Gout: colchicine for the treatment of
disease Colchicine is a medicine used to treat gout. The drug is a toxic natural product. Colchicine is isolated from plants of the genus Colchium. Initially, the drug was used to treat rheumatic diseases, especially gout, and still this drug is used, despite the toxicity. In addition to gout, colchicine is used to treat familial Mediterranean fever, pericarditis, Behcet's disease. Colchicine can be an alternative option for some people who can not take non-steroidal anti-inflammatory drugs. Currently, colchicine does not have a universally accepted alternative.
Gout is a relapsing form of arthritis that causes pain, swelling, and redness of the joints. Gout, as a rule, primarily affects the big toe. Subsequent outbreaks of lesions extend to other parts of the body, including the ankles, knees, elbows, wrists, fingers. Gout occurs when uric acid accumulates in the body, instead of leaving naturally. Men who drink alcohol, eat foods high in purines, such as liver and beans, are more likely to develop gout.
Colchicine - medicinal preparation
Colchicine is used to prevent gout attacks( sudden, severe pain in one or more joints caused by abnormally high levels of uric acid) in adults. The drug is not an anesthetic, so it can not be used to prevent pain, which was not caused by gout. The drug works by stopping the natural processes that cause swelling and other gout symptoms.
Treatment of gout with folk remedies
Today, the most effective means against the formation of uric acid in the joints are preparations of allopurinol, anururan and allomarone. In order to eliminate gout attacks, compresses with 55% dimexide content are used. This remedy perfectly eliminates inflammation and reduces the manifestations of pain. Compresses are applied for half an hour, with a frequency of 10-20 procedures. In addition to this, drugs containing anti-inflammatory action are used on the affected joint. This includes specialized ointments, gels and creams.
Recommended tinctures for gout attacks:
- Tincture based on Indian onion with celandine.15 g dried or 60 g crushed herb celandine, fill it in a glass beaker, mix there 20 grams of crushed leaves of Indian onions. Fill all this with 0.5 liters of vodka. Tincture store at room temperature for about 2 weeks in a dark place. After 2 weeks, when the tincture is ready, it must be filtered. Apply as lotions during gout attacks.
- Tincture based on Indian onion with chestnut flowers.15 g of chestnut flowers put in a glass vessel, fill with 0.30 liters of medical alcohol, insist about 4 days, then add the contents of ¼ sheet of Indian onions in a crushed form and continue the infusion process for another 7 days. After a week, when the tincture is finally ready, it must be filtered. Use as a lotion for gout attacks.
Colchicine and its side effects
Discontinue use of colchicine if you feel nauseous, vomit, or have diarrhea. Treatment of affected gastrointestinal tracts, which are reflected as side effects, may require medication. Other side effects that require medical attention include the following symptoms: blood urination, shortness of breath, fever, cramping, rash, unexplained bruising.10 important facts about colchicine:
- Colchicine is an alkaloid derived from dried Colchium Autumn seeds, also known as Crocus Autumn or Meadow Saffron. The beginning of the use of this drug dates back to 1810.Then it was used not only for the treatment of gout, but also for other diseases such as amyloidosis, Behcet's disease, herpetiform dermatitis, familial Mediterranean fever, Paget's disease, pericarditis, pseudogout, cirrhosis.
- Colchicine is available in oral or intravenous doses. Produced in two forms: tablets of 0.5 mg and 0.6 mg. The drug is also available intravenously, but there is a potential for serious toxicity using the parenteral route of drug administration.
- Colchicine has an anti-inflammatory property, but its use is limited to other diseases other than gout. Although the drug is considered a very effective way of treating acute gouty arthritis, it is important to know that its use for other purposes is prohibited. Colchicine is not an analgesic( an analgesic drug).
- Colchicine works differently than other painkillers or anti-inflammatory drugs. The medicine has a huge impact on neutrophils. Neutrophils are a type of white blood cells. By its principle, neutrophils can not migrate to the inflammatory region. The drug has an overwhelming effect that helps reduce acute attacks with gout, thereby relieving pain and discomfort.
- Colchicine is recommended for regular use between seizures, both for prophylactic purposes and for the prevention of signs of discomfort. The usual dose for relief of attacks with gout is from 1 to 1.2 mg( two tablets of 0.5 mg or two of 0.6 mg).This dose is taken in such a unit every hour or two units every 2 hours until the attacks go through. After taking the dose, the drug should stop gastrointestinal discomfort.
