Non-steroidal anti-inflammatory drugs( NSAIDs) for the treatment of jointsIn pathologies of joints accompanied by pain and concomitant signs of inflammation( swelling, hyperemia), prescribe drugs from the group of anti-inflammatory non-steroids. They have anti-inflammatory, analgesic and antipyretic effects.
Mechanism of action
Most of the drugs in this group inhibit the production of a cyclooxygenase enzyme, which is represented by two isomers: COX-1 and COX-2.The presence of an inflammation focus in the body stimulates the production of COX-2, which is not found in a healthy body. Inhibition of COX-1 is an undesirable reaction, since this enzyme is present in humans and is "responsible" for the synthesis of prostaglandins protecting the gastrointestinal mucosa, regulate renal blood flow and normal functioning of platelets.
Non-steroidal anti-inflammatory drugs for the treatment of joints are divided into two groups:
- Non-selective - inhibit the production of COX-1 and COX-2.
- Selective - exert a preferential( selective) inhibitory effect on COX-2.
NSAIDs should not be used in a number of pathological conditions, among which:
- gastric and duodenal ulcer;
- elevated blood pressure;
- diseases of the cardiovascular system, liver, kidney;
- disorders in the blood clotting system( frequent bleeding).
Carefully prescribe NSAIDs to pregnant patients so as not to provoke premature birth, kidney and heart pathologies in the fetus.
NSAIDs used in the treatment of joint diseases
Acetylsalicylic acid has a good antipyretic and analgesic effect. As an anti-inflammatory drug, aspirin is inferior to indomethacin, diclofenac. With prolonged use causes a number of side effects from the gastrointestinal tract.
( tilfen, orthophene, arthrosan, voltaren, etc.)
Provides rapid and continuous action. Produced in tablets, rectal suppositories, solution for intramuscular injection, gel( for topical application).
This drug has established itself as a good analgesic and anti-inflammatory agent in the treatment of Bechterew's disease, in the treatment of gouty attacks. Along with aspirin has gastotoxicity, so it is used with caution in the elderly, patients with a predisposition to stomach ulcers, as well as those who smoke and abuse alcohol. Produced in tablets( for oral administration), in the form of rectal suppositories, as well as ointments( for external use).
Has the lowest( in comparison with the above listed drugs) anti-inflammatory activity. It is prescribed for "light" arthritis. Among the advantages: good patient tolerance, minimal side effects. Adults are given in the form of tablets, children - candles and syrup. In pharmacies it is dispensed without a prescription.
It penetrates well through the skin, gives rapid anesthesia, which makes it effective in the form of an external gel. It is also available in capsules, tablets, candles and injection solutions.
New generation drugs from the NSAID
group These drugs are more effective than their predecessors. When they are taken, the GI tract does not suffer, and the cartilaginous tissue does not collapse.
Movalis( Myrlox, Arthrosan, etc.)
The absence of unwanted effects makes it possible to use this remedy for a long time. Self-medication is unacceptable. The dose and the frequency of reception is prescribed by the doctor. Produced in candles, tablets, injection solutions( for intravenous administration).
It is used in the treatment of osteochondrosis, arthritis and arthrosis. Has a strong analgesic and anti-inflammatory effect.
By action, the drug is similar to celecoxib. When treated with doses prescribed by a doctor, the gastrointestinal tract has no adverse effect on the mucosa.
It has the additional property of inhibiting active substances that destroy collagen and cartilaginous tissue. Form release: granules, tablets, gel.
List of modern medicines and joint preparations
NIPVC: first aid to joints - pros and cons
Nonsteroidal anti-inflammatory drugs ( NIPVC) is the most common group of drugs that are used for pain and inflammation of any organs.
best-known representatives are:
mechanism of action
wide popularity due to the rapid elimination of symptoms due to the triple effect of this groupmedicines:
The anti-inflammatory effect is due to other mechanisms than hormonal drugs, which is emphasized in the name - non-steroid agents. Maximum it is expressed in indomethacin, flurbiprofen and diclofenac, and minimal anti-inflammatory effect should be expected from ibuprofen, amidopyrine and aspirin.
These drugs block prostaglandins - mediators of inflammation, which are released when tissue is damaged. As a result, all the symptoms of inflammation decrease: redness, swelling, pain, fever and disruption of function.
Pain syndrome better eliminates ketorolac, ketoprofen, diclofenac and indomethacin. Less analgesic activity is possessed by aspirin, ibuprofen and naproxen.
The strength of different drugs depends on the structure of the molecule. However, individual sensitivity to different drugs can not be ruled out.
Prolonged use of NSAIDs necessary for the treatment of gonarthrosis is limited to the development of dangerous undesirable reactions, most often from the digestive tract and kidneys.
