List of drugs for the treatment of arthrosis of the knee
Osteoarthritis of the knee joint( gonarthrosis) is a complex disease that is not always treatable. Therefore, in this article, we have prepared for you a list of drugs that are most effective in treating this disease.
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1st group of drugs: anti-inflammatory drugs
What is the danger of NSAID administration?
2nd group of agents: chondroprotectors
What is important to remember when treating chondroprotectors?
Drugs for intra-articular injection
Warning: All information on remedies for arthrosis of the knee joint is published exclusively for informational purposes for personal review. Do not try to use them yourself without consulting a doctor: self-medication can cause irreparable harm to your health!
All medicines for the treatment of knee osteoarthritis can be divided into several large groups by the mechanism of action.
1st group: anti-inflammatory drugs
Aertal - one of the new drugs for gonarthrosis
It is with non-steroidal anti-inflammatory drugs( NSAIDs) that the treatment of osteoarthritis of the knee usually begins.
This group of drugs includes such drugs as aspirin( acetylsalicylic acid), phenylbutazone, etodolac, indomethacin, sulindac, ibuprofen, piroxicam, aceclofenac, tenoxicam, diclofenac, lornoxicam, naproxen, rofecoxib, ketoprofen, meloxicam, nabumetone, tiaprofenic acid, nimesulide, flurbiprofen, celecoxib and others.
NSAIDs differ in both the strength of the action and the likelihood of developing side effects.
These drugs do not contain anti-inflammatory hormones, but nevertheless in most cases are able to cope well with joint pains and reduce inflammation in them.
Thus, the greatest analgesic effect is usually possessed by ketoprofen, diclofenac, indomethacin, while aspirin, ibuprofen, amidopyrin relieve pain significantly worse. But since many people can have individual reactions to different medications, then the effectiveness of these drugs may differ significantly from the generally accepted norms - both in one and the other direction.
It is generally believed that the greatest anti-inflammatory effect is available for such drugs as indomethacin, diclofenac, flurbiprofen, and ibuprofen, aspirin and naproxen, on the contrary, are able to reduce inflammation worse.
Side effects of
Unfortunately, despite the fact that non-steroidal anti-inflammatory drugs usually help to effectively relieve pain in osteoarthritis and other diseases, they are not very safe for health and have quite strong side effects. That's why doctors usually appoint them not very long courses and whenever possible in small doses.
What is the danger of NSAID administration?
a) problems from the gastrointestinal tract, primarily - effects on the gastric mucosa
NSAIDs cause side effects from the stomach
The intake of NSAIDs dramatically increases the likelihood of erosion and even ulcers of the gastric mucosa. This is especially true of people who had previously( or at the moment) such diseases as gastritis and peptic ulcer of the stomach and duodenum, as well as elderly patients.
However, in recent years, NSAIDs of the new generation have been synthesized, in which the negative effect on the gastrointestinal tract is significantly reduced.
This group of drugs are called selective inhibitors of COX-2, and include agents such as nimesulide and celecoxib.
b) Side effects from the kidneys
NSAIDs reduce the rate of renal blood flow, and also contribute to the retention of water and sodium in the body, which can increase blood pressure, as well as the development of acute heart failure and kidney failure.
c) Heart and blood vessel problems
Non-steroidal anti-inflammatory drugs, among other things, affect the blood coagulation system. If they are not properly taken, patients may develop blood vessel thromboses and even stroke or myocardial infarction. To medicines for which such an effect is characteristic, first of all those same COX-2 inhibitors, which reduce the risk of developing gastric complications, are included.
Things to remember when taking NSAIDs
As you can see, non-steroid drugs are not nearly as harmless as it is commonly believed. That is why you should not prescribe yourself such treatment, but you need to see a doctor who will choose the drug that is right for you and its dose.If it is necessary to take painkillers for arthrosis of the knee joint for a long time, it is better to use for this medication other groups that, if taken for a long time, do not give such harmful side effects and have a large selective effect, without adversely affecting gastric, renal or cardiovascular diseases,cardiovascular system.
For these purposes, preparations like Movalis are more suitable, which can be taken in long courses - from several weeks to several months and more - but, of course, also only under the supervision of a doctor.
In addition, the intake of NSAIDs is fraught with the fact that it "obscures" the symptoms of arthrosis: as you know, pain is a signal from the body that something is wrong in it. If the pain is completely removed by the reception of these medicines, the likelihood is that a person with such a disease will wave a hand on the disease, relax and will not do anything for recovery, except for taking pain medications.
This approach is very dangerous, because despite the absence of pain, the disease continues to progress, the cartilaginous tissue is still destroyed, and a person can think that everything is in order with health and there is nothing to worry about.
In fact, the correct approach to taking NSAIDs should be as follows: it is necessary to take these medicines as prescribed by the doctor, but not to forget about the disease, but to create the opportunity to undergo complex treatment without joint pain: take other medications,which are necessary for the treatment of osteoarthritis, undergo the necessary physiotherapeutic procedures, massage courses and other medical measures that could not be carried out in the presence of pain.
The second group of agents: chondroprotectors
chondroprotectors are the most important drugs for arthrosis of joints.