- Colchicine can be administered continuously as a preventive treatment. In patients who have less than one attack with gout in the year, the usual dose is 0.5 or 0.6 mg per day, 3-4 days per week. For those who have more than one attack per year, the usual dose is 0.5 or 0.6 mg, two tablets per day.
- Side effects may occur if colchicine is used, it is important to take this into account. Serious adverse reactions: aplastic anemia, agranulocytosis, thrombocytopenia. Other possible reactions: peripheral neuritis, purpura, myopathy, hair loss, reversible azoospermia( complete absence of sperm).Vomiting, diarrhea and nausea are the most common side effects when taking colchicine.
- Colchicine should be used during pregnancy only if the potential benefit justifies the potential risk. Colchicine can stop cell division, so this can be a significant risk to the fetus. Care should be taken when taking the drug, especially for women in the situation.
- Colchicine is contraindicated and should not be used by patients with disorders of the gastrointestinal tract, kidney and heart disease. Patients with blood diseases should not use this medication.
- Colchicine is available only on prescription. To reduce the risk of side effects, the medicine is better taken while eating.
In gout attacks, colchicine has an effective response, apparently due to a reduction in the inflammation process caused by the urate crystal. The achievement of the drug is manifested by the launch of various mechanisms, in which the level of leukocytes decreases. Colchicine contains an antimitotic effect, which is why it is successfully used in medicine.
Tablets for the treatment of gout
The joint is destroyed by crystals of uric acid
Such a disease, like gout, is known to mankind since ancient times. The cause of its occurrence is an increase in the level of uric acid in the blood. Excess uric acid leads to the fact that the kidneys do not have time to remove it from the body. As a result, salts are deposited in the joints, which causes severe inflammatory processes.
Successful treatment of ailment largely depends on nutrition. From the diet should exclude all products that promote the formation of uric acid. Drug treatment for gout is prescribed when compliance with the diet does not bring relief and the level of uric acid in the blood is still high.
Features and symptoms of the disease
In the old days gout was considered a disease of aristocrats, as it developed as a result of excessive consumption of meat and alcohol, which the poor could not afford. Today, when meat products and alcohol became available to almost everyone, almost all strata of the population were affected. Prevalence of gout is low: on average, there are only 3 cases of diseases per 1 thousand people, while men suffer from it more often than women.
The peculiarity of the ailment lies in the fact that it has a chronic form and is not completely cured. If a person has been diagnosed with gout, he will need to adhere to a special diet in order to avoid exacerbations until the end of his life, eliminating meat and alcohol from the diet. The normal drinking regime is also very important. To remove uric acid from the body, the patient should drink 2-2.5 liters of fluid per day. But only if he does not suffer from kidney disease.
Gout is characterized by a paroxysmal course. Its symptoms are difficult to confuse with the manifestation of some other disease. The gouty attack always begins suddenly and is accompanied by unbearable pain and increased sensitivity of the area around the joint, inside of which accumulated salts of uric acid. At the initial stage of the disease, the pain is localized in the joint of the big toe. It becomes hot and red.
Manifestation of an acute attack of the disease
It occurs most often at night, when a person is at rest. If the patient does not pay attention to the alarming symptoms, does not go to the doctor and does not begin treatment, the ailment will progress and spread to other joints. A distinctive feature of gout is tofusi( gouty buds), formed on the site of a cluster of crystals of uric acid. If the disease is started, it will lead to serious impairment in the functioning of the kidneys.
Many people who suffer from bouts of gout, the question arises: how to treat this disease? Noticing the symptoms of ailment, the patient should apply to a medical institution and undergo an examination. If the result is that the level of uric acid in the patient's blood is increased, he will be prescribed medication.
There are not that many medicines for the treatment of gouty arthritis in modern medicine. They are divided into 2 groups:
- medications used by patients during an attack;
- tablets intended for long-term use during remission.
Drugs used during an attack
In the treatment of gout, the anti-inflammatory and anesthetic drug colchicine is widely used, its action is aimed at normalizing the exchange of uric acid in the body. Colchicine in tablets is intended for relief of acute attacks and reception as a preventive agent. It has a complex effect on the body:
- relieves pain syndrome;
- lowers the migration of leukocytes to the site of inflammation;
- reduces the production of uric acid salts and prevents their accumulation in the joints.
