the specialist must collect a complete history. The patient is offered to take the following tests and perform the following tests and perform:
- Clinical blood test to determine the level of ESR( in arthritis, the erythrocyte sedimentation rate increases markedly, with arthrosis close to normal).
- Biochemical blood test to identify the shortage of macro and microelements characteristic of arthritis.
- X-ray, helping to detect bone deformity inherent in arthrosis, and to determine the width of the joint space.
- MRI( magnetic resonance imaging), which allows to detect changes in cartilage tissue in the early stages of the disease.
Features of treatment of arthritis and arthrosis
Such similar diseases as arthritis and arthrosis, mean different processes. Although they are close not only by name - one often accompanies the other.
Difference between arthritis and arthrosis
Arthritis is an inflammatory process in the joint capsule. The cause of arthritis can be infectious processes in the body, joint trauma with subsequent development of infection, systemic diseases( such as rheumatism, gout).
Osteoarthritis is a process of joint deformation, degeneration of connective, cartilaginous tissue on articular surfaces. It occurs against the background of metabolic diseases( for example, with disturbed salt metabolism), against the background of the pathologies of the formation of connective tissue( including hereditary) or after injury to the joint.
The main difference between arthritis and arthrosis is that in the case of arthritis, inflammatory changes occur in the tissues of the joint and intraarticular fluid, and in case of arthrosis, degenerative changes are a priority.
The reasons for the development of these processes may be the same. After the transferred inflammation, deformation of the affected cartilage surfaces often occurs, and then, after arthritis, arthrosis is formed. And vice versa - deformed by the deposition of salts, connective tissue of the joint with arthrosis - is prone to inflammation. Then arthritis arises on the background of arthrosis.
A good example of joint disease
The main symptoms of diseases
Pain in the joint
With arthrosis pains increase with time, each exacerbation is more complicated than the previous one. Pain syndrome accompanies any strain on the joint. Features of the work or the manifestation of physical activity( long hikes, physical training) lead to the onset of pain after exercise. In severe deformities, the symptoms do not stop completely even after the course of treatment.
Pain syndrome in arthrosis is permanent, exacerbated by exercise and is increasing gradually every year as the cartilage tissue is destroyed.
In arthritis pain syndrome occurs during exacerbation and is accompanied by other signs of inflammation - swelling, temperature, redness in the area of the joint.
Under arthritis is understood as a more acute( in comparison with arthrosis) process, which is accompanied by an obvious inflammation and passes after treatment.
Movement disorders in joints affected by arthrosis occur gradually and do not go away after exacerbation. Arthrosis( or more correctly - osteoarthrosis) can manifest itself as a process in any connections, including in the spine.
Inflammation in the knee joints
When the spine "does not bend," this is a manifestation of the process of destruction in the cartilaginous tissue, it becomes inelastic, the regeneration processes in it are not fully performed. The phenomenon of osteoarthritis is accompanied by a natural aging of the body.
An important sign of arthrosis is a crunch and clicking on the joint during movement. He speaks of the thinning of cartilage, the inconsistency of connective tissue lining articular surfaces. Stiffness in the joints is permanent. In arthritis, movements in the affected joints are also impaired, but the symptoms of stiffness or mobility limitations appear with exacerbation and are treatable. However, chronic forms of arthritis most often form changes in cartilage surfaces and symptoms like arthrosis.
For clarification of the reasons and exact definition, what process is present in a joint, spend inspection.
For pain management, it is often necessary to do injections
Examination for arthritis and arthrosis
The blood test reveals the severity of the disease, its nature( increased ESR indicates inflammation, increased eosinophils - allergic reaction, immune complexes talk about a possible rheumatoid process,about the presence of infection).Biochemical analysis is conducted to find out the blood content of urinary and sialic acids.
X-ray examination is mandatory for joint lesions. It shows the presence of changes in the configuration of the joint and the reaction of the nearby bone tissue. In addition to the X-ray, ultrasound is often performed, which clarifies changes in soft tissues in the joint and around it.
Intra-articular puncture is performed with both diagnostic( fluid analysis in the capsule of the joint) and with a therapeutic purpose( medication administration).
The most informative method is MRI.This examination shows defects in cartilage, spine, ligament, knee joint meniscus, etc.
Methods of treatment
The main task in the treatment of arthritis and arthrosis with exacerbation is the fight against infection and inflammation. Diseases have stages in the development of changes. Depending on the stage or severity of the process, the drug can be prescribed in different forms. With initial changes in the joint, anti-inflammatory pills are usually prescribed. In an acute condition, antibiotics are prescribed against the infection.
In case of severe inflammation, the doctor can prescribe hormonal medications, injections for anesthesia.