Chondroprotectors( CP) are drugs that contribute to the protection of cartilage and the strengthening of its formation( synthesis) in the joints.
Unlike anti-inflammatory drugs, HP not only remove the symptoms of arthrosis of the knee joint, but also affect the very cause of osteoarthritis - they contribute to the improvement of cartilage tissue nutrition and its recovery. In this sense, chondroprotectors are one of the most important medicines for the treatment of this disease.
This group of agents includes such active ingredients as chondroitin sulfate and glucosamine. They can, in various combinations, be a part of various medications - such as Dona, Terafrex, Arthra, Structum, Chondroxide, Elbona, Chondroitin Akos, Chondrolon, Zinaxin, Arthrin and others.
Arthra is a combined preparation containing equally and glucosamine, and chondroitin sulfate( 500 mg each in one capsule).The drug is produced by the American company Unifarm, the cost of one of its packages, depending on the number of capsules, costs from 500 to 1,700 rubles. Arthra is considered one of the best chondroprotectors at the moment.
This medication is also combined: one capsule contains 500 mg of glucosamine and 400 mg of chondroitin sulfate, and is manufactured by the German company Bayer. Take teraflex, depending on the stage of the disease, 2-3 capsules per day. It is worth, depending on the number of tablets, from 600 rubles( for packing 30 capsules) to 1500( 120 capsules) and above.
Don contains only glucosamine. Produced by Don in the form of sachets( bags with powders for oral administration), capsules, as well as ampoules for intramuscular injection. For the most effective treatment, manufacturers recommend combining it inside with intramuscular injections.
This medicine is manufactured by Rottapharm( Rottapharm) and its price ranges from 1000 to 1300 rubles - both for capsules and sachets, and for ampoules.
This is a mono-drug of chondroitin sulfate, which is manufactured by the Russian pharmaceutical company Microgen. It is produced as a dry substance in ampoules for dilution and subsequent intramuscular administration.
One ampoule, which must be diluted in 1 ml of water, contains 100 mg of active substance. Enter chondrolone for 1 or 2( with good tolerability) of the ampoule every other day by a course of 25-30 injections. Its price at the beginning of 2013 is from 1000 to 1200 rubles per package of 10 ampoules.
Structum is also a mono-drug that contains chondroitin sulfate in an amount of 250 and 500 mg. Produced by Pierre Fabre Medicaments Productions( France).
It is prescribed in a dose of 1000 mg per day, i.e. It is necessary to take 2 capsules a day for 500 mg or four - about 250 mg. Packing with 60 capsules of this chondroprotector will cost you 1200-1300 rubles.
Elbona is a Russian remedy, which includes only glucosamine sulfate. This drug is produced in 2 ml ampoules( plus 1 ml ampoule with a solvent) for intramuscular injection;one ampoule contains 400 mg of active ingredient.
As seen from the name, this CP is also a mono-drug containing chondroitin sulfate in an amount of 250 mg of active ingredient in one capsule. This medicine, as well as the previous one, is produced in Russia.
ointment chondroxide for joints
This medication contains only one active ingredient - chondroitin sulfate, but is produced not only in the form of capsules( 250 mg each) but also as a 5% ointment. It is produced by the Russian pharmaceutical company Nizhpharm.
For the therapeutic effect, the dose of this drug, like other members of this group, should be 1000 mg of active ingredient per day, i.e.4 capsules per day.
Packing of 60 capsules will cost 400-500 rubles. Ointment in a 30 gram tube will cost from 250 to 300 rubles() .
What is important for a patient to remember when treating chondroprotectors?
- primarily, chondroprotective medications are time-consuming drugs. This means that the effect of treatment develops very slowly, and it can be seen only after 3-5 months, and the course of treatment with these drugs is from 6 to 12 months and sometimes more;please be patient.
- CP only work in the early stages of arthrosis - at 1 and 2 degrees;at 3 degrees of this disease, chondroprotectors do not make sense anymore, because on it the entire cartilaginous tissue of the joint is already destroyed and there is simply nothing to restore.
- among doctors now there is no general opinion about whether it is worth taking glucosamine and chondroitin sulfate together or separately. There are studies that suggest that with the joint administration of these two substances they can weaken each other's action. But while this question remains open, it is better to leave it at the discretion of your attending physician and, if possible, give preference to the products of large, reliable pharmaceutical companies with high quality products.
Medications for intra-articular injection( injections inside the joint)
In addition to drugs administered internally and intramuscularly, a large therapeutic effect in osteoarthritis gives the introduction of various drugs directly into the joint cavity( intraarticular injections).Thanks to this method of administration, the drugs directly fall directly into the area of action-into the synovial fluid through which the cartilaginous tissue is fed.
Most often, corticosteroid anti-inflammatory hormones are used to inject the joint: hydrocortisone, kenalog, celeston, diprospan, flosteron, and others. These drugs are injected into the joint, because when taken in tablets such medications give very many side effects. But when injected directly into the joint, they very quickly and effectively reduce pain and inflammation in the joint, facilitating the patient's condition.
Important point: corticosteroids, like NSAID preparations, do not treat osteoarthritis, but only have anti-inflammatory and analgesic effect. In order to really treat this disease, you need to use other drugs - the same chondroprotectors.