Treatment of gout with colchicine should be carried out at the initial stage of the attack, in this case the drug has the maximum therapeutic effect on the patient's body. If tablets are taken from gout at the height of an attack, they can not quickly remove its symptoms. To treat the acute form of gout on the legs and other inflamed areas, colchicine should be taken only as directed by the doctor. The duration of anti-gout therapy is determined by a specialist.
Before drinking colchicine, you should read the contraindications for its use. These include:
- hepatic and renal insufficiency;
- advanced age;
- is an individual drug intolerance.
The most common side effects in the treatment of the drug are allergic reactions, abdominal pain, vomiting, diarrhea, anemia. Long-term use may cause thrombocytopenia.90% of patients say that treatment of gouty arthritis with colchicine produces a positive therapeutic effect. Its analogues are such agents as colchicine and colchimine.
Today, gout attacks are successfully stopped by non-steroidal anti-inflammatory drugs( NSAIDs).These include phenylbutazone, methindole, indomethacin, ketazole, butadione and other drugs. Medicines from the NSAID group effectively relieve the pain syndrome in a gouty attack, reduce the temperature and contribute to reducing the inflammatory process in the affected joints. They are more effective than colchicine, and are better tolerated by the patient's body. The question of which of the non-steroidal preparations is best to choose is the doctor's decision. He will also prescribe the dosage of the medication and the duration of his admission.
Since gout reminds itself of itself always unexpectedly, it is advisable for the patient to constantly carry with him the prescribed pills and in case of an attack immediately take them.
Medications for the prevention of exacerbations
If a person has chronic gout, treatment is carried out with preventive medicines intended for long-term use. This drug is allopurinol - a drug whose main effect is to reduce the amount of uric acid in the body. Tablets are available in dosages of 100 and 300 mg. For the removal of seizures, this medication is not used, it is prescribed during remission, when the joint is not inflamed.
The doctor selects the dose of allopurinol individually for each patient, based on the results of his analyzes. The minimum dosage of the drug is 100 mg, the maximum dosage is 800 mg per day. To avoid negative consequences, allopurinol treatment is started with a minimal dose. Drink the medicine after eating. To achieve a positive therapeutic effect, allopurinol should be taken for several months. Contraindications for treatment with this medication:
- pregnancy and lactation;
- kidney failure;
- individual intolerance of the drug components.
Usually patients tolerate allopurinol well if it is to be drunk. In rare cases, they may experience side effects in the form of insomnia, depressive state, nausea, vomiting, diarrhea, blood diseases. At the initial stage of taking the drug, the aggravation of the illness is possible due to the release of uric acid from the gouty tofusi and other places of its concentration. If you feel worse when taking medication, the patient should consult a doctor.
In addition to allopurinol, anti-gouty drugs that reduce uric acid levels are thiopurinol, probenecid, benzobromarone, anthuran. They are also designed to prevent gout exacerbations and are prescribed for a long period.
Use of colchicine in the treatment of gout
Gout is an ancient disease, which often, as the statistics say, men are ill. Practically in all cases, gout is noticed when it has been going on for a long time. Now there are numerous ways to treat gout, which effectively contribute to getting rid of the disease.
Treatment of gout consists of a number of activities:
- compliance with diet;
- consumes a lot of fluids;
- use of medicines from folk and traditional medicine;
- warning of factors that provoke bouts of the disease.
Regarding compliance with the diet regime, it is necessary to limit the consumption of products containing purines as much as possible: meat of young animals, fatty fish, meat broths, spinach, beans, radish, beans, horseradish, salted and spicy cheeses, sorrel, lentils, spices, strong coffee, cocoa, products containing preservatives. Also, you should reduce the calorie diet, especially when overweight.
Use of folk remedies and medical preparations
There are many tools that are actively used to treat gout, one of them is medical bile. Thanks to compresses with bile, pain from cones on the legs disappears after 10-15 procedures, and to completely get rid of the hated cones should perform at least 35-45 procedures. To eliminate accrued cones on toes, it is necessary to prepare the following composition: 160 g of camphor alcohol, 1 tbsp.a spoonful of hot red pepper, 1 bottle of medical jelly, 4 pods of chopped hot pepper.