Since the anti-inflammatory effect is blocked by prostaglandins, a side effect is a decrease in the protective factors of the stomach. Most of the members of this group of medicines are acids, so they additionally irritate the gastric mucosa.
The result can be NSAIDs-gastropathies: erosive or ulcerative defects of the gastrointestinal mucosa, the most severe manifestation of which is gastrointestinal bleeding.
It is believed that indomethacin, ketoprofen, piroxicam are more aggressive in this respect. Rarely, such complications develop when taking small doses of ibuprofen and diclofenac.
How to avoid side effects from the gastrointestinal tract:
With a high gastric acidity, gastritis and a history of an ulcer, severe concomitant pathology, in elderly people the probability of gastrointestinal bleeding increases. In such situations, the use of selective drugs( meloxicam, nimesulide, celecoxib) that do not reduce the protective factors of gastric mucus is more justified and can be used for a long time.
You can use drugs that reduce the acidity of the stomach( proton pump inhibitors), however long-term therapy is estimated as economically unprofitable.
Side effects of NSAIDs are often manifested by the development of cardiovascular complications in the form of strokes, heart attacks and thromboses. More safe in this regard are naproxen and ibuprofen. The use of diclofenac significantly increases the risk of heart and vascular disease.
The development of arterial hypertension, heart failure, acute renal failure may be a consequence of decreased blood flow in the kidney vessels due to oppression of the synthesis of prostaglandins.
Possible development of aspirin bronchial asthma, Reye's syndrome( bleeding) and many other side effects.
Such formidable unwanted reactions do not allow self-treatment and dictate certain rules of application:
NSAIDs should not be taken for a long time. They are used as an "ambulance", quickly and effectively eliminating the symptoms of arthrosis of the knee joint.
The use of anti-inflammatory drugs masks the picture of the disease, without eliminating its cause, which often causes a delayed treatment to the doctor.
The choice of drugs is broad both in strength of action and in side effects. The physician will be able to select the optimal drug in a safe dosage and prescribe the necessary studies to prevent the development of complications.
Chondroprotectors: is it possible to restore cartilaginous tissue?
Because arthrosis of the knee joint is caused by damage to the cartilage of articular surfaces, the ideal drug should be able to restore them. Such hope appeared in the allocation of a group of chondroprotectors( CP), the most studied of which were glucosamine( HA) and chondroitin sulfate( cholesterol).
The last 25 years of conducting numerous studies have accumulated a vast base, both confirming the effectiveness of HP, and refuting it. As much as contradictory reviews on the use of drugs.
You should not expect a speedy recovery on the background of taking chondroprotectors: minimal results should be evaluated not earlier than after 6 months of therapy. Reducing the dosage of NSAIDs in the treatment of arthrosis of the knee joint is the first symptomatic effect of CP administration. These drugs are most effective at stages 1 and 2 of arthrosis.
Glucosamine and chondroitin, like nonsteroidal preparations, have an anti-inflammatory effect by suppressing "inflammation cells"( interleukins and prostaglandins).However, unlike NSAIDs, chondroprotectors have excellent tolerability.
Preventing the progress of the disease( on the roentgenogram - slowing down the rate of narrowing of the joint space) is also an important effect of this group of medicines.
Initially, HA and XC were used in isolation and in the form of injection forms, which limited their use. Then oral forms of release were developed. Here is an example of several drugs with chondroprotective effect.
Drugs containing chondroitin sulfate
Chondrolon( Russian company "Microgen") - available in the form of ampoules of a dry substance for intramuscular injection.
Chondroitin AKOS( Sintez, Russia) - capsules for oral administration of 250 mg and ointment for topical application. In a day you need to take 4 capsules.
Structum( "Pierre Fabre", France) - 250 and 500 mg capsules. The daily dosage is 1000 mg.
Preparations containing glucosamine
A study conducted in Belgium showed a greater efficacy of glucosamine in arthrosis of the knee than CS.
Elbona( ZAO "Moscow Pharmaceutical Factory") is a preparation for intramuscular injection of 400 mg of active substance in an ampoule.
Dona( "Rottapharm") - is available in the form of powder and capsules for oral administration, as well as a solution for intramuscular injection. In 1 sachet powder contains 1500 mg of active substance, and in one capsule - 250 mg.
Drugs containing HA and Cholesterol
Numerous studies have shown that the efficacy of the two components improves the treatment outcome by 60% and the monotherapy by 30.
Arthra( Unifarm, USA) and Teraflex( Bayer, Germany) - complex preparations containing both chondroprotectors, differ somewhat by the dosages of the incoming components: 500 mg of HA and XC in the first and 500 mg of HA and 400 XC in the second.
Means for insertion into the joint cavity
In severe pain syndrome, the doctor can recommend the introduction of the medicine directly into the joint cavity.