Pain syndrome and inflammation are also removed with topical medications, such as ointment, gel or compress.Also you can read: Difference of arthrosis from arthritis
Treatment with folk remedies is very popular with joint diseases. Starting from a diet rich in vitamins, lecithin and before making infusions and broths from herbs for compresses, home-made ointments. Golden mustache, flaxseed, hop cones, bay leaf - these and many other plants are found both in pharmacy ointments and in folk recipes.
Effective treatment of arthrosis provides drugs for the restoration of connective, cartilaginous tissues. They are called chondroprotectors. When there is a crunch and joint pain, it is recommended that they also be taken to prevent exacerbations.
Physiotherapy and medical gymnastics are important in maintaining the function of the joints.
In severe stages of arthrosis, only surgical treatment and prosthetics can help.
Prevention of arthritis and arthrosis
Prevention begins with a diet that excludes the excess of salts and products that interfere with metabolism( fatty meat, legumes, confectionery, alcohol).Desirable lean meat or fish, greens, cabbage, cartilage( cold).
To maintain joints, moderate exercise and warm-ups are required, combating obesity and timely treatment of inflammatory diseases.
Examination of a patient with arthrosis of the knee( gonarthrosis)
In our time, clinical and biochemical analysis of blood, radiography and magnetic resonance or computed tomography is most often used to clarify the diagnosis of gonarthrosis.
Clinical blood test
For this analysis, the blood is taken from the finger. With arthrosis, a clinical blood test, as a rule, does not show any specific changes. Only in some cases there may be a very slight increase in the rate of erythrocyte sedimentation( ESR or ROE): up to 20-.
On the contrary, a significant increase in ESR( above) in combination with nocturnal pain in the joint should prompt us to think about the possible rheumatic, inflammatory, origin of these pains.
If the patient also has an increase in the number of white blood cells, this fact confirms the presence in the body of
infectious inflammatory process, which is reflected, in particular, on the joints.
However, in any case, a clinical blood test does not give clear answers, it only indicates trends and narrows the range of diagnostic search.
Biochemical blood test
In carrying out this analysis, the blood is taken from the vein, and necessarily on an empty stomach. Biochemical blood analysis can be of great help to the doctor in carrying out differential diagnosis of joint damage: arthrosis or arthritis?
For example, in rheumatic diseases( arthritis), the level of the so-called markers of inflammation significantly increases in the blood:
of the C-reactive
protein, seromucoid, some globulins and immunoglobulins.
In arthrosis, these biochemical parameters, on the contrary, remain normal.
However, there are cases when certain types of arthritis also do not lead to a significant change in biochemical parameters. But still such an analysis, as a rule, helps to make a clear distinction between inflammatory and metabolic-dystrophic joint diseases( between arthritis and arthrosis).
Warning! In those cases where we find an "inflammatory" change in the blood taken from the finger or from the vein in a patient with arthrosis, we should be alert - after all, arthrosis does not cause any changes in the analyzes. And if the indices of inflammation are raised, there is a high probability that we are dealing not with arthrosis, but with arthritis. Then it is necessary to continue the examination of the patient until the final confirmation or refutation of the diagnosis.
Radiography of joints
Radiography is the most common and one of the most important methods of diagnosing arthrosis. In most cases, even the stage of arthrosis is established solely on the basis of an X-ray: after all, changes in the shape of the joint and bone deformities are quite visible on the x-ray;the bone is compacted under the damaged cartilage and osteophytes( "thorns") are clearly drawn. In addition, an x-ray image shows the width of the joint space, that is, the distance between the articulating bones.
But X-ray research has a serious disadvantage: only the bones are imprinted on the X-ray. But the soft tissue of the joint( cartilage, meniscus, joint capsule, etc.) on the x-ray, we can not see. Therefore, using only an X-ray, we can not with 100% accuracy assess the degree of damage to the articular cartilage, meniscus and joint capsule.
Fortunately, in recent years, the method of magnetic tomography has become increasingly widespread.
Magnetic resonance imaging( MRI, or NMR)
For the study, magnetic waves are used, as the name implies. They are able to reflect on the resulting image the smallest details of the joint. The method of magnetic resonance imaging is very precise: it helps to detect the earliest changes in the cartilaginous tissue( which are not yet visible on a conventional X-ray), and also allows to see damage to meniscuses and knee ligaments.
Therefore, I often recommend that my patients, in addition to the X-ray, use magnetic resonance imaging of the joint to specify the diagnosis.
Although here one must bear in mind one circumstance. Usually, having received tomographic examination data, doctors are so confident in their infallibility that they do not consider it necessary to double-check the results of the studies and conduct a personal examination of the patient. It is not right.
specialist of the tomography department, who carries out the decoding of the pictures, is also a human being and can make mistakes. In particular, I repeatedly came across situations when for arthrosis usual age changes or other, similar in a picture with an arthrosis, were accepted. It happens very often.
revealed on the tomogram arthrosis may not be the only patient's disease. And the main cause of pain, even with arthrosis, may be another disease: for example, arthritis or meniscus damage. And these diseases will need to be treated first( in parallel with the treatment of arthrosis).