All components must be put in a dark cool place for a week. Compresses for cones should be done for at least 10 days at night. Then you need to make a 3-month break, after which the course of treatment with bile should be repeated.
In addition to traditional medical treatment for gout, there are many medicines from traditional medicine. The most common is the saber, which can be treated at home. To do this, prepare a special decoction of 5 g of crushed roots of the saber per 200 ml of boiling water. Broth with sabelnikom need to eat before eating for half a cup. You can prepare an alcohol tincture with a swamp saber. To do this, take 500 ml of vodka and 250 g of dry root of the plant. Infuse 3 weeks in a dark place, then take up to meals 3 times a week for one glass. The general course of treatment with a saber continues for 2-3 months with a dosed intake of infusions.
Use of colchicine
Colchicine is a traditional drug that is used to treat gout. In particular, colchicine can alleviate the general condition of acute gout and carry out preventive measures when it becomes aggravated. The drug stabilizes the membranes of lysosomes of neutrophils, which leads to a decrease in lysosomal enzymes, which are mediators of acute gouty inflammation.
This drug belongs to the group of alkaloids of the tropolon series and is of vegetable origin. The main source of colchicine is a plant called autumn autumnal. The drug colchicine has an analgesic effect, so it can be used to treat acute gout even during an attack. Noticeable improvements in well-being when taking the drug are associated with a decrease in burning and inflammation, this is facilitated by the constituent drugs. Colchicine does not cause any harm to the human body. Its main part is absorbed in the intestines, and a small part is disintegrated in the liver, after which it is excreted from the body naturally. In addition, colchicine has an antimitotic( antifungal) effect.
Method of administration, contraindications, side effects of
Dosage of colchicine tablets is appropriate during the attack of gout, the dose should not exceed 1 mg, 1 tablet. After taking a break at two o'clock, it is necessary to repeat the medication. This dosage, as a rule, is enough to relieve pain in the joints. Significant improvement occurs in 3 hours and lasts from 12 hours. After examining the patient, the doctor has the right to increase the dosage of the drug, but taking more than 10 tablets per day is unacceptable.
There are a number of contraindications to colchicine treatment: hypersensitivity, hepatic and renal insufficiency, lactation( breastfeeding).During pregnancy, the drug is administered under strict medical supervision. Although the methods of intravenous drug administration always speed up the treatment process, but in the case of colchicine this theory is harmful, its intravenous use is strictly forbidden, since this can only contribute to the risk of obtaining fatal disorders in the body.
Side effects that can occur in case of colchicine overdose:
- stomach pain, nausea;
- neuropathy, myopathy;
- agranulocytosis, thrombocytopenia;
- alopecia( alopecia), skin changes;
- azoospermia in men;
- leukopetia, neuropathy.
In case of occurrence of the above-stated signs from reception of a preparation it is necessary to refuse.
Colchicine: instructions for use, price, analogues
Colchicine: formulation and manufacturers
Colchicine is available in the form of tablets. Each tablet contains 0.5 mg or 1 mg of active ingredient. Outside, the tablets are covered with a membrane that dissolves in the intestine and prevents the absorption of colchicine in the stomach.
Colchicine is imported to Russia from the European Union countries: Germany, Austria, Italy, Portugal, as well as from India and Vietnam.
- Pharmafar Srl( Italy) - the trade name of the preparation "Colchicina";
- Johannes Bürger Ysatfabrik GmbH( Germany) and Acarpia / Pharmafar S.r.l.( Portugal) - produce the preparation "Colchicum-Dispert";
- Brown Laboratories Ltd. for Rotec Ltd., India / Great Britain - produces "Colchicine".
Pharmacological action of
Colchicine regulates the formation and excretion of uric acid. As a result, inflammation decreases, joint pain decreases. The drug starts the following processes:
- reduces the production of uric acid;
- reduces the number of lysosomal enzymes that allow a chemical reaction to occur in the inflammation zone;
- reduces the movement of leukocytes to the site of inflammation;
- suppresses cell division in the area of inflammation;
- inhibits the growth of yeast-like bacteria.
The analgesic effect of the drug is supplemented with an anti-inflammatory effect. Colchicine not only anesthetizes, but also cures( reduces inflammation).A number of medical studies have proven the effectiveness of colchicine in the fight against cancer.