Also in recent years, such a method of treatment as intraarticular administration of hyaluronic acid( sodium hyaluronate) has been used. This tool acts on the joint as a "liquid prosthesis" or an additional synovial fluid that seems to create a protective layer in the joint that improves movement in the joint, helps to reduce the trauma of the joint during movements, moisturizes the cartilaginous tissue and improves its nutrition.
Sodium hyaluronate is available in the form of such drugs as fermatron, duralan, ostenil, synviscus. The therapeutic effect of the administration of these medications is usually very good, but, unfortunately, not everyone can afford this treatment.
So, one dose of a fermatron for intra-articular administration will cost 3500-4000 rubles, while the curative rate is 3-4 injections 1 time per week in each diseased joint. Therefore, a large price is the only factor that hinders the development of this method of treatment.
A good therapeutic effect for gonarthrosis is provided by various medications used locally.
So, such ointments as Fastum-gel, indomethacin and butadion ointments, Menovazine, Voltaren-gel, Nikoflex-cream, Espol, diclofenac-ointment and others have shown themselves as therapeutic ointments and gels for topical application.
They have a good therapeutic effect, but it is important to remember that only 4 to 8% of the drug substance passes through the skin to the "destination" - the patient's joint; therefore, anti-inflammatory and analgesic treatment with ointments, creams and gels is almost always necessary with drugs, taken orally or intramuscularly.
Various medicinal substances for external use can be used for the preparation of medical compresses. These include, for example, bischofite( an oil derivative that has a beneficial effect on arthrosis), dimexide( an anti-inflammatory and analgesic medicine that penetrates well through the skin), and a medical bile that has good warming and absorbing properties.
However, in order to keep under control such a complex disease as arthrosis of the knee joints, sometimes it is not enough just taking drugs in one form or another.
Drug treatment should be combined with physiotherapy procedures for arthrosis of joints, spa treatment, and if your doctor does not object, you can use effective folk recipes for treatment of gonarthrosis.
And remember: for effective therapy of arthrosis of the knee joint, it is dangerous to engage in self-medication. If you have joint pain, consult a doctor!
Intra-articular injections for joints
Intra-articular injections or injections are procedures for the administration of a drug into the cavity of a large or small joint. It is an integral part of the conservative therapy of inflammatory( arthritis) and degenerative-dystrophic( arthrosis) diseases of the musculoskeletal system. It is worth noting that the treatment of joints by intra-articular injection is not prescribed to all patients. Their use has strict indications and is prescribed by the doctor depending on the specificity and severity of the pathology.
Do not be afraid of an injection in the joint - the procedure for administering the drug is not much different from intramuscular or intravenous injections and does not cause much discomfort.
And here the benefit of such therapy with proper application can be significant - it will allow to continue treatment by other methods, stop the development of joint disease, help to avoid surgery or postpone surgical intervention. For injections, corticosteroids, chondroprotectors and hyaluronic acid preparations are used in medical practice. Most often, drugs are injected into the knee, shoulder, hip joint.
Intraarticular injections of glucocorticoids
Injection of hormonal drugs, which include glucocorticoids, in rheumatology and orthopedics have been used for a long time.
This is one of the most common options for treating arthritis, which are accompanied by inflammation and pain that can not be blocked by other drugs. In addition, hormonal injections are used for arthrosis, which occur with the symptoms of synovitis - inflammation of the synovial membrane of the joint with the accumulation of fluid( effusion) in its cavity.
Without eliminating the pathological process, it is impossible to proceed to other methods of conservative therapy, such as taking chondroprotectors, physiotherapy, massage or physical therapy.
Kenalog is one of the most popular preparations of glucocorticoids for insertion into the joint
. Indications for the introduction of glucocorticoids into the joint include:
- rheumatoid, rheumatoid, psoriatic, reactive arthritis;
- osteoarthritis with signs of inflammatory reaction;
- bursitis, tendovaginitis( inflammation of the periarticular soft tissues);
- Adhesive Shoulder Joint Capsulitis;
- carpal tunnel syndrome;
- gout, pseudogout.
The course of treatment appoint 1-5 injections, which are carried out with an interval of 7-12 days. This time is necessary to evaluate the effectiveness of the drug. Injections for joints with hormones have a powerful anti-inflammatory and analgesic effect, which is manifested most when the first injection of the drug. The following procedures will be less effective. Therefore, if at the beginning of therapy corticosteroids did not have a clinical result, then it is worthwhile to think about the advisability of continuing treatment. In such cases, either change the drug substance, or find another access point, and sometimes completely refuse injections for the joints.
During intra-articular injections, the drug is injected through soft tissues into the joint slot.
Glucocorticoid injections are used as symptomatic therapy to eliminate inflammation and pain, but are not a means to influence the true cause of the disease. Recent scientific studies have proven that, with unreasonably long-term administration of hormones in the case of arthrosis, metabolic processes in the joint deteriorate and the destruction of the hyaline cartilage progresses. In addition, the use of drugs can worsen the condition of patients suffering from hypertension, kidney failure, diabetes, obesity, peptic ulcer of the stomach or intestines. The appointment of intra-articular pricks to such patients should be carried out with caution in severe clinical cases.