In general, even having received a "full package" of patient's examinations( X-ray, analysis, tomogram), the doctor still must first conduct a personal examination of the patient and only then prescribe the treatment.
Computed tomography( CT)
In addition to magnetic resonance imaging, some hospitals still use computed tomography. In fact, computed tomography is the most advanced version of an X-ray: for computer tomography, all the same X-rays are used as in a conventional X-ray study. The only difference is that with a CT scan, the tomograph "shakes" the joint with a series of X-rays, and as a result, the image is more voluminous and detailed than with X-ray. But it is still inferior in order to the informativeness of the magnetic resonance tomogram. Therefore, CT should be used only in cases when
for some reason
, we can not conduct the patient magnetic resonance imaging( for example, if a patient has a pacemaker, a pacemaker, and magnetic waves can disrupt his work).
Ultrasound of joints( ultrasound)
Ultrasound examination in recent years has been actively used for the diagnosis of joint diseases. After all, ultrasound, like magnetic resonance imaging, allows you to see changes in the soft tissues of the joint - for example, using ultrasound can detect thinning of the cartilaginous tissue for arthrosis or an increase in the amount of joint fluid in arthritis;it is possible to identify meniscus lesions in the knee, etc. However, the method has a significant drawback - it is highly subjective, and the data obtained depend entirely on the qualifications of the examiner.
Of course, this does not mean that specialists in joint ultrasound are constantly mistaken. But even if such an accurate method as tomography leaves room for different interpretations of the findings and disagreements in the diagnosis, the ultrasound findings of the joints raise questions particularly often.
Therefore, I am not inclined to blindly trust the diagnosis obtained on ultrasound of joints, and I always recheck such conclusions( by personal examination of the patient, as well as by X-ray examination or by magnetic resonance imaging).
Osteoarthritis of the knee joint( gonarthrosis), treatment of arthrosis of the knee joint
Among diseases of the musculoskeletal system, osteoarthritis is the leader in frequency. It is believed that the vast majority of the world's population by the age of 60 have initial signs of articular cartilage change, and 14% have already manifestations of osteoarthritis. The most common variant of this disease is osteoarthritis of the knee joints.
All the same "arthrosis" or "arthritis"?
Do not confuse these two concepts. Arthrosis is a process of altering the structure of the joints in the first place, and arthritis is an inflammation that could arise both against the background of the "untouched" structure and against the background of arthrosis.
Changes in bone with arthrosis can be compared, for example, with knotty outgrowths on the trunk of a tree that grows close to the concrete fence and presses all this weight on this fence.
Normally, the bony surfaces facing each other are separated by two layers of cartilage and menisci( additional cartilaginous plates).In addition to the role of the "buffer" between the bones, the cartilage ensures that the bones slide and are mechanically matched to each other. Even more strengthen the contact of bones with each other menisci, which due to large or minor( but frequent) injuries, and over time lose their elasticity, can completely or partially burst.
With age, and especially in the presence of hereditary predisposition, articular cartilage becomes thinner. That is why the bones of the hip and lower leg, which make up the knee joint with their ends, dangerously approach each other, friction may even arise between them.
Usually, in parallel with the thinning of the cartilage, another unpleasant event occurs over the years: the amount of intra-articular fluid decreases. This liquid is not only a purely mechanical "lubrication" of the joint from the inside. It provides nutrition to the bone, menisci and articular cartilage. Breaking the "supply" of all these structures is a real catastrophe for the joint!
If there is a physical overload of the joint, then bony outgrowths appear on the bone surfaces and begin to grow, more like tapers, or thorns. For the knee joint, such overloading will be lifting of weights( including excess weight of one's own body!), Physical labor with emphasis on the knees( for example, weeding the garden), constant walking on stairs, running, wearing uncomfortable shoes, flat feet and many others. Now it is not difficult to imagine what happens inside the knee joint with the development of arthrosis, and how it manifests itself externally.
How does the joint work? What is the articular cartilage?
Each of us has seen articular cartilage on the end, for example, of chicken bone many times. It covers small areas of contiguous bones. Under the articular cartilage is subchondral, or okolochryshchevaya bone. The human musculoskeletal system is similar in structure.
Most human joints consist of bones, synovial( joint) membrane and intra-articular fluid.
What happens to the joint with arthrosis?
Under the influence of all those loads, which have already been mentioned, there is condensation and proliferation of the subchondral bone, as a result - increased traumatization of articular cartilage.
The products of cartilage destruction, formed as a result of microtraumas, enter the synovial fluid. So arranged by nature that they are foreign substances for the synovial membrane and provoke its inflammation. Violated the formation of synovial fluid, which is usually a sort of "conveyor", like a continuous cycle of enrichment and purification of blood. In addition, in the joint fluid becomes less hyaluronic acid. About this acid should be told specifically.