Indications for use
Colchicine is indicated in the following diseases:
- gout and gouty arthritis;
- phlebitis( inflammation of veins);
- Behcet's disease( middle and small arteries are affected, because of which the mucous membranes of the eyes, mouth, genital organs, and skin become inflamed, externally the lesions of the mucous resemble herpes);
- chondrocalcinosis or pseudogout( deposition of calcium in the form of salts on articular cartilage);
- scleroderma( a form of arthritis in which the skin and connective tissues are thickened and thickened to form scars);
- dental inflammation;
- Mediterranean fever is a family hereditary disease that is manifested by periodic fever, inflammation of the lungs, arthritis, skin lesions. Taking colchicine during recurrent relapse prevents the complication - the development of amyloidosis( a violation of protein metabolism).
Colchicine: contraindicationsSince the active substance of the drug is a poison, Colchicine may be taken only after consultation with the doctor and under his constant supervision. It should be remembered that you can not apply the medicine to everyone and not always.
Do not take the drug with:
- severe forms of hepatic or renal failure. The drug is absorbed in the intestine, then accumulates in three organs: kidney, liver and spleen. If the kidney or liver function is disrupted, the drug is withdrawn slowly, symptoms of severe poisoning are formed;
- serious violations in the organs of the digestive tract;
- of pregnancy. Colchicine, penetrating the placenta, destroys the chromosomes of the fetus during the period of intrauterine formation;
- neutropenia( a decrease in the number of neutrophils - white blood cells, followed by a decrease in immunity, development of purulent processes, inflammation, high susceptibility to infections and viruses);
- alcoholism;Alcohol is a poison. Thus, the effect of the two toxins is mutually reinforced, and as a result, the greatest poisoning is possible!
- elderly( often accompanied by a special susceptibility to toxic substances).
- high sensitivity to the active substance - colchicine or its shell components.
Side effects of taking colchicine
In small doses, the poison treats. But there are possible side effects:
- Pains in the stomach, diarrhea, nausea, vomiting.
- Kidney failure.
- Temporary infertility in men( colchicine stops spermatogenesis).
- Cramps and weakness in the muscles.
- Alopecia( alopecia).
If there is a significant excess of the allowable dose of the drug, a severe poisoning condition occurs, which manifests as vomiting, diarrhea with blood, severe abdominal pain, and a burning sensation in the throat and on the skin.
In case of signs of overdose, should immediately stop taking .Urgent hospitalization, gastric lavage, control of breathing, blood pressure, heart rhythm will be required.
How to take
The drug is taken orally, swallowing without chewing. The patient's condition is markedly improved already within the first 12 hours after taking the drug.
Scheme of treatment during acute gout:
- During the first day of treatment, take 1 mg of colchicine in three divided doses.
- On the second and third days, the total dose is reduced to 2 mg( in two doses of 1 mg).
- On the fourth and subsequent days - 1 mg once a day, it is better to do it in the evening.
To prevent gout attacks take one tablet( 1 mg of the drug) daily or every other day for 3 months.
For amyloidosis, the drug is taken for a long time at doses of 1 to 3 mg per day.
If an acute painful attack is repeated, then colchicine treatment can be resumed no earlier than 3 days after the end of the previous course.
The pharmacological industry in Europe produces various preparations based on colchicine: Colchimine ( the cheapest of a number of preparations), Colchicine , Colchicum-dispersant ( the most expensive drug).
Drugs used also in the treatment of gout and similar in their therapeutic effects:
- Ambene - used to treat rheumatoid arthritis, gout, neuralgia.
- Allopurinol is an antidotal drug.
- Voltaren - except for the treatment of arthritis and gout, has an analgesic effect, is used for migraines.
- Diclofenac - rheumatism, Bechterew's disease, inflammation of the joints.
- Naproxen - arthritis, arthrosis, neuralgia, radiculitis, postoperative pain syndrome, pharyngitis, tonsillitis, otitis media.
- Revmadore - exacerbation of gout, pain in the spine, traumatic inflammation, neuralgia.
- Fleksen - with phlebitis, articular pain, arthrosis, radiculitis.
Colchicine is a herbal preparation that does not have full analogues in modern medicine .Treatment with colchicine must be very literate, therapy requires taking into account the age of the patient and carefully monitoring the condition of his body.