Introduction of chondroprotectors
Chondroprotectors are medicinal substances that are used for the therapy of arthrosis, mainly at the 1 st and 2 nd stages of the disease development. In the advanced stage of the disease with complete destruction of the cartilaginous tissue preparations of this group are ineffective.
Chondroprotectors refer to the means of etiological therapy - they affect the cause of the pathology, which has a persistent positive effect and stop the progression of the disease. They participate in the metabolic processes of cartilage, contribute to the restoration of its elastic properties and elasticity, cause the normal flow of water and nutrients into the joint tissues, and activate blood flow.
Injections of chondroprotectors into the joint began to be used much later, at first they were prescribed in the form of tablets and intramuscular injections. However, such treatment was lengthy and lasted for several years. Preparations of this pharmacological group are rapidly destroyed in the body and slowly accumulate in the articulation. The use of injections in the joint made it possible to deliver the drug directly to the cartilaginous tissue, which greatly accelerated its action and increased the effectiveness of the therapy. Usually, treatment begins with the injection of the injection into the articulation, and then the tablet formulations are prescribed.
Chondroprotectors for injection into the joint:
- homeopathic target-T,
The most frequent injections are done in the knee joint. It is a complex articulation in the human body, which plays a supporting function and participates in movement. Arthrosis of this joint takes a leading position among degenerative-dystrophic diseases along with the hip joint, but is more accessible for injections.
Alflutop is a chondroprotector for intra-articular injection of
One of the most popular chondroprotectors for intraarticular administration is the drug alflutop, containing glucusamine and chondroitin sulfate. It is synthesized from marine fish concentrate, so it is a medicinal product of natural origin. At the beginning of therapy, 5-6 injections are given to the joint with interruptions of 6-10 days, and then the drug is administered intramuscularly. At the course of treatment there are at least 20 procedures. Instead of an aflutope, a monopreparation containing gyucasamine - Don injections - can be prescribed. Thanks to annual courses of therapy, intraarticular cartilage is restored, synthesis of synovial fluid is improved, pain is eliminated and motor activity is normalized.
Hyaluronic Acid Injections
One of the most innovative and effective methods of treating osteoarthritis today is intra-articular injection of hyaluronic acid preparations, which is also called a "liquid prosthesis".
Sodium hyaluronate is a natural component of the synovial fluid, which prevents friction of bones in the joints, provides physiological movements of the joint without pain and limitation of amplitude. Injections of hyaluronic acid restore the composition of the synovial fluid, thereby preventing the progression of arthrosis and eliminate its clinical manifestations.
Intraarticular injections with drugs of this group are prescribed at any stage of the pathological process, although in advanced cases of the disease they are less effective than at the initial stages of development.
What are the injections done to restore the composition of the synovial fluid? On the pharmacological market there are not so many. The most famous are:
- crepin gel,
Ostenil is produced in individual syringes and contains hyaluronic acid
They are considered the best injections for fighting degenerative-dystrophic diseases of the musculoskeletal system. Getting into the joint, hyaluronic acid envelops the articular surfaces of bones, improves the nutrition of the cartilage, normalizes the metabolic processes in the tissues of the articulation. Most often, drugs are injected into the hip, knee, and shoulder joint, but injections can also be used for smaller joints: ankle, wrist, elbow. The course of treatment is prescribed from 1 to 5 injections at intervals of 6-10 days per year from 2 to 4 years, depending on the severity of the course of the disease. Thanks to therapy, it is possible to avoid surgical intervention for prosthetics of large joints or postpone surgery for a long time. It should be remembered that before the introduction of the articulation of hyaluronic acid, it is necessary to eliminate the phenomena of synovitis through injections of glucocorticoids or the intake of non-hormonal anti-inflammatory drugs.
Other types of injectionsRead more: Drugs for knee joints
In recent years, domestic medicine has adopted the experience of foreign colleagues and began to use so-called gas injections. They are an introduction to the tissues of the articulation of high-purity carbon dioxide using a medical gun. Treatment improves blood supply to the joint, normalizes metabolic processes, reduces pain and restores motor activity. The therapeutic course usually consists of 4-6 procedures, which take place after 3-4 days.
Also used is the classic method of eliminating pain and inflammatory reaction in the place of pathology with the help of blockades. They are divided into intraarticular and periarticular depending on the localization of the focus of pathology. Blockades are carried out with the help of anesthetics, antibiotics, antiseptics, hyaluronic acid. Thanks to therapeutic blockades, spasticity of muscles is reduced, puffiness of tissues is eliminated, blood supply and nutrition of the articulation are improved, metabolism is normalized. The number of procedures is chosen by the doctor depending on the severity of the disease.
Complications of intraarticular injections
Like any medical intervention, intraarticular injections are associated with a risk of complications.
- Infectious( septic) arthritis, which is characterized by purulent inflammation when entering the infection during the procedure. The probability of the development of pathology is higher with injections of glucocorticoids due to a decrease in the body's immune defense, which causes hormonal agents. When observing the rules of asepsis, the risk of infectious complications is minimized. It is also important to begin treatment after the elimination of chronic foci of infection and acute inflammatory processes that cause the emergence of infectious arthritis.