As preparations that quickly eliminate the symptoms of inflammation, glucocorticosteroids are most commonly used:
Chondroprotectors, called the "liquid prosthesis", are more optimal. Sodium hyaluronate in preparations:
They practically replace articular fluid, improving nutrition of cartilaginous surfaces. However, these medicines are not yet available to everyone at a cost.
Drugs for topical therapy are additional methods for the treatment of arthrosis of the knee joint. Usually the active substance is an NSAID, such as in the preparations Voltaren-gel, Fastum-gel, Menovazine, diclofenac ointment, indomethacin and butadione. Medical compresses with bischofite( an oil derivative), dimexidom( anti-inflammatory drugs), medical bile expand the range of therapeutic measures for gonarthrosis.
Absorption of the drug with local treatment is no more than 7-8%, so monotherapy is rarely effective.
Since the course of the disease is accompanied by periods of exacerbation and remission, it is important to combine different methods of treatment, apply effective physiotherapy procedures, sanatorium treatment, possibly traditional medicine.
The doctor will help with recommendations at any stage of the disease!
Innovative BAA for joints
Food supplements are not medicines, but biologically active substances( food additives), which consist of natural components and are considered to complement the basic therapy.
For the treatment of joint diseases, all companies - world leaders in the manufacture of dietary supplements( such as NSP, Vision, Vitaline Inc) and Russian manufacturers - offer a huge number of complexes.
They can contain components that have different effects:
herbs with anti-inflammatory activity;
vitamins and minerals for the activation of metabolic processes;
calcium, vitamin D, collagen to strengthen bone tissue.
There are even components that improve blood circulation, and detoxicants( for example, Dectox in Vision).
Innovative drugs for the treatment of inflammatory degenerative diseases of the joints are chondroprotectors - the means that protect against inflammation and repair cartilage tissue.
Before their appearance in joint diseases, it was possible to carry out only symptomatic therapy, that is, the elimination of pain syndrome. The era of chondroprotectors marked the possibility of influencing the cause of the disease - cartilaginous tissue.
Glucosamine and Chondroitin were the first to use this group. They have been actively studied in official medicine for more than 40 years. Recent years of use have accumulated numerous evidence of the effectiveness of chondroprotectors in the pathology of both large and small joints. For example, a study in Belgium showed that patients taking chondroprotectors for 1 to 3 years were less likely to need joint replacement for arthrosis of the hip joints by 60% less than those taking a placebo( a substance-free tablet).
In 2014, they entered the mandatory algorithm for the treatment of residual arthritis, recommended by the European Society of ESCEO.
Most manufacturers of dietary supplements have in their arsenal Chondroitin and Glucosamine in the form of 100% natural product of high purity.
Chondroitin sulfate( ChS) is a specific component of cartilage, it is a natural mucopolysaccharide. In patients with joint diseases, its concentration in the synovial fluid is reduced. It is found in cartilages, ligaments of animals, fish.
Chondroitin sulfate has regenerative( regenerative) activity:
is involved in the process of calcium deposition in the bones, preventing the development of osteoporosis;
increases the synthesis of collagen, strengthening ligaments, tendons, cartilage;
retains the cellular structure of the cartilage, which increases the strength of bones;
increases the production of intra-articular fluid, which prevents cartilage friction;
slows the narrowing of the joint gap in gonarthrosis;
reduces the destruction of chondrocytes( cells of the cartilaginous tissue), making them resistant to the action of inflammatory enzymes.
In addition, chondroitin sulfate has an anti-inflammatory effect by suppressing the activity of "inflammatory cells" - the enzymes and mediators involved in the cascade of inflammatory reactions. Due to this, soreness in the joint decreases, and its mobility increases.
Supplements Chondroitin sulfate is usually available in capsules of 250-350 mg( 50-60 pieces per pack).It is more often recommended to take 1-2 capsules a day. Note that the drugs have a much higher dosage: 500-1500 mg 3 times a day.
The cost per month of treatment varies considerably, depending on the manufacturer, and is 300-2500 rubles.
Contraindications for use are increased bleeding of blood vessels and individual intolerance, pregnancy and lactation.
Glucosamine( HA) is a component of chondroitin and a precursor of glycosaminoglycan, the main component of cartilage. It is isolated from chitin( a substance that is part of the shell of crustaceans).
GA has similar effects with chondroitin: symptomatic( reduction of soreness in movements and improvement of joint function) and regenerative( restoration of cartilage tissue with prolonged use).
In addition, Glucosamine has some differences from chondroitin:
has better results and the highest level of evidence in the treatment of arthrosis of the knee joints( cholesterol showed the best effect with arthrosis of the hip joints);
is a more preferred building material for the formation of glycosaminoglycans in the human body( in particular, hyaluronic acid).