Hyaluronic acid provides the viscosity of the synovial fluid, creates a "buffer effect" and "lubrication effect" between the bones, reducing their friction against each other. It is thanks to this substance that the articular fluid resembles egg white, rather than water, in consistency. Another important role of hyaluronic acid is to ensure the delivery of nutrients from the articular fluid deep into the articular cartilage, since it can not take any more food: the blood vessels do not fit directly to the cartilage. In the same way, the "spent" substances are removed from the cartilage into the joint fluid: with the help of molecules of hyaluronic acid.
So, there is an increased compaction of the bone and unbearable conditions are created for the articular cartilage.
Cartilage receives a signal to adapt to these extreme conditions, and it begins to change, in another way it is called remodeling. This is mainly manifested by a decrease in the elasticity of the cartilage.
In the late stage of arthrosis development, the bone becomes stiff, but at the same time more fragile, the cartilage itself is partially impregnated with calcium - it is calcified.
Diagnosis of arthrosis of the knee
In the early stages of the disease the joint is unchanged, mobile, muscles around it are preserved, and strong enough. Only with palpation( pressing) of certain points, more often on the inner surface of the joint, local( local) soreness is determined. The doctor asks the patient to perform several sit-ups, bend, unbend his leg in the knee, put him on the couch face up and conduct the flexion-extension itself( this is called "passive" movement).In addition to pain and the limitation of the volume of movements, it is possible to determine the crunching, clicking of the joints. With a pronounced inflammatory component, the joint is enlarged in size, it seems that it is "pumped up" with liquid. With a far-reaching process, flexion in the knee may be partially or completely absent, when viewed, the surface of the joint seems uneven, bumpy, the limb may be curved( displacement of the limb axis, "stiffness").
Laboratory and instrumental research
- the obligatory laboratory examination program includes general, biochemical and immunological blood tests, urine analysis .In a general blood test, attention is drawn to the increased level of leukocytes and the increased rate of erythrocyte sedimentation, which indicates inflammation. In the biochemical analysis of blood, the indicators of uric acid metabolism, the level of "liver" enzymes are important. In the immunological analysis determine the presence or absence of signs of systemic inflammation - this is indicated by the level of C-reactive protein. The analysis of urine will reveal the content of "sand" - crystals of uric acid.
- analysis of the synovial( joint) fluid is given when this fluid is in sufficient quantity. That is, when the joint is swollen, swollen. Under sterile conditions, the doctor pierces the joint capsule in a strictly defined place, inserts the needle into the joint cavity, and then removes excess fluid. Some of the material is sent to the laboratory for analysis. At the end of the procedure, an anti-inflammatory drug from the group of glucocorticosteroids( for example, diprospan) is most often injected into the joint cavity with a syringe.
- radiography .A photograph of both knee joints is mandatory, this is necessary to compare a diseased knee with a healthy one. The picture draws attention to the width of the joint gap( it is judged on the condition of meniscuses and cartilages), the presence or absence of osteophyte bone spines, signs of destruction( destruction) of bones.
- AS of the knee joints will answer questions about the safety of the meniscus, the presence of Baker's cyst, the severity of inflammation, the presence or absence of uric acid crystals( in the presence of gout).
- MRI( magnetic resonance imaging) .This study is appointed if ultrasound does not provide an exhaustive answer to the questions of a specialist. Mandatory MRI is performed for patients who are scheduled to perform arthroscopy.
- Arthroscopy .Allows you to visualize, that is, personally assess the condition of the joint. The method is indispensable in case of disputable diagnoses, suspicion of traumatic damage to menisci and ligaments( then, at the time of the study, operative removal of broken menisci or ligation of ligaments is possible).
Treatment of arthrosis of the knee
Adherence to the principles of complex treatment, which include:
- Detailed information of the patient about the disease
- The use of curative physical exercises, which includes: specific exercises for joints in the prone position, swimming
- Maintaining an optimal body weight
- Wearing an orthosissoft bandage or at least elastic bandage) during the increased load on the joint - on the road, during walking and so on.
- Non-medicinal methods( physiotherapy).This type of treatment gives excellent results for arthrosis of the knee joint( gonarthrosis).Apparently, this is due to the fact that the joint is available for exposure to such factors as magnetic and laser radiation. For the treatment of the knee joint, you can apply magnetic currents, UHF, cryo-impact( in translation from Greek means exposure to cold).Physiotherapeutic procedures are widespread, treatment courses are usually short-lived - 10, maximum sessions daily or every other day. One should only remember the possible contraindications, which include tumor processes, thyroid and pelvic organs diseases, as well as systemic( autoimmune) inflammatory diseases.
- Drug therapy.