- Exacerbation of the joint disease in the first few days after the injection, which is due to the action of the drug and usually takes place within a week. Sometimes there is an allergic reaction to the components of the injection solution, with the drug should be discarded.
- During the injection, the joint tissues are injured, and frequent injections of glucocorticoids destroy cartilage, weaken ligaments and tendons, which leads to "looseness" of the joint.
Procedure for the introduction of carbon dioxide into the joint
It should be noted that the development of complications with the correct method of therapy is rare.
Vasily, 46 years old: "Had knee arthritis for several years. I took anti-inflammatory pills, but the disease progressed. Recently, the joint began to accumulate fluid, could not move, was suffering from severe pain. The doctor suggested hormonal injections into the knee, after which I got to my feet within a week, I was able to return to work in a short time. "
Svetlana Alexeyevna, 56 years old: "I suffer from arthrosis of the knee joint for more than 15 years. Every year the condition worsened, which led to disability. The doctors raised the question of conducting an operation, which I found difficult to agree with. The last few years, I receive annual courses of injections into the joint with a drug ostenil. I feel good and can move without a cane. "
Elena Nikolaevna, 47 years old: "I was diagnosed with knee arthrosis 5 years ago. During the first few years the disease caused severe pain while walking. The attending physician advised taking chondroprotectors and prescribed a course of injections with hyaluronic acid inside the joint. After the first course of therapy, I felt better, and a year later began to play sports. The doctor said that the right treatment, appointed on time, gives a good chance to defeat the disease. "
Intra-articular injections are effectively used to treat diseases of the musculoskeletal system and are prescribed in those clinical cases where other methods of conservative therapy are ineffective. The choice of medicinal product and the duration of therapy are determined by the physician after a diagnostic examination.
What drugs are used for injections and injections in the joint with arthrosis of the knee joint?
One of the methods of treatment of destruction of cartilage tissues is associated with pricking in the joint with arthrosis of the knee joint. There are several reasons for this disease: weight gain, age changes in cartilage and their tissues, professional sports and others. The illness torments the person with constant pains.
Not only injections into the knee joint are used as aids to the patient. The injections are given both intramuscularly and intravenously. What exactly is necessary, the doctor chooses. Physicians believe that it is impossible to achieve improvement in the patient's condition only by therapeutic methods. No nail can not do.
Intra-articular administration of
drugs Intra-articular injections have many advantages over other treatments. They alleviate the suffering of the patient, relieving pain. The drugs used have a long resorption time, up to about a year. They act on all tissues of the cartilage, while not affecting the work of other organs, since they are not capable of significant penetration into the bloodstream. They are used for many concomitant diseases, even for those that interfere with the treatment by other methods.
But there are injections and a number of drawbacks. The main one is this: there is no way to introduce the drug into a small or far-located joint. If it is not available to penetrate the needle, then the procedure does not work.
There is another significant drawback, very dangerous. With the introduction of the drug, there is the possibility of the emergence of complications of an infectious nature.
It is most convenient for a specialist to put an injection in the knee. Other joints are more difficult to access.
Introduced drugs relieve pain. After them, some manifestations of the disease disappear. But the problem is not all the injections decide.
Intra-articular injections can not be done frequently. This will not only not help, but rather will do much harm. Therefore, they are appointed in extreme cases.
Indications for intraarticular injections are edema of the joint area and the appearance of fluid in it. If, for some reason, physiotherapy can not be performed, injections can be given.
After the injection, relief does not come immediately, but after about a week. At this time, the beginning of therapeutic activities. They are able to prevent the development of ailment.
The introduction of drugs is limited to certain rules. Among them are the following:
- An injection in the joint of the knee can not be done more than once a week. This is due to the fact that the drug begins to act no earlier than 7 days after the injection.
- The drug should be replaced with another, if after its introduction there is no relief after 7-10 days after the injection. It is possible that the matter is not in the drug itself, but in the fact that it was injected into the wrong zone, which is inflamed. It is necessary to carry out the procedure more precisely.
- One joint does not make more than 6 injections during the entire treatment. Otherwise, there may be complications.
What drugs are used for injection?
For this treatment, not one drug is used, but several of them, for example glucocorticoid hormones.
These drugs have an anti-inflammatory effect on the joint. The pain begins to decrease gradually after 2 days after the injection. Redness begins to subside, swelling is going on. A positive result lasts about a month, and then disappears. Among the drugs in this group are Betamethasone, Methylprednisolone. They are effective for pain, but they also have disadvantages. The main and most dangerous is the destruction of the cartilaginous and bony tissues of the joint with frequent use of funds. Therefore, you can not use them more than 3 times in one year.
The next group of drugs is medicines with hyaluronic acid. This, for example, Ostenil or Sinokrom.
Hyaluronic acid helps with many pathologies, including that involved in the restoration of cartilage. It is part of the cells that produce connective tissue. The acid helps the cartilage to regain its lost elasticity. It also returns the viscosity of the fluid that is present inside the joint.
Drugs with hyaluronic acid, introduced into the knee for arthrosis, create all the necessary conditions for the rapid restoration of cartilage. The drug dissolves for a long time in the joint cavity, from 3 months to a year. And throughout this period has a positive effect.