Often used association that Glucosamine in the structure of the cartilage is a brick, and chondroitin - cement.
Supplements Glucosamine is also available in capsules, the cost varies depending on the manufacturer in approximately the same range as chondroitin.
Contraindications to use are similar to those of cholesterol.
Both drugs are transferred very well, no side effects are reported.
Due to the peculiarities of the action of glucosamine and chondroitin sulfate, complexes appeared containing both preparations. In 1999, a convincing study was carried out, which showed that, when combined, cartilage cells began to produce twice as many glycosaminoglycans, and in single-agent therapy, only one-third.
The combination of two drugs costs on average the same as one drug. For example, Doppelgerz asset offers a complex at a budget price - 250-300 rubles per month of treatment. It contains 700 mg of glucosamine and 100 mg of chondroitin sulfate in a capsule.
Different manufacturers try to improve the complexes with other components. So, Glucosamine Forte - BAA, containing, in addition to HS and HA, the grass root "Devil's Claw" and shark cartilage ecstasy( Santegra, USA)."SOLGAR Glucosamine-Chondroitin Plus" has additional components in the form of vitamin C and manganese.
Thanks to the latest research in medicine, it can be said that the best BADs for joints combine the 4th component: Glucosamine, Chondroitin, Methylsulfonylmethane and Celadrin.
Methylsulfonyl methane( MSM, DMSO2, dimethyl sulfone) - is called the "third whale" in the treatment of joint diseases. This organic compound contains sulfur and is present in all tissues of the body. MSM improves the supply of nutrients through the cell membrane. With its deficiency, trophic tissue disorders are formed.
Sulfur is the fourth mineral in the human body by mass fraction, which has many positive effects: antioxidant, antihistamine, analgesic and anti-inflammatory. It is the latter two effects that are used in the treatment of inflammatory joint diseases. Sulfur is found in many foods: vegetables, fruits, cereals, milk, meat, but is destroyed when cooked. With age, the need for it increases.
MSM promotes faster muscle recovery after exercise, so it has long been used as a sports nutrition in Ice Power Plus, Bone Boost from SAN, Animal Flex from Universal Nutrition and others.
The use of MSM with chondroitin and glucosamine has become the next step in the treatment of joint diseases. It turned out that it enhances the effect of both drugs.
The French company Arkofarma developed such a complex preparation and named it "Inzhoy Enti"( Vision).The composition of BAA includes Glucosamine, Chondroitin, Methylsulfonylmethane and Bamboo Extract, rich in silicon.
To avoid allergic reactions associated with the release of a preparation from bovine protein, glucosamine and chondroitin are of marine origin. To maximize the preservation of useful properties of components in the production process, cryocorrelation technology is used.
The drug is available in capsules of 30 pieces per pack, take 1 capsule per day. The month of treatment "Inzhoy Enti" will cost 2300-2500 rubles.
Supplements "Glucosamine Chondroitin Super Formula" is characterized by a higher content of 3 specified components than analogues. It also includes selenium, magnesium and vitamin E.
"Glucosamine chondroitin MSM"( Doctor's Best) contains additionally sodium and potassium.
The latest effective compound for the treatment of joint diseases is Celadrin.
Celadrin is a special complex of fatty acids( LC), isolated from bovine fat. LCs are part of the lipid of cell membranes responsible for transporting nutrients into the cell and the products of decay from it.
Celadrin has a whole complex of unique effects:
When exposed to negative factors, including inflammatory mediators, on the cell membrane, it quickly restores its integrity.
Oppresses the production of "inflammatory cells" in the development of autoimmune and pathological inflammatory processes.
Improves the composition of the joint fluid, as a result of which the amplitude of movements in the joints increases, the friction of cartilage is not allowed.
Due to the listed properties, Celadrin improves the flexibility of the ligament apparatus, reduces pain, restores the volume of movement in the joint.
Celadrin 525 from the company Solgar( USA) is available in the form of capsules( 60 pieces per pack), a day is recommended to take 1-2 pieces. The cost of treatment will average 2100-2300 rubles.for 1-2 months.
New Celadrin &MSM from Now contains Celadrin and MSM.It is recommended to apply a daily dose of 3 capsules, a 20-day course of treatment will cost about 600-700 rubles.
The Agel FLX( Agel Enterprises, USA) is the group of drugs containing the four most important components for the restoration of joint function.
It is available in the form of a gel with a taste of fruit( 21g) and contains active ingredients in an increased amount: Chondroitin sulfate 1200 mg, Glucosamine sulfate 1500 mg, MSM 400 mg and Celadrin 750 mg. The monthly course of treatment with an innovative drug is about 3000 rubles.