Gout remedy stops the development of the disease
Treatment of gout in modern ways
There are many methods for treating gout, but first of all, the level of uric acid in the blood is determined and the degree of involvement of other internal organs is determined. When prescribing medicines, for example, it is important to know whether the kidney function is impaired and whether there are any stones. The main methods are as follows:
The first step is the removal of pain in the joints. To do this, the level of uric acid in the blood decreases. The first quick and independent help can be done at home. For this, the patient with his suffering joint is laid in bed to ensure complete rest. The joint is fixed on a hill( pillow, roller) and an ice pack is applied to it.
At this time, it is necessary to drink a lot of liquids, especially a rosehip drink, which quickly removes uric acid from the body. By directly treating the area of the foot, patients often resort to the method of acupressure and acupuncture. In this way stagnation in the blood is eliminated, deposits of salts are eliminated and the tissue structure is restored.
Any treatment method is accompanied by an adjusted diet. Nutrition can prevent the occurrence or stop the development of gout, excluding excessive consumption of meat, mushrooms, salt, legumes.
deposits of urates on the joint
In modern medicine, non-steroidal anti-inflammatory drugs are used. One of the oldest and most powerful means of blocking pain is colchicine. On the drug, indeed, the body reacts very quickly in terms of alleviating the attack of gout. But, unfortunately, this drug is very toxic, can cause nausea, vomiting, stomach spasm, diarrhea. P The use of colchicine is prohibited when alcoholism, kidney failure, pregnancy, purulent infection and in old age. When non-steroidal drugs are powerless, steroid drugs are prescribed, which can act as injections.
What's new today?
In the treatment of this disease, medicine is making significant progress. Medications relieve gout symptoms within the first two days, and then their action is directed at preventing subsequent attacks, which is achieved by controlling the permissible level of uric acid in the blood. Today, new drugs for gout are less toxic and very effective against acute attacks. With the same colchicine, which is effective at an early stage, the use of allopurinol is well combined. This is especially good for patients with kidney stones.
At first, there may be a rash and a slight upset stomach, but there is a rapid addiction to the drug. For people working with mechanisms and driving, allopurinol is administered cautiously, as it can cause drowsiness. During an acute attack of gout, this drug is not used. In this case, we can talk about its combination with colchicine, which blocks the attack of gout, and in the future the action of allopurinol is aimed at reducing uric acid in the blood and the risk of new attacks. This drug is also used as a supporting agent in the treatment of cancer.
tablets stop gout attacks
Thus, it is seen that two lines of therapy are allocated in the treatment of gout: one is aimed at treating an acute condition( eg colchicine), the second - reduces the level of uric acid( until recently the only effective was considered the action of allopurinol).Now a new era - new drugs. Modern scientists in the field of pharmacology are studying which drugs can safely reduce the level of uric acid in the blood. With the development of new methods for diagnosing gout and its attendant diseases, a new treatment for gout is being identified. But the diet, physiotherapy and recommendations of sanatorium treatment remain unchanged.
Fullflex for the treatment of attacks
Often when prescribing gout treatment, fullflex appears. The advantage of this drug is that it is created on the basis of herbs: martini, scented, white willow. Virtually no contraindications and no side effects. The root of martini sweets included in the pharmacopoeia countries such as France, Germany, England. He resembles a crooked hand and was called "the devil's claws."
This agent is able to bind uric acid in the blood and remove it from the body. The presence of the extract of the bark of the white willow removes puffiness, joint pain and restores their mobility. It contains salicylate, which has an anti-inflammatory effect. The drug has the form of capsules or cream, and the full price of the price is so insignificant that it is available to a patient of any social group. What is convenient is that one capsule per day is sufficient. The remedy is not a medicine, it is a dietary supplements and the only contraindications are pregnancy, breast-feeding and children under 14 years of age.
This tool is based on modern research, is unique and reduces the cholesterol to anything. Ointment fulflex must be applied to the painful joint and rubbed with light circular motions. This external application reduces the pain syndrome. The combination of external application with internal is considered the most effective. As a result, we get the receding gout and the adjusted work of the joints.
Gout is a chronic disease, and it is completely impossible to cure it. An ideal medicine does not exist, since tolerability of all is different and individual reaction. It is always recommended to conduct treatment under the supervision of a doctor. Self-medication is in any case prohibited, in order not to harm the joint completely.