Hyaluronic acid often causes an allergy in a group of patients. These are the people whose body reacts to chicken protein. You can not put a shot on those who have a skin on their knees. This is all taken into account by the doctor when prescribing the treatment course.
Another drug for intra-articular injection is Alflutop. This agent has in its composition a concentrate obtained from 4 types of fish.
Alflutop synthesizes hyaluronic acid, therefore it participates in the process of cartilage tissue regeneration. For a short time after the injection, inflammation in the affected joint is removed. The ulcers formed on the tissues are healed during the period of illness. The properties of fluid inside the joint are improving. The pain gradually stops, the joints return their lost functions. In the future, it is possible to slow the development of arthrosis.
Intramuscular and intravenous injections of
This method of treatment for diseases of joints of the knees is prescribed more often than injections directly into the joint itself. The doctor selects medicines, proceeding from many factors: the course of the disease, the age of the patient, how much the joint is affected.
Among the drugs used, non-steroidal anti-inflammatory drugs are often used. They help reduce inflammation in the cartilage, relieve swelling of the knees. Drugs are good in that they have a quick effect.
The lack of non-steroidal agents is a negative effect on the digestive tract. Such injections contribute to the formation of ulcers on the gastric mucosa, the liver and gall bladder lose some of their functions. Therefore, the drugs are prescribed in a dosage strictly individual for each patient. After this, a vitamin course( B1 and B6) is needed.
The next group of prescription drugs are analgesics and antispasmodics. They reduce pain. But these drugs do not have an effect on the joint, cartilage tissue is not restored.
For the removal of spasm in the muscles, which sometimes begins with arthrosis, the doctor appoints Midokalm, Sirdalud and others.
Take them no more than a week. There are almost no contraindications. You can not use them for pregnant women and nursing mothers.
Steroid drugs are also used for intramuscular administration of drugs. They are used for severe lesions. Among them, Ambene is most famous. He quickly relieves pain, reduces inflammation, restores joint. But the drug has negative qualities - after using them, the cartilage loses its ability to produce new cells. Doctors resort to steroids only in extreme cases.
Vitamin complexes are indispensable in the combined treatment. Vitamins B1, B6, B12 are involved in the restoration of cartilage tissue. Intramuscularly injected Kombilipen and others. Vitamins relieve pain, improve the momentum of nerve cells.
Intraarticular Injections into the Knee Joint
Imagine that you are in the doctor's office and he says: "I want to inject an injection into your knee today."What do you say to that? If you, like many others, suffer from arthritis, you can answer: "No, not today! With my knee, all is well. Maybe next time".On the one hand, you know that your knee has recently been sore, swollen and badly moving, and on the other hand, you want to escape from the office as quickly as possible.
Nobody likes local injections, but especially in the joint, which already hurts. But it is important to understand that injections can be very effective for treating arthritis. If you have rheumatoid arthritis( RA), osteoarthritis( OA), gout or bursitis, injections can reduce pain, swelling and improve joint mobility.
- 3 Procedure for Injection of
Who needs intraarticular injections in the knee joint?
Intra-articular injections are best used for localized pain and swelling, that is, with symptoms in one joint. If you are hurt "everywhere", then a local introduction is not the best treatment option. But if one joint gives you particular anxiety, then such an injection can be useful.
Intra-articular injections should not take the place of other methods of treating arthritis. They should be part of a general treatment regimen that can include oral medications, exercise, relaxation, heat and ice, tires, the use of crutches, walking sticks and other aids, depending on the type and severity of your arthritis. If medications and other conservative therapies do not help enough, and one of the joints continues to be a problem, then your doctor may recommend injections into the joint.
There are two main types of articular injection: injections of corticosteroids and injections of hyaluronic acid. What type of injection can help depends on the type of arthritis you have, and also on which joint and how exactly it is affected. Here's what you need to know about injections of corticosteroids and hyaluronic acid, including how they work, risks, side effects and other aspects.Learn about the popular methods of knee pain treatment here
Learn how to reduce the manifestations of side effects from medications in this article.
What should I do if I feel sick of drugs?
Injections of corticosteroids
Corticosteroids are potent anti-inflammatory drugs. People with RA and other types of inflammatory arthritis( but not OA) often take corticosteroids, such as prednisolone, inside to reduce inflammation, regardless of the site of its localization. When using corticosteroids directly into the joint, inflammation is reduced only in this joint, which can lead to less pain and better mobility.
Corticosteroid preparations for injection differ from those used in tablets, and are designed to ensure that their maximum concentration was in the joint. Corticosteroids, which are used for joint injections, also come in various combinations. Which drugs, more or less strong, will be used depends on the condition of the joint in which they are injected. Most often for injections, such corticosteroids are used: triamcinolone acetonide, methylprednisolone acetate, dexamethasone sodium phosphate and sodium betamethasone phosphate. In some cases, the physician can apply two types of corticosteroids to enhance the effect by combining the benefits of a quick and prolonged action. The physician can also prescribe corticosteroids and local anesthetics such as lidocaine to provide immediate pain relief or dilute a less soluble but more potent corticosteroid, so that the anesthesia will spread to a wider area.
To whom are injections of corticosteroids shown?