There is no information on large meta-analyzes confirming the effectiveness of Agel FLX, however, the drug is considered very promising. A three-year study conducted at the Department of Traumatology and Orthopedics of the St. Petersburg State Medical University named after. I.P.Pavlova, in which 134 patients participated, demonstrated a significant reduction in the pain syndrome and an increase in the amplitude of the movements.
What is important to remember the patient when using dietary supplements?
Does the doctor help?
The doctor can not prescribe dietary supplements officially, since they do not belong to the group of medicines. However, he can advise them as an additional method of prevention and treatment. The doctor may have experience in the application of dietary supplements to other patients with a similar pathology and long-term observations of the dynamics of the disease.
Can I treat food supplements as a waste of money?
It is possible, except that 35% of the world consumption of dietary supplements is in the US, where they take into account the economic validity of spending each dollar. On the second place - Europe( 32% of the market), on the third - Japan( the country of long-livers).It is important to choose the right manufacturer and full ownership of information that dietary supplements do not act quickly!
When to wait for the result?
Taking dietary supplements, it is important to follow the admission rules( multiplicity and timing of application), but do not treat them as medications that should help instantly( eg, NSAIDs).A group of chondroprotectors are drugs with a delayed effect( the minimum course is 3 months).Supplements act more gently, the result often has to wait longer than when taking medications.
How to evaluate the result?
The result can be assessed objectively by reducing the intake of NSAIDs not earlier than six months after the beginning of the application of dietary supplements. This indicates a reduction in pain syndrome, stiffness, and improved joint function. BADy for joint disease use for life, treatment is carried out by courses.
Side effects and contraindications
The tolerance of dietary supplements is usually good, no side effects are described. This is due to the fact that the basis - 100% natural substance without preservatives, additives and dyes. Seldom can be an individual intolerance. Contraindications in dietary supplements are usually very small: pregnancy and lactation. There is no danger of addiction and overdose.
There are references both to the ineffectiveness of applying BADs and chondroprotectors. The reason for them is most often the discrepancy between expectations and reality: the patients suggest that after 1-3 months of application the cartilage tissue should be restored, and the pain syndrome should be left for good.
In fact, the correct approach to taking dietary supplements is this: to use them as an additional method of therapy for a long time. BADs, like chondroprotectors, will work more effectively in the early stages of the disease. The very first result can be considered a reduction in the dose of NSAIDs, which indicates a decrease in the pain syndrome. About other effects in relation to cartilaginous tissue can be said no earlier than 1.5-2 years after admission. To suspend the course of the disease is already a huge result!
Author of the article: Alexeyeva Maria Yurievna, therapeutist
Anti-inflammatory drugs for joint arthrosis and arthritis
What are the most effective anti-inflammatory drugs for joint diseases? What is their use, and is there any harm from them? How do these drugs affect the disease and joint condition, and also the body as a whole? We will talk about this in this article.
Fast navigation for the article:
What is important to know the patient before using the anti-inflammatory drugs
List of non-steroidal anti-inflammatory drugs
The COX-2 inhibitors are the new generation
NSWS Warning: self-medication can harm your body! Take only the medications that you prescribed a doctor. Before using any medications, consult a doctor!Non-steroidal anti-inflammatory drugs( NSAIDs) - one of the most important groups of drugs for the treatment of diseases such as arthritis and osteoarthritis. The main function of these drugs is to reduce the level of inflammation in the joints, and also to reduce painful symptoms.
Unlike hormonal anti-inflammatory drugs( corticosteroids), NSAIDs do not contain hormones and give far fewer side effects to the body as a whole.
What is important to know the patient before using NSAID
1. Despite the relative safety, most NSAIDs can not be taken with long-term courses, since they have significant side effects and are contraindicated in many diseases of the gastrointestinal tract, liver, kidneys, and the cardiovascular system.
2. Anti-inflammatory drugs should not be used if the patient currently or in the past had such diseases as gastritis, peptic ulcer and duodenal ulcer, colitis. Unfortunately, this group of drugs has a very negative effect on the mucous membranes, causing inflammation and even the formation of ulcers.
3. With great care, you should take these medications with kidney and liver diseases. NSAIDs strongly affect the renal blood flow, cause a delay in water and sodium, which can provoke not only an increase in blood pressure, but also serious disruption of the kidney and liver.
4. Sometimes, some people may have individual reactions of intolerance or hypersensitivity to anti-inflammatory drugs, so even in the absence of the diseases listed above, they should be started very carefully and in small doses, gradually.
5. Before you take the product, read the entire instructions carefully to it and act only in accordance with it.
6. In order to reduce the negative effect of NSAIDs on the gastric mucosa, take the tablets with as much liquid as possible - best with a whole glass of water. For drinking, try to use only water, because other liquids can affect the absorption of the drug.