Injections of corticosteroids can be used to treat a number of conditions in different joints. They can provide short-term relief in RA or OA of knee or hip joints. Carpal tunnel syndrome, which causes pain in the wrist, may also be an indication for injections of corticosteroids, an adhesive capsulitis commonly known as a "frozen shoulder" is also on this list. With gout and "pseudogout" - diseases in which the crystals in the joints cause inflammation and pain, the doctor can prescribe injections of corticosteroids. Injections of corticosteroids are used not only for joints. They can also be used to treat inflammation of soft tissues, for example, in bursitis and tendinitis.Which supplements will help you cope with arthritis?
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What side effects and risks can there be?
Of the risks that arise when using injections of corticosteroids, the most dangerous is the infection in the joint. Fortunately, the risk of infection is extremely low if the doctor performs the procedures under sterile conditions.
Other side effects of injections of corticosteroids are face hyperemia, this is a fairly common phenomenon, but usually does not last long. In some cases, the patient may develop an allergic reaction to such injections. Some people may have a temporary exacerbation of arthritis in the joint, which begins several hours after the injection and lasts for several days. Cope with it can be with the help of ice and pain medications. On the other hand, with an infection that is much more dangerous, there may not be any symptoms a few days after the injection.
Some side effects are the result of an incorrect injection technique or an incorrect dose, so make sure your doctor has experience in doing such injections.
People whose joint pain is caused by an infection( a condition called septic arthritis) should not receive corticosteroid injections. Septic arthritis is treated with antibiotics and joint drainage.Active infection in any organ is a signal that injections of corticosteroids are contraindicated.
Patients with poorly controlled diabetes should also avoid injections of corticosteroids, as they increase the risk of a significant increase in blood glucose levels. Those who have been diagnosed with bone thinning( osteoporosis), especially in the bones around the joint, can be advised to avoid injections into this joint, as corticosteroids can further weaken the bones. Injections of corticosteroids are not made to the joint, which was changed.
Doctors are generally cautious in prescribing corticosteroid injections to those who take blood thinning medications, such as warfarin or heparin, because of the risk of bleeding. If you are taking one of these drugs, your doctor can check the condition of your blood coagulation system before taking an injection to make sure there is not too much risk of bleeding.
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Injections of hyaluronic acid
The second, less common type of intraarticular injection, uses hyaluronic acid, or hyaluronan, which is sometimes called a "liquid implant" or "viscosity reducer."
How do hyaluronic acid injections work?
Hyaluronic acid is a substance that normally belongs to the joint synovial fluid. This gives the synovial fluid the necessary viscosity, which plays the role of lubricant and absorbs the impacts in the joint. In joints affected by OA, there may be less hyaluronic acid in the synovial fluid. It is believed that injecting a synthetic version of hyaluronic acid into the joint improves the viscosity of the synovial fluid, which allows for smoother movements and less pain.
Who is shown?
Hyaluronic acid preparations can be shown to those people with knee pain that greatly reduces the quality of life, and to those who have not received relief using other procedures, including injections of corticosteroids. It is also an option for people who are unable to become a candidate to replace joints that are afraid of surgical treatment, or those who for some reason have to wait for the replacement of the joint for some time.When is it necessary to perform an operation on joints with arthrosis?
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What are the side effects and risks?
Possible side effects of hyaluronic acid injections include exacerbation of pain and swelling after injection. Therefore, doctors advise to avoid heavy physical exertion and other activity within 48 hours after the injection. Some of the concerns about injections of corticosteroids are also applicable to injections of hyaluronic acid, namely:
- patients taking blood thinning medications are at greater risk of bleeding after these injections;
- injection should not be done in an infected joint.
Injection Procedure When you receive intraarticular injections, whether corticosteroids or hyaluronic acid, the doctor's goal is to insert the needle into the so-called joint space, that is, the space between the ends of the bones. Before inserting the needle, the doctor will feel your joint to determine how to position the needle. After the entry point is determined, the doctor disinfects the surface with alcohol, and, as a rule, freezes the entire working area with an anesthetic spray. This helps to reduce discomfort, making the needle entry almost painless.In some cases, the doctor uses one of the types of fluoroscopy, directing the needle using the fluoroscope so that it is at the desired point. Ultrasound is also becoming more common.
Before the injection, the doctor can first do the joint aspiration, i.e.suck liquid out of it with a needle and syringe. The doctor then examines the liquid by eye and can send it to the laboratory to assess the presence of signs of infection( leukocytes), trauma( erythrocytes), crystals( gout or pseudogout) or inflammation. In addition to the use of articular fluid for diagnosis, such aspiration can lead to the joint being more mobile, and feeling more comfortable. Aspiration of fluid from the knee joint also reduces the risk that fluid will accumulate under the knee, and a condition called the Baker cyst will form. After the liquid is removed, the prescribed medication is inserted into the joint. The doctor rotates the joint to distribute the medicine and applies a bandage to the injection site.
It's all over. You will not immediately feel better, but within a few days you will notice a decrease in pain and a decrease in edema. If you are not sure about joint injections, remember that maintaining your joints in a healthy state means maintaining a healthy body and looking good. So if you have problems with joints, do not let the needle dislike you to scare you away from the treatment that can help you. Talk with your doctor about what is best for you - injections of corticosteroids or hyaluronic acid.