7. Take care not to take two or even three different NSAIDs for the same time. The drug effect of this is unlikely to increase, but the number of side effects can easily multiply.
when taking NSAIDs it is important to give up alcohol
8. Preparations of this group are highly not recommended during pregnancy. If you need to take such medications, you definitely need to discuss this with your doctor!
9. At the time of taking drugs from the NSAIDs, it is recommended that you refrain from drinking alcohol, as this greatly increases the negative effect on the gastric mucosa.
10. And, finally, the most important advice: try not to engage in self-medication and take medications for the treatment of joints, including these, only at the doctor's prescription and under his supervision! This will avoid many complications when taking these medications and at the same time achieve the maximum therapeutic effect.
List of NSAIDs in joint diseases
All NSAIDs are divided into 2 large groups: cyclooxygenase inhibitors of the 1 st and 2 nd type, in short, COX-1 and COX-2.
Aspirin, or acetylsalicylic acid
This is not only the first open drug in this group of drugs, but in general it is one of the oldest medications: it continues to be used and administered, despite the fact that it has been more than a hundred years, and now there are manyother synthesized and more effective medicines. It is with aspirin often begins treatment of osteoarthritis.
Despite the fact that this remedy is effective in many fields of medicine, it is usually weak for the treatment of arthrosis and arthritis, and it is usually quickly replaced with other medications, or even begins treatment with other means.
Aspirin should be taken with caution in blood diseases, as it slows blood clotting.
Perhaps one of the most popular NSAIDs, created back in the 60's. Produced in the form of tablets, and in the form of ointments. In this agent, for the treatment of arthrosis, both high analgesic activity and good anti-inflammatory properties are well combined.
Available under the names of Voltaren, Naklofen, Orthofen, Diklak, Diklonak P, Wurdon, Olfen, Dolex, Diclobert, Clodifen and others.
Read also an article about the "distant relative" of diclofenac - the drug Aceklofenac( Aertal).
ibuprofen is a good aid for joint diseases
This drug for joints is slightly inferior in its anti-inflammatory and analgesic effect to other medications, including, for example, indometacin, but it is fairly well tolerated.
This preparation is available under the names Ibuprom, Advil, Reumafen, Nurofen, Faspik, MIG-400, Bonifen, Brufen, Ibalgin, Solpaflex, Burana, Dolgit, Bolinet, etc.
This action is one of the most powerful;analgesic effect from its use is also quite high.
Produced in tablets of 25 mg, in the form of gel, ointments, rectal suppositories.
Has a pretty decent list of side effects, but it is considered a highly effective drug for arthritis and arthrosis of joints, and in addition, it is quite cheap( the cost of a tablet form varies from 15 to 50 rubles per package depending on the number of tablets).
This active substance may be supplied by different pharmaceutical companies under the names Metindol, Indovis EU, Indotard, Indocollir, Indovazin, etc.
In addition to the above preparations, the group of drugs of the first type, nonselective NSAIDs, ie, COX-1,, as ketoprofen. Its strength is close to ibuprofen, and is available in the form of tablets, gel, aerosol, cream, solutions for external use and for injections, rectal suppositories( suppositories).
Buy this product can be under the trade names Artrum, Febrofid, Ketonal, OKI, Arthrosilen, Fastum, Bystrum, Flamax, Flexen and others.
Inhibitors of COX-2: NSAIDs of the new generation
This group of NSAIDs has a more selective effect on the body, due to which side effects on the side of the gastrointestinal tract are much less, and the tolerance of these drugs is increased. In addition, it is believed that some preparations of COX-1 can adversely affect the state of cartilage tissue. Medications from the same group of COX-2 are devoid of this feature, and it is believed that they are good drugs for arthrosis.
However, not everything is so rosy: many of the tools in this group, without affecting the stomach, can negatively affect the cardiovascular system.
Drugs of this group include such medications as meloxicam, nimesulide, celecoxib, etorikoksib( arkoksia) and others.
movalis - the drug of choice for joint arthrosis
One of the most famous agents with this active substance is movalis. The main advantage of this remedy is that, unlike diclofenac or indomethacin, it can be taken for a long time - many months and even years( of course, under the regular supervision of a doctor).
Produced by meloxicam in the form of tablets, rectal suppositories, ointments and solution for intramuscular injection. Meloxicam( Movalis) tablets are good because they last for a long time, and it is enough to take only one tablet throughout the day - in the morning, or, for example, at night.
Other trade names for this active substance are Arthrosan, Movasin, Mesipol, Amelotex, Melox, Meloflam, Myrlox, Bi-xikam, Mixol-od, Lem, Melbeck and Melbeck-Fort, Matarin, and, of course,country Movalis.
The drug was originally developed by the pharmaceutical company Pfizer called Celebrex.