And here's a video in which they tell about intraarticular injections with arthrosis.
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Age, weight, long walking on heels, playing sports, deficiency of vitamins В1 and В6 - possible causes of wear of joints and, as a result - destruction of cushioning cartilage, painful and constant pains. This disease in medicine was called arthrosis of the joints.
Aching joint pains disturb sleep, are able to loosen the nervous system and lead to an imbalance in blood pressure. Osteoarthritis more often affects the following joints:
If you have the first symptoms of arthrosis, you need to start treatment using pain medications that can stop the pain of the shoulder and knee joints for a while. It should be noted that analgesic drugs in injections( both intramuscular and subcutaneous) against tableted drugs help much faster. But the inflamed joint does not a little anesthetize, it is necessary to remove the inflammatory reaction. So:
Drugs for intramuscular injection
- Analgesics .Such as actually Analgin and Baralgin. Dull pain of the knee joint, shoulder joint, do not have arthrosis.
- Spasmolytics .For injection by injection subcutaneously with joint arthrosis, one antispasmodic - Midokalm - is very helpful. Quickly removes spasms from the musculature of the skeleton, while reducing the pain in the joints.
- Non-steroidal anti-inflammatory drugs .The most popular are Ibuprofen, Diclofenac, Ketonal, etc. These medicines can not only relieve the pain, but also remove puffiness and stop the inflammation of the hip, knee, shoulder and other joints. At course treatment it is possible to forget about pain for ever. But to use these drugs should be cautious: the fact is that anti-inflammatory drugs are very irritating to the mucous membrane of the stomach and contribute to the formation of ulcers in it. Therefore, these medications are usually prescribed by short courses and strictly under the supervision of a doctor. After the course of such drugs, it is worthwhile to take a course of support with vitamins B1 and B6.
- Steroid preparations .Ambene is the first in terms of efficiency. This is a complex preparation consisting of six special syringes: in the amount of three pieces with solution A( lidocaine hydrochloride and dexamethasone) and three with solution B( vitamin B1, B6, cyanocobalamin, lidocaine).These drugs have pronounced both analgesic and anti-inflammatory effects, regenerating the processes of the knee joint. The content of lidocaine makes the injections completely painless. Solutions A and B are mixed, injected into the gluteus muscle deeply, before the introduction of the solution, warm up to body temperature.
In modern medical practice, it is possible to treat arthrosis with the help of an effective technique, the essence of which is the introduction of drugs not subcutaneously, but directly into the joint. Preparations are made on the basis of hyaluronic acid, corticosteroid hormones, vitamins for the restoration of cartilage tissue B1 and B6, as well as other components.
Intraarticular injections are prescribed in cases where the usual pain relievers described above are no longer effective. The most popular and common drugs for these types of injections are the drugs listed below.
Drugs for intraarticular injections
Intraarticular injections are administered for the treatment: corticosteroid hormones Celeston, Kenalog, Flosteron, Diprospan, Hydrocortisone. Corticosteroids are valued for the rapid and effective suppression of pain of the knee, shoulder and other joints. But the downside is that these substances are not able to cure arthrosis. There is no influence on the joint: they do not improve the condition of the cartilaginous tissue, do not restore blood circulation( especially the knee).In this regard, use of such intraarticular prick is necessary in conjunction with vitamins B1 and B6.
Hyaluronic acid is an innovation in the physician's arsenal - it is a lubricating fluid that helps slip almost destroyed cartilage and is a 100% replacement of the synovial fluid of the knee joints. Often, intra-articular injections are performed with lesions of the knee and shoulder joints as the most vulnerable. It should be noted that treatment with this drug is effective, but expensive. For the injection of enough 3 to 5 injections, which contains acid.
These are medical intraarticular preparations, which heal joints. They are more often used for malnourishment of the joint( often with a deficiency of vitamins B1 and B6) or when injuring the shoulder joint or knee.
It is advisable to start treatment and use intraarticular nyxes for arthrosis of the knee, hip and shoulder joints only after removal of the inflammation.
Intra-articular prick with chondroprotectors have their effect faster, against oral medication. Having already received the first injection the result will not be long in coming. The knee or shoulder will get sick less.
All described preparations for intraarticular injections do not pass without a trace - after their treatment, it is necessary to restore the balance of certain vitamins( B1, B6, B12, A, C, etc.) using Neurobex complexes( B1, B6, B12), Triovit, C, E) or directly administering these vitamins subcutaneously or intravenously.
Often used for arthrosis of the shoulder and knee joints. This is a special treatment, during which an injection of novocaine with a certain frequency and frequency as an intramuscular injection is injected into the inflamed area of the shoulder joint affected by arthrosis, as well as adjacent tendons and muscles. The use of the so-called Novocain blockade in medicine makes it possible to remove painful contracture. The procedure is repeated 1 to 3 times a month. It is also combined with mandatory vitamin therapy( B vitamins, especially B1 and B6).
All these injections are good, but self-medication is not worth it. Therefore, it is important to see a doctor and get expert help in diagnosing and in the appointment of correct and effective treatment if pain symptoms of knee, hip and shoulder joint arthrosis appear.