Has a powerful anti-inflammatory and analgesic effect for arthritis and arthrosis, with virtually no side effects from the gastric mucosa and the gastrointestinal tract as a whole. The form of the drug - capsules of 100 and 200 mg.
In addition to the fact that nimesulide has sufficient anti-pain and anti-inflammatory effects for the treatment of joint arthrosis, it has antioxidant properties and slows down the effects of substances destroying the cartilaginous tissue, collagen fibers and proteoglycans.
This medication has many different release forms: external gel, oral and resorption tablets, granules for solution preparation, etc.
Nimesulide is available under the trade names Aulin, Rimesid, Nise, Mesulide, Nimegesic, Aktasulid, Nimika, Flolid, Aponin, Kokstral, Nimid, Prolid, etc.
The most famous in our country is its form under the trade name Arkoksia. If the drug is taken in suitable, not very high dosages( up to 150 mg per day), then the effect on the gastric mucosa in this drug is very small - as with other representatives of COX-2.Arthrosis of joints Arkoksia appointed usually in a dose of 30-60 mg per day.
Buy the drug Arkoksia can, for example,
Since the medicine of this group can have a pronounced negative effect on the cardiovascular system, in the first days and weeks of taking this medication, constant blood pressure checks should be performed.
And, of course, this drug should be taken only on the advice of a doctor and under his supervision.
Please note: even if you use the newest and highest quality non-steroidal anti-inflammatory drugs, remember that these medications DO NOT TREAT arthritis and arthrosis of the joints: they are only needed to reduce inflammation and relieve pain, after which it is possible to carry out physiotherapeutic procedures andapply other methods of treatment.
In order to stop the development of the disease and in general to be treated correctly, it is necessary to consult a doctor and take complex treatment, which includes taking medications of other groups, including chondroprotectors!
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.
Fast navigation for the article:
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 about medicines for knee arthrosis 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 medications 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.
So, 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 accepted that such drugs as indomethacin, diclofenac, and flurbiprofen have the greatest anti-inflammatory effect, while ibuprofen, aspirin and naproxen, on the contrary, can 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) gastrointestinal problems, in the first place - 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 in 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 on the part of 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.
What to remember when taking NSAIDs
As you can see, nonsteroidal 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 such as movalisa 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 to the doctor's prescription, but not to forget about the disease, but in order to create an opportunity without joint pain to undergo comprehensive treatment: take other medicines,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 medicines that help protect cartilaginous tissue and enhance 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 help improve the supply of cartilage tissue 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 medicine is also a combined medicine: 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 the 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 substance - chondroitin sulfate, however it is not only available as 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 course is 3-4 injections once a 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 in 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 many others have shown themselves as therapeutic ointments and gels for topical application.
They have a good curative effect, but it is important to remember that only 4 to 8% of the drug substance passes through the skin to the "destination" - the joint of the patient, 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), as well as 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 to just take drugs in one form or another.
Drug treatment should be combined with physiotherapeutic 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!
Non-steroidal anti-inflammatory drugs( NSAIDs) of the new generation for joints
Non-steroidal anti-inflammatory drugs( NSAIDs) are a series of drugs that have pronounced anti-inflammatory, antipyretic and analgesic abilities. Their action consists in the inhibition of certain enzymes, with the help of which biologically active substances catalyzing the inflammatory process are formed.
These medications are used during acute or chronic processes, accompanied by pain and inflammation. Now they are studying their effect on one type of cancer and the effectiveness in the treatment of cardiovascular pathologies.
Usually NSAIDs are used in diseases:
- pain of weak and medium strength in inflammatory processes or trauma,
- postoperative pain syndrome,
- metastases of tumors in the bone, accompanied by pain syndrome.
What are drugs and how do they work?
Non-steroidal anti-inflammatory drugs, the list of which is quite wide today - are substances that have an anti-inflammatory effect and are not related to steroid hormones. Any inflammation occurs with hyperthermia, pain and swelling. In the human body, these three processes are controlled by biologically active substances( prostaglandins), they are formed in the tissues where the inflammatory process is started, affecting the vessels and nerves of the affected area, they cause a reduction in edema, redness and pain.
NSAIDs slow down the formation of prostaglandins and signs of inflammation subsiding. Many anti-inflammatory drugs have a strong analgesic effect, comparable to the effect of narcotic analgesics. At the same time, these nonsteroidal drugs help reduce blood coagulability.
Types of NSAIDs
Consider several classifications of nonsteroidal drugs in this group.
The chemical structure distinguishes:
- Salicylic acid derivatives - this includes aspirin.
- Derivatives of pyrazolone - the group includes analgin.
- Derivatives of anthranilic acid - sodium mefenaminate.
- Propionic acid derivatives - group representative - ibuprofen.
- Derivatives of acetic acid - in this group diclofenac-sodium.
- Derived oxycamides are representatives of piroxicam and meloxicam.
- Derivatives of acids isonicotinic - this includes amizon.
- Derived coxibs - in this group celecoxib, rofecoxib.
- Derivatives of other chemical groups - mesulide, etodolac. Combined drugs - rheopyrin, diclokaine.
All preparations of this group are divided into 2 types:
- Type I cyclooxygenase inhibitors;
- Inhibitors of cyclooxygenase type 2.
What you need to know before using
- Drugs are relatively safe, but their use for a long period of time is undesirable because of the harmful effect on the mucous membrane of the entire gastrointestinal tract, liver and other systems.
- These drugs are not allowed for people who have the following pathologies in an anamnesis: gastritis, duodenal ulcer and stomach, colitis. Such drugs can cause inflammation of the digestive tract until ulceration.
- With pathologies of the liver and kidneys, drugs are taken cautiously, as they are able to delay the excretion of water and sodium, provoking an increase in pressure and a malfunction in the work of these organs.
- There are patients who are hypersensitive to these drugs. They should be taken from small doses gradually.
- Read the instructions for the drug carefully and take the medication only as directed in the manual.
- Drink such medicines only with water, as other beverages can change the properties of the drug. NSAIDs are washed down with plenty of water to reduce its harmful effects on the stomach.
- Pay attention to all medicines that you take. It is necessary to control to avoid simultaneous reception of 2-3 similar drugs. The effect will not increase, but the negative impact on the organs will increase.
- These drugs are prohibited for use during pregnancy and during the period of feeding.
- It is necessary to exclude alcohol during the course of these drugs.
- Do not practice self-medication, all means by which you are treated should be agreed with the doctor.
Novelties among NSAIDs
All NSAIDs inhibit both isoforms of the cyclooxygenase enzyme-COX-1 and COX-2.But if COX-1 is a protective enzyme, then COX-2 is an inflammatory enzyme. All the withdrawn preparations of this group inhibited COX-1, practically not affecting COX-2, which led to a strong decrease in the protective functions of the mucosa of the digestive tract.
The creators of these medicines sought that the COX-2 inhibition would be more active. What served as an incentive to create new drugs. So the group of medicines was created - non-steroidal anti-inflammatory drugs of a new generation. New medicines met expectations and became more selective. They suppress COX-2 more, and the effect on COX-1 can be considered insignificant.
Studies of a new generation of NSAIDs have shown that they are much more effective than predecessors, and a negative effect on the gastrointestinal tract is almost absent. In addition, preparations of the previous generation had a destructive effect on cartilaginous tissue, and no new properties were observed for these properties, so these preparations are also called non-steroidal anti-inflammatory drugs for joints.
The most famous of these drugs is movalis. The main advantage of him is that unlike the first generation of drugs, it can be used for a long time. Other names of this drug are Movasin, Arthrosan, Mesipol, Amelotex, Myrlox, Meloks, Lem, Melbek. All these analogues also have a positive effect on joint diseases. Nonsteroidal anti-inflammatory drugs for arthrosis are often prescribed from this list.
Along with movalis, non-steroidal anti-inflammatory drugs for osteochondrosis are used: celecoxib, Nimesulide, etorikoksib and oxicams. Consider these tools in more detail.
Celecoxib .This drug, produced by Pfizer, carries a pronounced anti-inflammatory and analgesic effect in arthritis, arthrosis, osteochondrosis. Side effects from the digestive system are minimal or absent altogether.
Nimesulide .In addition to its anti-pain and anti-inflammatory actions, this drug has antioxidant properties. It inhibits substances that destroy cartilaginous tissue and collagen fibers. Produced in many forms: tablets, gel, granules.
Etorikoksib .This means in our country is better known as Arkoksia. If you take the drug at recommended doses, then it has minimal effect on the intestinal mucosa.
Oksikamas became the founders of a new generation of NSAIDs. This group is characterized by an increased half-life. As a result, the action of the medicine is prolonged. This ability has reduced the frequency of daily medication, which further reduces the likelihood of side effects.
An example is Xsefokam .This drug has a high analgesic ability, its strength can be compared with morphine, but the addictive and opiate-like effect on the central nervous system is not revealed. Patients who tested this drug noted that the analgesic effect lasts about 12 hours. With regular admission, this remedy effectively fights with pain.
These drugs have become widespread, and their only disadvantage is the high cost.
Do not forget that using drugs with NSAIDs for osteochondrosis, arthritis, joint arthrosis, you can not achieve a complete cure. These funds are necessary for the removal of inflammation and relief of pain, after which drugs of a different kind should be prescribed.
Watch an interesting video on how to choose NSAIDs: